Archived: Enhanced Care and Bathing Service

At the time of this inspection 15 people were using the service, nine of whom were receiving support with personal care needs. The total hours of personal care provided were around 40 hours per week. Calls were provided from 0900 to 1700 hrs, with a typical call lasting an hour. The service also provided domestic support and companionship to people, but we did not inspect these aspects of the service as the Care Quality Commission does not regulate these services. This inspection looked at the care and support of those people who received assistance with their personal care.

This inspection took place on 6 and 7 September 2016.This was an announced inspection which meant the provider had prior knowledge that we would be visiting the service. This was because the location provides a domiciliary care service, and we wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

The owner of the company (known as the provider) also held the position of registered manager and managed the service on a day to day basis, in addition to providing care to people who used the service. 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.

The service was last inspected in September 2014 when we found it was not meeting the regulations in relation to maintaining adequate care records and assessing and monitoring service provision. During this inspection we found the provider had breached Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider's quality monitoring process failed to identify our concerns in relation to care records lacking sufficient detail and individual risk assessments not being reviewed regularly.

Training records showed not all staff training was up to date. Staff had not completed up to date training in infection control and safeguarding.

We found some improvements had been made in assessing and monitoring the quality of the service as staff received regular observations of their competence and people's feedback had been sought.

People told us they felt safe and comfortable with staff, and were happy with the continuity of care they received.

The provider had policies in place to deal with safeguarding concerns, accidents and incidents but no events of this type had occurred since the last inspection.

People and relatives told us staff were caring and listened to what people wanted and needed. People said they had positive relationships with care staff. One person said, “They’re lovely girls. I can’t think of anything to make it better. I’m very happy with the service.” Another person told us, “The staff listen to me and are very caring.”

The provider had a ‘service information’ booklet for people who used the service. This included information about how to make a complaint, including the contact details of the provider. People we spoke with said they felt comfortable about contacting the provider at any time to discuss the service.

People and relatives felt the service was well-run. People told us the provider was very approachable.

You can see what action we told the provider to take at the back of the full version of the report.

We considered the evidence collected under these outcomes and addressed the following questions, is the service safe and is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

Although we saw some evidence that people's care plan records had been reviewed by the service, we found that the records we looked at were not as complete or accurate as they should have been. People's care plan records did not provide clear guidance to staff in how to deliver safe and effective care.

Is the service well led?

There was not an effective system in place for the provider to identify risks or shortfalls in the service that people received. The provider did not have appropriate measures in place to obtain the views of people who used the service. We found that the service's statement of purpose contained misleading information regarding the professional status of a staff member. There was no system in place to identify gaps in staff training and schedule in further training for staff members. We found that the service did not have an established system in place for the provider to routinely check the quality and accuracy of people's care plan records.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

People were treated with dignity and respect by staff. People told us they had no concerns about the care they received.

People were assisted by staff who observed appropriate hygiene practices and provided appropriate assistance with medication.

We found that people's care records did not always provide staff with clear detailed guidance about how to deliver care or provide an accurate record of the support people received.

Is the service effective?

People's care needs were assessed with them, and where appropriate their families were involved. People's care plans were person centred, however clearer guidance for staff was needed in how to deliver people's care.

Staff understood the importance of working with other professionals involved in people's care and their responsibilities in accessing this support, which promoted continuity of care between providers.

Is the service caring?

People receiving a service commented positively about the care they received. Staff we spoke with spoke with warmth and understanding about the people they supported and how much they enjoyed their work. We observed the registered manager's warm and relaxed approach with people who used the service.

Is the service responsive?

We saw that reviews of people's care was carried out and the provider had a flexible approach to the care they provided, taking time to build relationships and trust with people, supporting them at their pace.

There was a complaints procedure in place and the people who used the service, who we spoke with, and staff, felt able to express their concerns, although they had not felt the need to.

The views of people who used the service and their relatives were sought, however this was done on an informal one to one basis by the registered manager during the course of routine contact. Providing people with appropriate methods of giving feedback, such as formal request for feedback covering key areas of service quality helps to identify strengths as well as concerns and shortfalls in the service provided.

Is the service well led?

The staff we spoke with felt supported by the registered manager who was approachable and proactive in resolving issues.

We found however there was an absence of written policies and detailed guidance around assistance with medication and infection control. There was also a lack of formal quality assurance systems in place to identify and address shortfalls in the service.

There was a proactive approach to working with other professionals involved in people's care and staff were clear about their responsibilities when accessing medical input when it was needed. People who used the service felt supported by the registered manager when discussing their care and treatment with health professionals.

The people we spoke with had no complaints all said that they were very pleased. One person said that the staff were all 'very pleasant'. Another person said 'I could tell Julie (provider) if not happy with anything, we are all good friends."

A family member told us 'I am involved with the care plan and kept informed of any changes that may be necessary; the agency is extremely flexible; very pleased.'

The two care workers we spoke with said that they felt well supported by the provider and that they had enough time to carry out their visits.

We looked at two of the care files for people who use the service. We found that the provider/manager had all the necessary information so that the care workers provided personal care safely. We also looked at the personnel files for the four people employed by the service. There was evidence that Criminal Record Bureau checks had been completed and references obtained so that as far as possible only suitable people were employed.

The person that we visited who used the service told us that they were 'Very happy with the service'. We were able to observe the friendly and relaxed relationship between the person and the provider/manager.

We have been unable to seek further views from the people who used the service and the care workers at the time of writing this report. This was due to us being unable to contact the provider/manager for information to enable us to obtain peoples view by telephone.