Background to this inspection
Updated
20 February 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection activity started on 13 December 2018 and ended on 02 January 2019. It included visiting the office location on 13 December and 02 January 2019 to see the registered manager; and to review care records and policies and procedures. On 20, 21 and 28 December 2018, we spoke with six relatives of people who used the service via telephone and six staff. During the inspection, we spoke with two commissioners and one social worker who had recent experience working with the provider. One inspector carried out this inspection.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We looked at care plans and associated records for four people and records relating to the management of the service. These included three staff recruitment files, accidents and incidents, quality assurance records and the computer based rota management system. We looked at key policies developed by the provider.
The service was last inspected in June 2016 where the service was rated good.
Updated
20 February 2019
People’s relatives, commissioners and staff told us that there were not sufficient numbers of staff in place. This had resulted in the provider being unable to fulfil all the hours of care that it had been commissioned. People’s families told us staffing levels meant that they were sometimes left without care, particularly when main staff were absent. This meant that families were required to cover care call in staff’s absence. The registered manager had recognised that staffing levels were an issue and had informed commissioners where they were struggling to cover care calls.
The registered manager had identified actions to take to improve staffing levels. The provider needed more time to demonstrate these improvements were effective and sustainable.
People’s relatives told us there had been frequent changes in the management, which had a negative impact on the quality and consistency of the service. Relatives told us that communication from the provider required improvement and that they were often unaware of who to contact to discuss their family members care. The registered manager was addressing these issues and was in the process of recruiting additional office based staff.
The registered manager was committed to their role and understood the key challenges to improve the quality of the service. They started working for the provider in 2018 and had implemented improvements in care planning, reporting of safeguarding and staff training. The changes made in these areas had been effective and sustained.
The registered manager had auditing and monitoring systems in place to assess the quality of key aspects of the service. Senior management from the provider had oversight of the service through regular reports and meetings with the registered manager.
Staff had access to training relevant to their role, including specific training to meet people’s individual needs. The provider had systems in place to support staff and assess their competence in their role. The provider had robust recruitment policies and procedures in place to help ensure only suitable candidates were employed.
People’s relatives were involved in developing and reviewing people’s care plans. Where people had complex medical conditions, input from other professionals was also incorporated into plans of care. The provider had a team of clinical staff who oversaw the writing and review of care plans and guidance. People had access to healthcare services as required.
People’s care plans included details about their routines, preferences and communication needs. There were systems in place to help ensure the service ran safely outside of office hours.
Staff understood the need to gain appropriate consent to care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were supported appropriately with their medicines and there was guidance in place to mitigate the risks associated with people’s health and medical conditions. People’s nutritional needs and preferences were identified in their care plans and where people required specialist techniques to gain nutrition, staff had relevant guidance and training in place.
Staff were knowledgeable about the people they cared for and relatives told us that their permanent members of staff were kind, reliable and treated their family members with dignity and respect. People were given a choice about their staffing and the provider had systems to ensure only suitable staff were allocated to work with people.
There were systems to ensure people’s concerns and complaints were dealt with appropriately. The registered manager listened to feedback from people to identify where they needed to make changes. Relatives told us that historically the provider had not always acted responsively to their concerns, but told us the registered manager had made some improvements in this area.
The provider had policies to help safeguard people from avoidable abuse and harm. Where concerns were raised, the registered manager understood their responsibilities in reporting to local safeguarding teams. The provider had policies in place which detailed how staff could raise concerns, which including external organisations they could contact if required.
The provider had policies and procedures to protect people from the spread of infections.
No-one using the service was receiving end of life care at the time of inspection.
We found one breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as there were not sufficient numbers of staff in place to meet people’s needs.
You can see what action we told the provider to take at the back of the full version of the report.