Archived: Age Concern Slough and Berkshire East

We previously inspected the service on 15 May 2014. The service was meeting the requirements of the regulations at that time.

Age Concern Slough and Berkshire East provide support to people in their own home in the Slough, Maidenhead and surrounding areas. It was supporting seven people at the time of our inspection. This included older people who had varying levels of physical disabilities.

The service had a registered manager in post. 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.

We received very positive feedback from people who used the service. Comments included “They are one hundred percent, really, really pleasant. I couldn’t have any better support” and “They do a good job, they are excellent.”

The service did not always ensure that all pre-employment checks were routinely conducted. This meant that it potentially could employ people who were not suitable for the role.

The provider is required to inform CQC of certain events. We found this did not always happen when required.

People were protected from abuse as staff had received training and were able to communicate what they would do if they suspected abuse.

People received personalised care as care plans were detailed and people’s likes and dislikes, were clearly documented.

People described the staff as caring and felt they had a good relationship with them. Staff were able to demonstrate how they provided dignified care.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 and one breach of the Care Quality Commission (Registration) Regulation 2009. You can see what action we took at the end of this report.

Below is a summary of what we found. The summary is based on observations during the inspection, speaking with people using the service, the staff supporting them and looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

The care co-ordinator told us, 'As soon we get a referral we make arrangements to conduct a home visit. We get to build a picture of the person's needs and establish if we can safely meet those needs.' This showed people had safe and appropriate care because people's needs were established from when they were referred or began to use the service.

The service provided guidelines for the administration of medication. This outlined what should happen before taking on the administration of medicine as part of a care plan, what staff members should do when administering medication and what should happen when people refuse to take doses of regularly prescribed medication. The guidance also gave clear instructions on what should happen if a staff member missed or omitted or in any way mal-administered medication. For example, staff members should ensure they report it immediately to their line manager, the relevant health professional and a notification should be sent to the Care Quality Commission (CQC). This meant there were clear procedures in place for staff members to follow to ensure where they assisted in the administration of medication, this was done safely, securely and appropriately.

All care and staff records were stored in lockable cupboards. This meant all care records and staff records were kept securely and could be located promptly when needed.

Is the service effective?

We saw environmental risk assessments were undertaken to protect staff members and ensure the safety of people they provided care to. These looked at the potential risks in people's homes both internally and externally. For example, at one individual's home staff members were instructed to take a torch for night calls due to where the home was located. In the kitchen, staff members were told to ensure mats was kept flat and in regards to mobility aids staff members were to ensure they were used correctly. We noted the name of the person who carried out the assessment and their signature and the date it was carried out. This meant the service managed risk through effective procedures.

Is it caring?

People told us they were able to choose specific times for staff members to visit. One person commented, 'They (staff) asked me what times suited me and I was able to get the times I chose.' This was confirmed by a relative who commented, 'There were a couple of days when there were no one from the family to support my mum. Staff was quite flexible and accommodated us with the times we needed.' The care plans reviewed reflected this. This meant the delivery of care and support was determined by people's individual needs.

Is it responsive?

There were arrangements in place to deal with foreseeable emergencies. We saw a contingency plan outlining what action would be taken if carers were not able to provide care at the agreed times recorded in each care plan. For example, the service would call to give the person to give them an update. This would then be followed by a visit by a staff member who lived closest to the person. The service would telephone the person at regular times to keep them informed of the situation. This showed there were arrangements in place to deal with emergencies.

In one care plan it identified in order to ensure an individual's safety, bed rails would be required. The care plan recorded the service carried out an assessment then made the necessary referral to social services who arranged for bed rails to be installed. This demonstrated people's assessed needs were met by the service or agencies accountable for ensuring those needs are met.

There was learning from incidents/investigations took place and appropriate changes were made. We spoke with one staff member who told us, 'All staff received a letter from management after an incident occurred with another carer. We were told to ensure we followed the guidelines in regards to providing care to people and what disciplinary actions would be taken if we failed to do this.' This meant improvement was made by the service by learning from incidents or adverse events.

Is it well-led?

We saw regular reviews of people's care and support needs were undertaken. On the day of the inspection we visited one person's home. When we arrived we observed the care co-ordinator conducting a spot check on a staff member (this was an unannounced visit to check on staff member's performance). The care co-ordinator told us they had also carried out a review of the person's care at this visit. We looked at the care plan in the person's home and later during the day, the person's care plan based in the office and saw it reflected recent changes in the person's health and what actions that had been taken to address this.

The care co-ordinator told us that the service had built up good rapport with people and therefore if people wanted to give any input whether positive or negative they would just call the office. We saw one recorded feedback received by a person on 30 October 2013. Whilst having a review of their care the person commented positively about their carer and felt the service received was excellent. We spoke with two people. One person told us, 'I know I can give my opinions and they will be listened to.' A relative for another person told us,' I always get the opportunity to feedback.' This showed the service regularly sought the views of people who used the service.

People told us they felt safe enough to speak to a member of staff if they were worried about being abused. We found action was taken to identify and prevent abuse from happening in the service.

People told us staff knew their individual preferences. They said staff would get expert advice if they were not able to meet their needs. We found appropriate checks were undertaken before staff began work. This showed there were effective recruitment and selection processes in place.

People told us the carers who looked after them were well trained. We saw staff in their supervision meetings were given opportunities to discuss a number of issues. This showed supervisory support arrangements in place for all staff involved in delivering care, treatment and support.

We found the service has now developed client satisfaction feedback forms specifically produced for domiciliary care clients. This showed the service took into account the comments and complaints of people using the service.

People's consent was obtained prior to the agency providing a service. This included access of their home and the information the agency holds about them.

The appropriate checks were not being completed prior to staff starting work which had the potential of placing people at risk. The staff recruitment process was not robust. It was not possible to establish the skills and knowledge the person had that would support their recruitment as a suitable person for the role.

Staff had received training that was relevant to their role and future training was planned. However, staff were not being supported in their role through supervision and appraisals. Therefore staff were not receiving feedback on their own performance and development plans and training needs were not being considered in a formal way.

There was a complaints system though no complaints had been received. People told us that they had no concerns and would contact the office if they did have.

There was no established system for monitoring the quality of the service delivered and people’s views were not being actively sort to inform service developments.