IMPACT

IMPACT is a domiciliary care service providing personal care to older people aged 65 and over in their own homes. The service was supporting 13 people at the time of the inspection including some people with learning disabilities.

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

This inspection identified three breaches of the regulations. We identified one breach of the regulations due to concerns around risk management including with people’s medicines support and the quality of some people’s risk assessments.

Learning had not been taken from one reportable incident, to promote people’s safety as far as possible and we had not been notified of this incident as required. This is in breach of the regulations.

We identified a third breach of the regulations because the provider’s auditing systems and processes did not effectively assess, monitor and improve the quality and safety of the service. Although people and relatives spoke positively about the service, we found improvements were required to processes related to recruitment, medicines management and how people’s care records were maintained.

People and relatives told us they felt the support people received was safe. Staff showed an understanding of most people’s risks and knew how to identify and report any suspicions of abuse. People and relatives told us they generally received their calls on time. Systems were being developed further to reduce the likelihood of late calls.

The provider’s systems did not demonstrate people always received safe support with their medicines, although people and relatives raised no concerns about this aspect of people’s care.

The provider was not able to demonstrate they had always carried out robust recruitment checks to promote people’s safety as far as possible.

People and relatives all spoke positively about the care provided and told us they had regular carers who knew people’s care needs and preferences, and who were equipped for their roles. Staff felt they had enough guidance and training to provide support in the way people preferred. People and relatives spoke positively about support provided from staff to access healthcare services and to prepare meals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however the policies and systems in the service did not always support this practice and ensure this was a consistent experience for all people using the service.

Our discussions with people, relatives and staff reflected a caring service that respected and promoted people’s privacy, dignity and independence. All people and relatives told us staff were kind and caring. People and/or relatives as appropriate were involved in discussions about the care provided to help gather and meet people’s individual needs and preferences.

People’s communication needs were known to and met by staff however care planning processes did not meet the Accessible Information Standard (AIS). Nobody using the service required end of life care and support at the time of our inspection. People’s cultural needs and preferences were known to the service and the nominated individual told us they would further develop care plans to reflect people’s end of life care plans as appropriate. The service had received no complaints. Relatives told us feedback they had previously raised had been dealt with appropriately.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 04 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report. We prompted the provider to take action to mitigate risks these concerns posed to people using the service and informed the local authority of our findings.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We had previously inspected the service on 02 April 2015. We rated the service as good overall with no breaches of regulations. However the service required improvements and further training so staff fully understood the principles of the Mental Capacity Act 2005. At this inspection we found that improvements had been made.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults. At the time of our inspection 14 people were receiving a service.

There was a registered manager in post at the time of 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.

There were some systems in place to gather the views of people and to monitor the quality of the service however, some of the systems were not sufficient to identify shortfalls and to take the actions when improvements were required.

People were safe because staff had received training and understood the different types of abuse and knew what actions they should take if they thought that someone was at risk of harm. Staff were knowledgeable about the actions to take in the event of emergencies and about how the risks to people in respect of their care should be managed. There were sufficient numbers of safely recruited staff to provide people with regular staff to support them.

People were happy with the support they received and were encouraged to make choices. Staff understood the requirements of the Mental Capacity Act so that people were supported to consent to their care and make choices about how they were supported.

Staff were caring and treated people with dignity and respect, involved them in their care and enabled their independence.

People and staff told us that they felt supported by the registered manager and felt able to speak with him if they needed to. People had no complaints about the service but felt they could raise any complaints with the registered manager. The registered manager worked with other agencies to ensure that people’s needs were met.