Archived: Grays Quality Home Care Limited

' 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

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

During our telephone calls with people and their representatives we were told about several times where the service provided to people by Grays Quality Home Care was not safe. Some people had been supported by one member of staff when they required two staff to uphold their safety. Medicine support and welfare checks had been cancelled and family members had been asked to give the support in place of staff. This meant that people's health, safety and welfare were at risk.

There were a number of recording errors and gaps on the medicine administration record (MAR) charts. The assistant manager had recently put in place a new auditing and error recording system to address this in future. We found no evidence to confirm that all staff who administered medicines had up to date medicine management training. All staff we spoke with confirmed they had completed the training although for two staff, this was during previous employment. The manager confirmed that they had completed a medicine competency assessment for one member of staff but not for any others. This meant that people were supported to take medicine by staff who had not been assessed as competent to do so.

Our checks of staff personnel files found that the provider had not completed all the required checks to ensure staff were of good character before they started work.

Is the service effective?

People's health and care needs were assessed and care plans were in place, however, the information in the care plans was not always up to date. The provider had a system in place to review care plans although we found this did not happen as frequently as the manager stated. We were told that one person's care plan had not been updated following significant changes in their needs. This meant that staff did not have current information with which to support the person effectively.

The manager did not have a system to monitor incidents and she confirmed that incidents and accidents were not currently monitored in a formal way. This meant that learning from events was not effectively supported in a way that enabled the manager to identify patterns and increases in risk.

Is the service caring?

Most people and their representatives told us that they were satisfied with the care they received from individual members of staff. They described staff as kind, friendly, polite and respectful. However, five out of six people and their representatives told us that they had some concerns about how the service was organised and reported occasions where the service had failed to meet their needs satisfactorily. For example, two people told us about occasions where their family member had stayed in bed all day because the right number of carers had not been provided.

People's preferences, interests, aspirations and diverse needs had not always been recorded. Because of this care and support could not always be provided in accordance with people's wishes.

Is the service responsive?

The manager told us that they had not received any complaints in the last year. However, during our telephone calls with people who used the service and their representatives we were told that people had raised concerns about various aspects of the service they received with the manager. Some representatives told us that they had done this several times but that the issues were not resolved. One representative told us that they had tried to arrange to meet with the manager but that no one had returned their calls. Staff told us that the manager was approachable but they did not all have confidence that the manager would take action to resolve any concerns they raised. This meant that the provider was not responsive to the views of people, their representatives or staff.

Is the service well led?

The manager completed spot checks and quality monitoring visits. However, we noted that there was no record of action taken to address issues that were raised through these processes. A satisfaction survey had recently been sent out to people who used the service, but no responses had been received at the time of our visit.

During our telephone calls with people, their representatives and staff, we heard about many concerns regarding the way in which the service was led. For example, there was a lack of communication about which carer would be coming, what time visits would be made, or to inform people about late or cancelled calls. Some staff confirmed that they did not believe that the service was well organised.

The manager told us that they were aware of a number of shortfalls in the service and that they had recently appointed an assistant manager as an attempt to address this.

During this inspection we found that the provider had taken effective action so that there had been improvements in the way medicines were managed.

During an inspection on 28 September 2012 we had found that the provider was not compliant with the regulation relating to care and welfare, or with the regulation relating to medicines. This inspection in April 2013 showed that some improvements had been made with regard to care planning and delivery. The majority of care plans had been updated and gave staff clear guidelines on the care each person needed, and the way in which they preferred the care to be delivered by staff.

Staff had received training in a number of topics relating to the work they perform. One person we spoke with told us that staff were 'very helpful and very careful.' The provider had a system in place to monitor the quality of the service. This included an annual survey for people who received a service.

However, medicines were still not managed well enough to ensure people received their medicines safely and as prescribed.