Archived: S10 Homecare

At the last inspection on 21 September 2016 the service’s overall rating was Requires improvement. We asked the registered provider to take action to make improvements relating to their governance processes and staff training, supervision and appraisal. Whilst there had been some improvement, this had been insufficient to meet the requirements in regard to those regulations. The inspection found a further two 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.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

This is the second time the service has been rated Requires improvement. We will meet with the registered provider to discuss our concerns and their plans for improving their service to good.

This inspection was undertaken on 6 February 2018 and was announced. We gave the service 48 hours’ notice of the inspection because the service is small and we wanted to ensure the registered person would be available.

The service did not require a registered manager as the service was operated by the registered person. 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.

There was no planned programme of a system that continuously assessed and monitored the service to ensure it was safe, effective, responsive and well led and met regulations associated with those key question areas.

We found the service’s recruitment process required improvement to ensure that information and documents were obtained in accordance with the regulations to demonstrate staff were suitable to work with vulnerable adults.

People told us where necessary they were supported by staff to take their medicines. Staff had received formal training in this task since the last inspection. However, we found this was ineffective in ensuring staff had sufficient knowledge and competence to deal with medicines in a safe way.

Records and documentation did not provide assurance that staff were provided with relevant training to help them maintain and develop their knowledge in regard to their role. Staff had not received an annual appraisal.

Records did not show a thorough assessment of people’s needs had taken place containing information about people’s preferences, backgrounds and interests. This meant a detailed plan of care, with associated risk assessments were insufficient to fully inform staff of the care and support to be delivered.

There was a lack of documentation and liaison with other organisations to support that people consented to their care in line with legislation and guidance so that they had maximum choice and control of their lives.

S10 Homecare needed to demonstrate that information in relation to people’s care delivery was in a format that was accessible to them.

Safeguarding procedures were robust and staff understood how to safeguard people they supported.

We found there were enough staff to make sure people received the care they had requested and at the agreed times. People told us staff were generally on time and if they were likely to be late for any reason, they would telephone to let them know.

Systems to control the spread of infection were in place.

Staff had regular meetings in order to share information about the service.

Staff were provided with regular supervision for development and support.

People were supported to eat and drink in accordance with their assessed needs and plan of care.

When needed, staff supported people to attend healthcare appointments and liaised with GPs and other health and social care professionals.

People receiving support and their relatives told us staff were caring, understanding and professional in their approach and treated them with dignity and respect.

Support staff were positive about the registered person and the way in which they led the service. Staff told us they were supportive and listened to suggestions and ideas about how to improve the service.

People were aware of the complaints procedure, but had not used this as they were happy with the service they were provided with.

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.

Our inspection was discussed and arranged with the registered manager two days in advance. This was to ensure we had time to visit and contact people who used the service and speak with the registered manager and staff.

The general view was that this service was very good. People felt the service benefitted from being a small company and this meant support was, “More personal.”

People told us they were, “Extremely happy” with the service. We were told the care workers were “Nice”, “Really kind” and “Very reliable.”

People told us where necessary they were supported by staff to take their medicines. Staff had a good understanding of the procedures for the safe administration of medicines but had not completed formalised training in this. During the inspection the registered manager arranged for all staff, including herself to complete a recognised medicines training course the following week.

Staff had completed some training which helped them to carry out their role. However some essential training had not been provided to staff before they were allowed to provide care and support to people.

Staff were provided with informal support and were able to speak with the registered manager at any time. However there was no planned programme of staff supervision and appraisal.

People told us that they tended to have the same care worker and they had built up a relationship with them. They also said all expected tasks were completed and they felt staff, “Genuinely cared” about them.

S10 Homecare respected the right to confidentiality for people who used the service. How they made sure people’s confidentiality was kept was described in the ‘Service user guide.’

We found there were enough staff to make sure people received the care they had requested and at the agreed times. People told us care workers were generally on time and if they were likely to be late for any reason, they would phone to let the person know.

People were aware of the complaints procedure but had not used this as they were happy with the service they were provided with.

Documentation which related to the management of the service required improvement. For example, audits of medicines and spot checks of staff were not recorded in writing to evidence they had been completed.

We were told the registered manager was, “Very good” and “Responsive.” People told us if they called the office the phones were answered quickly.

Everyone we spoke with told us they would recommend this service to a friend or relative.

We found two breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in regulation18: Staffing and regulation 17: Good governance.

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