5 January 2015
During an inspection looking at part of the service
This inspection took place on 5 January 2015 and was announced. Caring for You Limited -24/7 Care provides a domiciliary care service to enable people to maintain their independence in their home environment. There were 33 people using the service at the time of the inspection, who had a range of physical health care needs.
At our previous inspection on 29 April 2014 the provider was not meeting the requirements of the law in relation to medicines, staffing, supporting workers and records. Following the inspection the provider sent us an action plan and informed us they would make improvements to meet these requirements by 28 November 2014. During this inspection we looked to see if these improvements had been made. Although the provider had made improvements in relation to medicines new breaches of this regulation were identified. They had met the requirements of the law in relation to staffing, supporting workers and records.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Following the last inspection the registered manager had changed to an electronic medicine administration record (MAR) sheet which was easier to update when people’s medicines changed and ensured staff signed all MAR entries. However, staff had not always followed the provider’s guidance in relation to omissions in the administration of medicines, the disposal of medicines and homely remedies. People were at risk from the unsafe management of medicines as not all staff had followed the guidance provided. This was a new breach of this regulation.
People gave mixed feedback with regards to how the quality of their care had been monitored. People’s care had been negatively impacted upon as there was ineffective monitoring of the quality of the service. People who received care from two staff did not always receive the full duration of their call. The provider’s clinical governance systems were not robust. The regional manager visited the service but did not provide the registered manager with guidance about what areas of the service they could improve. The registered manager completed audits, but there were a lack of robust action plans to address any identified issues in order to improve the service. People’s experience of their care had not been effectively monitored.
Since the last inspection staffing levels remained the same, but there had been a significant reduction in the number of people using the service. There were enough staff to provide people’s care. People were protected from the risk of abuse because the provider had robust recruitment procedures in place to ensure staff providing support were of good character and had the appropriate skills and experience.
People told us staff had taken appropriate action in medical emergencies. The provider had identified and managed a range of risks to people. Risks to people relating to their care needs were managed.
Most people told us they felt safe. However, for two people who told us they had not always felt safe, we noted the registered manager had taken appropriate action to address their concerns. Staff had access to safeguarding guidance and had received relevant training. Staff understood how to respond to safeguarding concerns. People were safeguarded against the risk of abuse.
Staff had received an induction into their role. The registered manager completed checks of staff competence to undertake their roles and staff received supervision and appraisals. People’s care was provided by staff who received appropriate training and support.
The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to community services. The provider is required to submit an application to the Court of Protection if they assess a person’s liberty is restricted. There was no evidence of people’s liberty being restricted and no applications had been made. The registered manager had received training in the Mental Capacity Act (MCA) 2005 but was unaware of a Supreme Court judgement which widened and clarified the definition of deprivation of liberty. We have made a recommendation that the registered manager access further information on the judgement in relation to DoLs.
People told us staff had sought their consent before delivering their care. Where people lacked the capacity to consent to their care relevant guidance had been followed to make best interest decisions on their behalf. The provider had not documented in their assessment why they believed people lacked capacity. The provider had documented people had a power of attorney in place but not the type. People’s capacity to consent had been assessed but the recording of these decisions required improvement.
People’s care plans documented what support they required in relation to nutrition and hydration. There were processes to monitor and record what people ate and drank. People were supported to ensure they had enough to eat and drink.
Staff liaised with a range of health care professionals on people’s behalf to ensure their health care needs were met. Staff had good links with local health care professionals.
People told us staff were caring and treated them with dignity. One person’s relative said “Staff respect her.” Staff provided people’s care in a warm, friendly and compassionate manner. Staff had an understanding of people’s care needs and checked how they wanted their care provided if they were not familiar with the person’s care needs.
Information about the service and details of their care was given to each person. People had been supported to express their views about how their care was provided. The information they provided was reflected in their care plans. People had been actively involved in decisions about their care.
Staff were encouraged to treat people as a member of their family. Staff received guidance on how to uphold people’s dignity. People were supported by staff to be independent where possible. People’s privacy and dignity was respected in the delivery of their care.
Most people were positive about their care and said they received it at the times they needed it. However, not all people who required care from two staff had positive experiences. People who required two staff had not always experienced consistency in staffing. They had not always received their care at the times stated in their care plans. The registered manager took action and returned these people’s care packages back to the local authority following the inspection.
The provider had a complaints process for people. When a person made a complaint this had been investigated and resolved to their satisfaction.
The service had clear aims and objectives for the delivery of people’ care. Staff were not managed appropriately because they were changing people’s visit times to suit themselves.
The registered manager understood the issues facing the service. Staff felt supported in their role although staff morale was low. The support the registered manager received from the provider was not fully effective in enabling them to carry out their role.
The registered manager had improved people’s care plans. People had accurate care plans and these were stored securely in the office.
We found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.