Archived: Key Care Management

We carried out an announced inspection on 3 September 2014 in order to check up on compliance following enforcement actions taken against the service at the previous inspection in February 2014.

We gave 48 hours' notice of the inspection. This was given because the service was a domiciliary care agency and the offices the service was based at had been damaged by the weather. The service was not able to store files or use electrical equipment at the location and we wanted to make sure that the provider had the information we needed for the inspection.

We spoke with the registered providers and one member of staff at the office. We also contacted and spoke with two staff by phone. We were not able to speak with people who directly received the service because they were not able to speak to us over the phone. We did speak to two relatives/representatives.

Since our last inspection, the number of people the service provided care for had reduced significantly. They now provided care to four people and employed five care staff.

Two inspectors carried out the inspection.

We considered our inspection findings to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found. This summary is based on our findings during the inspection, discussions with people/representatives using the service, staff supporting people, the management team and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Risk assessments had been carried out concerning the management of medicines, mobility, moving and handling and environmental hazards. When risks were identified management plans were in place to minimise the risks. Identified risks were managed to protect people's safety.

There were sufficient numbers of staff available to make sure people were safe and received the care and support they needed, when they needed it. The providers or a senior member of staff were available at any time in case of an emergency.

The systems in place to manage people's medicines were effective so ensured that medicines were given to people in a safe way.

Staff demonstrated that they had the skills and knowledge to carry out their role safely. They felt supported by the management of the service.

Is the service effective?

The service was effective. People were happy with the care that they received and their care needs were met.

People's health, care and support needs were assessed with them and /or their representatives. Care plans were regularly reviewed to reflect any changes in a person's needs.

Staff ensured the care and support met people's changing needs. When a person's condition deteriorated, the service promptly contacted healthcare professionals from outside the service and made sure that appropriate support and treatment was made available.

The records at the service were now up to date and accessible. Care plans contained all the information needed to make sure that people were receiving the care and support that they needed.

Is the service caring?

The service was caring. People were supported by staff who were kind and attentive. People felt staff respected their privacy and dignity and staff were polite and caring.

People's needs, care and treatment were planned and delivered in line with their individual care plan. We reviewed and discussed with staff the care records of two people who received a service. These had detail and guidelines about the support people needed. Staff were aware of the information and guidance in the care plans and of people's needs.

Relatives told us they felt that communication with them was good. They said they felt informed about their relative's care and any events that took place.

Is the service responsive?

The service was responsive. People and their relatives felt that the management team were responsive when they had any concerns or if they wanted to discuss aspects of their care.

People's care plans and risk assessments were reviewed regularly to check they were up to date. Reviews were carried out to ensure that changes of needs were re-assessed and care plans were updated to reflect any changes.

The service had a complaints process in place and information had been given to people about how to make a complaint. Complaints received had been acted on and action had been taken to address people's concerns.

Is the service well led?

The service was well-led. There were systems and processes in place to monitor the quality of the care. A variety of audits and checks contributed to the services assessment of the quality of care given. When shortfalls were found the management team took action to address them.

Surveys were sent out to people so they could give their views about the service.

Staff told us that they felt supported by the management. They said the provider listened to and acted on their ideas on how to improve the service.

People confirmed that they had given their consent and been involved in discussions about their care, sometimes with a family member, when the service had first started.

We found that care plans did not contain all the guidance and information about the care and support staff needed to provide, and lacked detail about how to deliver care safely and in ways that suited people best. A relative told us 'I told the office a month ago that (my relative's) care plan needed updating but I haven't heard back yet.'

The systems in place to manage peoples' medicines were not effective so did not ensure that medicines were given to people in a safe way. A relative told us '(My relative) has a 08.00am slot, but it has been as late as 10.00am which is bad because she is on morphine.'

People were receiving care from staff that had been checked to work with vulnerable people. However a full employment history had not been obtained for staff in all cases we checked.

People using the service told us that the care staff did not always arrive on time. People said 'My supper visit can be anytime between 5pm and 7pm' and 'I don't really know what time they are coming.' Five people told us that they had complained about their care staff being late. They described the timings as 'erratic' and 'variable.' People told us that although staff were sometimes late, they felt that it was the organisation of staff by the management rather than the staff at fault. Everyone we spoke with said that the staff were kind and caring and that staff respected their dignity and privacy.

People had been asked for their views and feedback on the service provided but had not received any feedback from the agency about how they intended to improve based on these views. There was a lack of systems in place to monitor the quality of the service.

Records were not always accurate and fit for purpose.

People told us that their dignity and privacy was respected. One person said "The staff treat me with respect." Peoples views and experiences were taken into account in the way that their care was provided.

We found that people did not always receive the arranged care at the agreed time and that sometimes carers had not stayed for the time stated in their individual care plan.

People that we spoke with told us that they had no concerns with medication. However people were not protected against the risks associated with medicines as there were no systems in place to ensure that safe practice had been carried out.

People who used the service had their health and welfare needs met by sufficient numbers of appropriate staff. This was because the care manger had completed a needs assessment tool for deciding staffing levels.

We asked the care manager, the provider and the people who used the service about the systems that were in place to monitor the quality of service provided. The provider could not show that appropriate systems were in place to gather, record and evaluate information about the service provided from all relevant sources.