This inspection took place on 24 and 30 May 2017 and was announced. We gave 48 hours’ notice of this inspection because the service is a domiciliary care agency and we needed to be sure there was someone in the office available to assist with the inspection. We last inspected South Tyneside Home Care on 17 May 2016 and found the provider had breached three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014.
At the last inspection we identified concerns in respect of the safe care and treatment of people using the service. Care plans were not person-centred and did not demonstrate any clear involvement of the person or their relatives. Care plans did not always contain detailed information on how to support them. Risk assessments lacked sufficient information to enable staff to support people consistently and safely. Risk assessments were not reviewed appropriately. The provider’s quality assurance system did not include managerial oversight resulting in a lack of knowledge on how the service was performing and what areas were in need of development and improvement.
We undertook this inspection to check that the provider now met legal requirements. We found the provider continued to breach regulations.
We found care plans were being updated to include more personalised information for staff. However some plans did not contain detailed information on how to support people with specific needs.
Risk assessments were in place and had been updated, however not all risk assessments contained sufficient information to enable staff to support people consistently and safely.
The quality assurance process had been reviewed and the registered manager was routinely checking audit results and actions. Care file audits had not identified any of the issues or concerns we found at this inspection.
You can see what action we told the provider to take at the back of the full version of the report.
South Tyneside Home Care is an employee owned social enterprise that is registered with the Care Quality Commission for the regulated activity of personal care. The service provides domiciliary care and support for people in South Tyneside. The workforce are the owners of the agency and they participate in the decision making process about the direction of the agency by making provisions for appointed employees to serve on the board.
The service had a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like provider’s, 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 provider had developed a more structured approach to quality assurance. A new post of compliance officer had recently been filled with an operations manager post soon to be advertised. Documentation was being reviewed to be more standardised across all locations and a new risk assessment process being implemented to provide more detailed information for staff. This meant the provider was proactively working to improve the quality assurance process in order to drive improvements.
Medicines were managed by staff who were appropriately trained. Checks were in place to ensure staff remained skilled and competent. MAR charts were completed correctly with no gaps or anomalies.
Medicine administration records (MAR) we reviewed did not contain information for staff to follow when people were prescribed topical medicines (used on the skin) as to which specific area of the body the cream or ointment was to be applied. We found the assistant manager had identified this concern and had developed body maps to be issued with people’s MAR setting out where topical medicines were to be applied.
Recruitment practices at the service were thorough appropriate and safe so only suitable people were employed. Staff shadowed experienced care workers before being given their own calls.
Environmental risk assessments were completed for staff working in people’s homes to include access to the property, fire hazards and cleaning products.
Staff had been received training in the safeguarding and Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were clear about their responsibilities to recognise and report any incidents of abuse and were able to describe how the MCA impacted on their roles.
Staff training was up to date. Staff told us they felt supported and received regular supervision and annual appraisals to discuss performance and personal development. Supervisors told us they undertook spot checks to observe care workers were supporting people appropriately.
Processes were in place to consult with people before their package of support commenced. Consultations took place with supervisors and plans of support were completed with the person and if necessary family members.
People’s dietary needs were respected with support given where necessary to prepare meals. Healthcare needs were acknowledged and contact was made with other health care professionals when necessary.
We saw that systems were in place for recording and managing safeguarding concerns, complaints, accidents and incidents. People and relatives knew how to make a complaint.
The service sent out annual surveys to people to gain their opinions and views on the service. We found several comments outlining relatives and people’s satisfaction with the service they had received.
Staff told us they felt the service was open and approachable. Regular meetings were in place for staff to raised concerns and issues, on a regular basis.
Statutory notifications were submitted to CQC in a timely manner. Personal records were held in line with Data Protection Act.