8 July 2015
During a routine inspection
We carried out an announced inspection on the 8 July 2015. Our previous inspection took place on 16 October 2013 and we found the service met the regulations inspected.
Geneva Healthcare is a domiciliary care service that provides support to adults and children with physical disabilities, mental health needs and general health needs in their own home. There were thirteen people using the service on the day of the inspection.
The service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
We saw that risk assessment reviews were not always being undertaken in a timely manner. There was no policy or procedures in place relating to when risks should be assessed or by whom, therefore we could not be assured that risks were being appropriately assessed by the provider or adequate steps put in place to minimise any risks identified.
Care plan reviews were not always being undertaken appropriately in a timely way and there were no policies and procedures in place stating the frequency of reviews, therefore people may be receiving inappropriate care and support that may not meet their individual needs.
The service had a complaints procedure was out of date and hadn’t been reviewed monthly as stated. The complaints log did not address how the complaint would be addressed, the outcome expected from the complainant and any learning points that may need to be shared.
Feedback received during the inspection raised some concerns that lessons learnt from situations that had not gone well were not shared across the whole organisation.
We recommend that a clear process is put in place to respond to incidents that may arise. Including any actions taken, recommendations and how learning is shared.
We could not find evidence that regular spot checks to assess staff performance in the field were being carried out.
There was engagement with community health and social care professionals where needed. However there was a general concern that performance information and policy updates requested by them was not always supplied and followed through in a timely manner.
Service user surveys were carried out. However We did not see any analysis of the feedback, which meant that any recurring themes could not be picked up and dealt with as appropriate.
Staff had completed a staff survey. However, there was no date on any of the returned documentation, which made it impossible to confirm which year they related to.
Regular audits of service quality and delivery were not being carried out effectively; they had not identified the shortfalls we found during the inspection.
We saw separate policies that covered safeguarding adults and children that were written in August 2013. The policies were due to be reviewed in August 2014 but we saw no evidence that this had happened.
We recommend that policies and procedures relating to safeguarding adults and children are updated regularly to incorporate any updates to policy and practice or changes in legislation. This is to ensure best practice in safeguarding people.
We saw evidence that staff had undertaken training in medicine administration. However there was no evidence kept on staff files of training provided by the district nurses or checks on staff to ensure their competency in this area. Administration and the Administration and Assistance of Medicines Policy had not been reviewed since January 2013.
We recommend that there is a robust process for monitoring the competency of staff administering medicines and the Administration of Medicines Policy should also be regularly reviewed to take into account any updates in good practice and changes in legislation.
We saw that supervision had not always been carried out regularly. The content of these supervisions was very basic and whilst there was some reference made to people using the service, there was little by way of discussion, analysis or learning recorded.
We saw there was adequate staff allocated to provide care and support for people on the staff rota. Recruitment practices ensured staff undertook relevant checks prior to employment to ensure they were suitable to work with the people using the service.
The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to support people who lacked the mental capacity in line with the principles of the act and particularly around decision making.
Records we saw demonstrated that all staff had completed mandatory training in the past year. Most training was undertaken as e-learning and some courses were done face to face, such as manual handling, epilepsy and PEG (percutaneous endoscopic gastrostomy) care.
There were care plans on each record we looked at. These were drawn up as part of the initial assessment. Care plans were detailed in content and covered all aspects of a person’s life. People and their relatives were involved in developing their care and support plan and identifying what support they required from the service and how this was to be carried out. People were treated people with dignity and respect and the care provided was person centred.
Staff had an understating of and received recent training on issues of equality and diversity.
People and their relatives told us they thought the management team, including the registered manager and the senior care coordinator, were responsive and fair. Staff told us they thought the management team were supportive and they received regular guidance and supervision through telephone calls, emails, text messages and face to face meetings.
At this inspection we found several breaches of regulations in relation to person centred care, receiving and acting on complaints and good governance. You can see what action we asked the provider to take at the back of the full version of the report.