Archived: Integrity Home Care Limited

This inspection took place on 24 November 2016 and was announced. We gave the registered provider notice of the inspection to make sure that the registered manager was available on the day of the inspection. This inspection was to check that the registered provider was now meeting legal requirements we had identified as not being met at inspections in January 2015, April 2016 and July 2016.

At the comprehensive inspection in January 2015 we found the registered provider was in breach of regulation pertaining to good governance. At the comprehensive inspection of the service in April 2016 we found the registered provider had failed to achieve compliance with this regulation. The focused inspection held on July 2016 found that the registered provider had met this breach of regulation, but further work was needed to embed new practices. During this inspection we found further improvements had taken place and robust monitoring of the service was evident.

At the comprehensive inspection of April 2016 we found the registered provider was in breach of regulation pertaining to safe care and treatment. During this inspection we found improvements had taken place in relation to the safe handling of medicines and there was sufficient evidence to say this breach of regulation was now met.

The registered provider is required to have a registered manager and there was a registered manager in post who was registered with the Commission. 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 people using the service told us that they felt confident about their safety. We found that their support workers had a good knowledge of how to keep people safe from harm and the support workers had been employed following robust recruitment and selection processes.

There were sufficient support workers employed to meet people’s individual needs. The support workers received induction, training and supervision from the management team and we saw they had the necessary skills and knowledge to meet people’s needs. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People told us that they had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions. There was a complaints procedure in place and people told us that they would not hesitate to contact the agency office if they had a concern.

We observed good interactions between people who used the service and staff on the day of the inspection. We found that people received compassionate care from kind staff and that staff knew about people’s needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks. People were happy with the assistance they received with the preparation of meals.

People were treated with respect and dignity by the support workers. Every person we met, or spoke with, agreed that they received a very personal service from support workers they knew and trusted.

People and the support workers told us that the service was well managed. The registered manager monitored the quality of the service, supported the support workers and ensured that people who used the service were able to make suggestions and input to the development of the service.

The remaining breach was in respect of Regulation 17: Good Governance and was a continued breach of Regulation 17. We dealt with this by issuing the registered provider with a written warning notice for improvement of the breach. We informed the registered provider in the warning notice that they had to become compliant in respect of quality assurance and record keeping including staff recruitment, records relating to people using the service, care plans and risk assessments, medication administration records, audits, staff induction, training and supervision by 30 June 2016.

We carried out a focused inspection on 5 July 2016 to check whether the registered provider had achieved compliance with the shortfalls we identified. This report only covers our findings in relation to the warning notice. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Integrity Home Care Limited on our website at www.cqc.org.uk.

Integrity Home Care Limited is registered as a domiciliary care service providing support and personal care to people in their own homes. The location office is situated in the old town area of Bridlington, in the East Riding of Yorkshire. At the time of our inspection there were seven people using the service.

The registered provider is required to have a registered manager in post and on the day of the inspection the manager who was employed at the home was registered with the Care Quality Commission (CQC). 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.

During our focused inspection we found all the care staff had completed training deemed by the registered provider as essential or mandatory. Staff had also completed the induction programme and received supervision from the registered manager.

We saw that previous gaps in the staff recruitment records had been identified by the registered manager and action had been taken to ensure all checks had been completed. This ensured the staff employed by the registered provider were fit for practice and suitable to work with vulnerable adults.

The registered manager had carried out medicine competency checks on all staff to ensure they had the skills and knowledge to safely manage and administer medicines to people using the service. Improvements were seen to the recording of medicines on the medication administration sheets.

Improvements were seen to the quality of information in the care plans and risk assessments. The risk assessments gave staff clear and precise information on how to reduce the risk of harm to people and the new care plans were more detailed and reflected the care being given.

Improvements had been made to the quality assurance system. Audits had been completed and action plans identified where practice could be better. Issues identified were discussed with staff during their supervision sessions.

We saw these changes resulted in the registered provider meeting the breach of Regulation in respect of quality assurance and record keeping, previously identified in the Warning Notice for Regulation 17: Good Governance, under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Integrity Home Care Limited is registered as a domiciliary care service providing support and personal care to people in their own homes. The location office is situated in the old town area of Bridlington, in the East Riding of Yorkshire. At the time of our inspection there were six people using the service.

At our last inspection of the service on 20 January 2015 we identified a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection we asked the registered provider to take action to address this breach of the legal requirements. This inspection was planned to check whether these improvements had been made and that the registered provider was now meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

During the inspection we found that our concerns had not been addressed and the service was not well-led. Records were not always well-maintained and risk assessments contained insufficient information and detail.

The quality assurance systems had not identified or resolved issues with poor record keeping.

This was a continued breach of Regulation 17 (1) (2) (a) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the registered provider to take in relation to this breach at the back of the full version of the report.

Medication administration records (MARs) used to document prescribed medicine given to people using the service were not completed correctly. Audits of MARs had not addressed these issues or concerns. The registered provider did not document medication competency checks to ensure and evidence that care workers had the appropriate skills and knowledge.

This was a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the registered provider to take at the back of the full version of this report.

The registered manager accepted certificates of training completed with previous employers and did not complete competency checks with new care workers to verify that this training had equipped care workers with the necessary skill and knowledge to enable them to effectively carry out their role. We have made a recommendation about this in the body of our report.

There were systems in place to ensure that care workers were able to identify and respond to safeguarding concerns.

Sufficient care workers were employed to meet people’s needs.

People were supported to make decisions and care workers had training in the Mental Capacity Act 2005. However, people’s consent to care and treatment was not consistently recorded in their care plans.

People using the service were supported to eat and drink enough and access healthcare services where necessary.

We received positive feedback from people using the service about the kind and caring attitude of care workers. People had established caring relationships with the care workers supporting them as there was good continuity of care.

People using the service told us their privacy and dignity were respected.

People using the service were complimentary about the responsive care and support provided by care workers.

People told us they were able to make complaints or raise concerns if needed and felt that the registered manager was approachable and open to feedback.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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.