21,24 and 26 August 2015
During a routine inspection
The inspection took place on 21 August and was announced. We gave ‘48 hours’ notice of the inspection, as this is our methodology for inspecting domiciliary care agencies. We visited people who used the service on 24 and 26 August.
The service was previously registered with us at a different location. The service moved to its present location in September 2014 and this is our first inspection of the service at its location in Canterbury.
Key Care Management Limited provides live-in care staff for people in the Kent area. Staff provide personal care and support to older people in their own homes. At the time of the inspection the service provided live-in personal care support for five people.
The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 agency had a comprehensive medicine policy to guide staff. Staff had received e-learning training in medicines management, but not all staff had had their practical skills and competency in giving medicines checked to ensure they were doing so safely and in line with the agency policy. There was a higher risk of medication errors occurring because medication administrative records had been completed by one person from the agency and had not been checked by another person to ensure their accuracy.
New staff did not receive a comprehensive induction which ensured that they had the skills they required, before they started to support people in their own homes. Staff undertook e-learning training in essential areas and face to face practical training in how to move and handle people safely. Relatives said that staff had the skills and knowledge they needed to support their relative. However, not all staff had received training in food handling or The Mental Capacity Act 2005. The MCA 2005 provides the legal framework to assess people’s capacity to make certain decisions, at a certain time.
There were not effective systems in place to assess and monitor the quality of the service. The agency had not identified shortfalls in staff induction and training. Although the medication policy had been reviewed, this review had not been effective as it contained legislation that was applicable 15 years ago. The agency had not followed its only policy on supervision, appraisal and staff meetings as these were not all taking place.
Relatives said that they had confidence in the live in care staff and felt that their relative was in safe hands at all times. Staff had received training in how to safeguard people and knew how to report any concerns so that people could be kept safe.
Comprehensive checks were carried out on all potential staff at the agency, to ensure that they were suitable for their role. This included obtaining personal and employment references and a criminal vetting and barring check.
Assessments of potential risks had been undertaken in relation to the environment that people lived and worked in and in relation to people’s personal care needs. This included potential risks involved in moving and handling people, supporting people with their personal care needs and with eating and drinking. Guidance was in place for staff to follow to make sure that any risks were minimised.
The agency had sufficient numbers of staff available to provide each person with a main live in member of staff or two live in staff members as needed. There were also sufficient staff available to accommodate live in staff when they had a week’s break.
People’s health care and nutrition needs had been comprehensively assessed and clear, step by step guidance was in place for staff to follow, to ensure that their specific health care needs were met. Staff were knowledgeable about people’s complex health care needs and liaised with health professionals and family members when appropriate.
Relatives said staff knew people extremely well as they spent their day together in the same house. They said staff were kind and caring and always treated their relative with dignity and respect. Staff demonstrated they knew people well and so could quickly respond to any change in their needs.
People’s needs were assessed before they were provided with a service and people and their relatives were fully involved in this process. These assessments were developed in to a personalised plan of care. The care plans gave detailed guidance to staff about how to care for each person’s individual needs and routines. As people had one or two main staff members to support them, staff were very knowledgeable about their likes, dislikes, choices and preferred routines.
People were informed of their right to raise any concerns about the service. Relatives said that when they had raised concerns that the manager was quick at addressing them to their satisfaction.
Relatives said that they would recommend the service and that their views were listened to. Staff understood the aims of the service and put them into practice by providing personalised care. Staff had confidence in the management of the service which they said was supportive.
We found three breaches of the Health and Social Care Act 2008 (Regulated activities 2014). You can see what action we told the provider to take at the back of the full version of the report.