Archived: PA Care Agency

This inspection took place on the 20 April 2016 and was announced, which meant the provider knew before the inspection we would be visiting. This was because the location provides domiciliary care services. We wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

A registered manager was employed by the service. 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 registered manager was available for the all of the inspection.

People using the service and their relatives said they valued the relationships they had with staff and were satisfied with the care they or their family member received. People were supported to have a say in how their care was delivered.

Staff were aware of the types of abuse people may be at risk of and the actions to take if they suspected someone was at risk of harm. Staff were aware of their responsibility to report any concerns they had about people’s safety and welfare.

People received their care at the correct time and had support given by the same members of staff to ensure consistency of care.

There were enough staff deployed to fully meet people’s health and social care needs. Appropriate recruitment processes were in place to reduce the risk of unsuitable staff being employed by the service. Staff received training and support from management to ensure they had the right knowledge and skills to meet people’s needs.

Systems were in place to ensure people were given their medication in a safe way.

People told us staff sought their consent before providing any care or support. Staff had an awareness of the Mental Capacity Act (2005) and knew how to support people to make their own decisions.

People’s needs were assessed and care plans developed to identify the care and support people required. People and their relatives told us they were involved in the planning and reviewing of their care and support and that when they required changes to be made, this was actioned by staff or the registered manager.

People and their relatives told us they knew how to raise any concerns or make complaints should the need arise. The registered manager sought feedback from people to ensure the quality of care was maintained.

People, relatives and staff all spoke positively about the management of the service. Staff felt supported and confident in raising concerns and felt the registered manager would act on these.

Staff working in the service had access to personal protective equipment (PPE) such as gloves and aprons to help prevent cross contamination and promote infection control.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us; what we observed and the records we looked at. There were two people using PA Care Agency at the time of our inspection. The registered provider was also the manager of this service.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found that the service was safe. We saw that risks to people who used the service were being assessed and support was planned and delivered in a way that was intended to ensure people's safety and welfare. People's support plans contained guidance on maintaining their safety.

We found that there were enough experienced staff employed who had the knowledge to meet the needs of those using the service. There were procedures in place to ensure that people received their medicines safely and that staff were appropriately trained in medicine management.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. While no applications had needed to be submitted, policies and procedures were in place and relevant staff had been trained.

Is the service effective?

We spoke with one person who used the service and one relative. They were both very positive about the support given. The person who used the service told us ''Best one [agency] I've had. The secret of it is that small is beautiful, they give much better customer care.'' The relative we spoke with described the staff as ''Very supportive.'' We asked them if they were happy with the agency and they replied ''Without a doubt.''

We found that consent was sought from those using the service. Where one person required support with complex decisions, we found that their relative had been involved and consulted.

Is the service caring?

Both people we spoke with told us about the close relationship they had with care staff and the provider, one saying ''It's like a family.'' We found that staff assessed people's needs and provided appropriate support. Staff supported people who used the service to see health and social care professionals if they needed to.

Is the service responsive?

People we spoke with confirmed they felt able to raise concerns when necessary. One person told us ''Yes I can say if I have a problem and I feel [the provider] gets a grip of it.'' Another person said that they felt the provider was ''approachable'' and that they had a good level of communication with them.

We saw that the provider took action when they found issues that needed addressing. They told us about health and safety concerns they had dealt with and how they managed a poorly performing staff member.

Is the service well-led?

The provider displayed awareness of the number of people the agency was able to realistically support without compromising the care provided. They told us of how they were recruiting extra staff before taking on another person who wished to use the service.

There were quality assurance processes in place to ensure people's opinion on the service was sought. Staff we spoke with were happy working for the agency. One told us they thought the agency was ''Absolutely excellent'' and another said ''It's really good.''

We received positive feedback from the person who used the services and from relatives. One person told us that that because the agency was small they could offer personalised care, 'nothing was too much trouble'. One relative stated 'They offer an excellent service'. During a previous inspection we had found that improvements were needed to the records for the assessment and management of people's needs. In addition, a more robust recruitment and selection process was required and mandatory training for staff.

The provider had made the relevant improvements. We found that care plans and records were comprehensive and person centred and appropriate risk assessments were in place. There were recruitment processes in place and staff had undertaken/or were booked to undertake mandatory refresher training. Specialist training which related to people's needs had been completed.

We looked at care records and found there had been inadequate assessment of people's needs. There was limited information available about how people should be supported and how risks to their health and wellbeing should be managed.

Staff understood their responsibilities towards the vulnerable adults they supported and knew how to report any concerns about people's safety. However the agency had inadequate recruitment processes in place to ensure that people were cared for by suitable individuals.

Staff told us they felt well supported by the manager. However, they had not received recent training in mandatory subjects such as manual handling, infection control, medication and safeguarding or specialist training to support the people they cared for. Supervision of staff was inconsistent and informal.

There were few systems in place to monitor quality and safety and those systems that were in place were not fully developed or sufficiently robust to provide assurance of quality and safety.