Archived: Q Care- Ross on Wye

Q Care – Ross on Wye is a domiciliary care agency based in Ross-on-Wye, Herefordshire. The service supports younger or older adults, who may have learning disabilities or autistic spectrum disorder, dementia, mental health care needs, sensory impairments or physical disabilities. At the time of our inspection, there were 42 people using the service.

People's experience of using this service and what we found

People were at increased risk of harm because of the lack of robust procedures in relation to the management and administration of their medicines. The information recorded on people's medicines records was not always accurate or complete. The risks associated with people’s individual care needs were not always fully assessed to provide staff with clear guidance on keeping people safe. Staff training had not always been kept up-to-date to ensure staff had the skills and knowledge needed to support people safely and effectively. The provider’s quality assurance systems and procedures were not as effective as they needed to be. The records maintained in relation to the assessment and planning of people's care were inconsistent.

Staff understood how to identify and report potential abuse involving people who used the service. People received a consistent and reliable service from the provider. Prospective staff underwent pre-employment checks to confirm they were suitable to provide care in people's homes. Staff took steps to protect people from the risk of infections by, for example, wearing disposable gloves and aprons during people’s personal care. The management team monitored any incidents or accidents involving people who used the service, in order to learn from these.

People's individual needs were assessed with them before their care started. Staff and management recognised the need to promote people's equality and diversity through planning and delivering their care. People had the level of support they needed to prepare meals and drinks. Staff helped them access professional medical advice and treatment if they were unwell. Staff and management worked effectively with community health and social care professionals involved in people's care. Staff understood people’s right to make their own decisions.

Staff treated people with kindness and compassion and had taken the time to get to know people well. People and their relatives were encouraged to express their views about the care provided. Staff treated people with dignity and respect.

People and their relatives were clear how to raise any concerns or complaints about the service. Most people, relatives and staff spoke positively about their relationship and communication with the management team, who they found approachable and ready to help. The management team recognised their responsibility to be open and honest with people and relevant others in the event something went wrong with the care provided.

Rating at last inspection

The last rating for this service was Good (published 20 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches at this inspection. These relates to the provider's failure to identify and reduce risks to people who use the service, including the safe management of medicines, and the need for more effective quality assurance processes.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A registered manager was in post and was present during our inspection. 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. At the time of inspection the registered manager had applied to deregister as a manager with CQC. A new branch manager was in post and present during the inspection. They had applied to become a registered manager with CQC.

At the last inspection the provider had not displayed their most recent CQC rating at their registered premises, in order that this was accessible to the people who used the service. The provider was now displaying the ratings clearly.

There were quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided. However the provider had not always identified issues that affected the quality of support provided.

Staff did not always feel listened to and supported with concerns that they had raised with the provider.

People felt staff provided support in a safe and caring way. Staff understood how to recognise and protect people from abuse and received regular training around how to keep people safe.

Staff were not recruited until checks had been made to make sure they were suitable to work with the people that used the service.

People were confident that staff had the knowledge, skills and experience to provide effective care and support. Staff had training relevant to their roles.

People’s care records contained the right information for staff to follow to meet people’s health needs and manage risks appropriately.

People’s consent was always gained before any care and support was given. Staff understood that care could only be given if the person consented.

People had the support they needed to ensure that they had adequate food and drink.

Staff had knowledge of people’s individual needs and how to meet them.

The management team promoted an open culture within the service. Staff knew what to do if they suspected abuse and were aware of when to whistle blow.

A registered manager was in post and was present during our inspection. 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 provider had not displayed their most recent CQC rating at their registered premises, in order that this was accessible to the people who used the service. The provider had not informed the Care Quality Commission about two allegations of abuse.

Staff had received training in how to keep people safe from harm and abuse. They knew how to spot the signs and symptoms of abuse and neglect, and how to report these to a manager or senior member of staff. The risks to individuals had been assessed and managed, and people’s involvement in these decisions had been encouraged. The provider followed safe recruitment practices to make sure staff were suitable to work with people.

People and their relatives were pleased with the support staff provided in relation to people’s medicines. Staff had been trained in how to handle and administer people’s medicines safely and their competency was checked.

Staff had the skills and knowledge needed to meet people’s individual needs. Staff received an induction to the service and an ongoing programme of training. Staff attended regular one-to-one sessions with a senior member of staff or manager.

The management team understood the requirements of the MCA, and the provider had taken steps to raise staff awareness of its implications. Staff sought people’s permission before carrying out care tasks and respected their decisions.

People received the level of support they needed with their food and drinks. Any risks associated with people’s eating and drinking were recorded in their care files and managed by staff. Staff played a positive role in helping people to maintain good health and assisted them in seeking professional medical advice and treatment when needed.

Staff adopted a caring approach towards their work with people, People felt listened to and involved in their own care. Staff treated people with dignity and respect, and understood the importance of respecting their people’s rights.

The management team encouraged people’s involvement when assessing or reviewing their care and support needs. Staff understood people’s individual needs and preferences, and promoted their people’s independence. People and their relatives knew how to raise any concerns or complaints about the service, and felt confident about coming forward with these.

The management team promoted an open culture within the service, based upon good communication. People found the management team approachable. Staff experienced consistent leadership and management and were well-supported. The provider had implemented a number of quality assurance systems and checks to assess, monitor and improve the quality and safety of the service provided.