7 and 13 April 2015
During a routine inspection
This inspection was unannounced and carried out on 7 April 2015. A second, announced inspection took place on 13 April 2015. The service had registered with the Care Quality Commission (CQC) in December 2014, and this was the first inspection.
High Level Care Limited is a domiciliary care agency which provides care and support to people in their own homes and in the community. Care is provided for people with physical or mental health needs. At the time of our inspection the service provided care for two people.
A registered manager had been in place and our records showed she had registered with the Care Quality Commission (CQC) in December 2014. However the provider told us that she had left the company approximately one month before 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.
Staff had not received training in how to identify and respond to potential abuse. One member of staff told us about their concerns for a person using the service. We found this information had not been shared with the local authority safeguarding team which meant the provider’s protocol had not been followed. The acting manager of the service, and the provider told us they had not undertaken any safeguarding alerter training, about what to do if staff came to them with concerns, but said would arrange this training after our inspection.
Risks had not been properly assessed. We saw incorrect information had been recorded on some risk assessments and there were no assessments in place for risks associated with the activities people were supported to take part in.
People we spoke with told us the service was reliable and there were enough staff to meet their needs. However, robust recruitment processes had not been followed and staff had started working for the service, providing care to people, before checks had been carried out to determine if they were suitable to work in a caring role.
Staff had not completed any training whilst they had been working for the service. They had been provided with DVDs to watch and then expected to complete a questionnaire testing their knowledge on the training. None of these questionnaires had been completed at the time of our visit and the provider was unable to tell us how they ensured staff were competent to deliver care.
Staff had not received any supervision sessions. The acting manager told us these would be arranged for every three months, but that none of the staff had been in their roles for three months at the time of our inspection. Staff told us the organisation was supportive and they could contact the acting manager or provider with any concerns.
Staff, the acting manager and provider of the service had an awareness of the Mental Capacity Act 2005 (MCA) and were able to tell us about the way they followed the requirements of this law. Staff told us people had capacity to make all of their own decisions, including the right to refuse care if they wished. The person we spoke with confirmed that staff respected their wishes.
A range of assessments had been carried out to determine people’s needs. However, we saw when people’s needs changed these had not always been updated which meant they were not accurate.
The care delivered did not always match the care that had been planned. We saw staff did not follow a moving and handling assessment provided by an occupational therapist which meant people may have been at risk of receiving unsafe care.
The records we viewed as part of this inspection were not completed to a high standard. Care records were unnamed or undated. The acting manager and provider were unable to provide us with records or information during our inspection. They told us they had not recorded information.
Risks to staff had not been assessed and mitigating actions to reduce risks had not been put into place.
We found four breaches of regulations. These related to; Safe care and treatment, Safeguarding, Good governance and Fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the report.
Where we have identified a breach of regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is complete.