16 June 2015 and 22 June 2015
During a routine inspection
This inspection was announced and took place on 16 and 22 June 2015.
Way Ahead Care-Somerset provides personal care and support to people living in their own homes in the Taunton area. At the time of the inspection they were providing a personal care service to 154 people.
There was no registered manager in post. The previous registered manager had left in January 2015. Following their resignation the service had been managed by the nominated individual who was applying to be the registered manager with the Care Quality Commission. 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.
Before this inspection we had received concerns from two relatives. Part of their concerns was the lack of detail recorded by care workers in people’s care plans. When we looked at care plans in the office and in people’s homes we found they included very clear guidance for staff on the care needs and preferences of the people they cared for. However each care need was given a code, for example, assist to wash and dress could have a code of C3. The care worker would record the code rather than write at any length how the person had been and what care they had required. This practice placed people at risk of unsafe and inappropriate care and treatment; and did not reflect a person centred approach to care. It also meant other staff or family members could not see if a person had refused care or had specific issues that day.
There were quality assurance systems to monitor care and plans for on-going improvements. However they had failed to identify the lack of detail being written in care plans by care workers. This meant some issues had failed to be communicated to other care workers and family. The manager had carried out an investigation into the concerns and had introduced a new way of recording information in care plans. Way Ahead Care acknowledged that a change was required to the way in which care workers recorded what had occurred during their visits. It was identified that the current system needed to be reviewed and consideration given to a more person centred approach. Some care plans showed there had been a change in the way staff were recording their visits but this was not consistent throughout the agency at the time of the inspection.
People told us they felt safe receiving care from the agency, one person said “Yes I feel safe and if I didn’t I would say something.” A relative said, “I am confident my [relative] is looked after in a safe way.” Staff had received training in understanding and recognising abuse. They were able to tell us about the signs they would look for and who they would talk to if they had concerns. All the staff spoken with said they were confident that any concerns they raised would be taken seriously and reported to the correct people. The manager had worked in partnership with the Somerset safeguarding team to look into concerns raised. The manager had also alerted Somerset when they had concerns about a person’s safety.
People were protected from harm and unsuitable staff as the agency followed robust procedures when recruiting new staff. New staff didn’t work with people until they had completed their induction training and worked supervised with senior care workers until it was agreed they were competent to work alone.
People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care. Care workers had comprehensive information and guidance to deliver consistent care the way people preferred. People told us they were cared for by staff who knew what their care needs and preferences were. One person said, “They know me really well, I have a team of girls that I know and they know what I like and how I like it.” A relative said, “They know how my [relative] likes to be looked after and they have had the training they need as they have complex needs.” Staff members told us they had good guidance in care plans but they always asked the person how they would prefer things done. However one person who insisted they liked to be independent said nobody really understood them.
The agency had a complaints policy and procedure that was included in people’s care plans in large print. People said they were aware of the procedure and had numbers they could ring. People and staff spoken with said they felt confident they could raise concerns with the manager and senior staff. Records showed the agency responded to concerns and complaints and learnt from the issues raised.
There were systems in place to monitor the care provided and people’s experiences. A regular survey was carried out asking people, their relatives, staff and service commissioners about the service provided by the agency. Suggestions for change were listened to and actions taken to improve the service provided.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.