The inspection took place on 29 April, 5 May and 6 May and was announced. We gave ‘48 hours’ notice of the inspection, as this is our methodology for inspecting domiciliary care agencies.
This was the first inspection of the service since it was registered with us on 30 September 2014.
Marjon Home Support Agency provides personal care and support to adults in their own homes. It provides personal care in two separate geographical areas. These are Whitstable and surrounding areas and Bromley and surrounding areas. The service provides care and support for older people and people with a physical disability. At the time of the inspection it provided a personal care service to 12 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.
Comprehensive checks had not been carried out on all staff at the service, to ensure that they were suitable for their role. The agency relied on criminal record/barring checks that had been undertaken by the staff’s previous employer and therefore did not contain up to date information. People’s employment histories were not dated, so it was not clear if there were any gaps in their employment which required further investigation. The provider had received verbal references for staff’s previous employment in a health or social care setting, but had not recorded the reasons as to their suitability for employment at the agency.
Assessments of potential risks had been undertaken in relation to the environment. Staff knew how to minimise individual risks, such as risks of people falling, but these assessments, together with the steps that the agency was taking to minimise their occurrence, had not been formally undertaken.
People told us they received their medicines as they were prescribed. Staff had received training in the administration of medicines and clear procedures were in place which defined staff’s roles and responsibilities. We have made a recommendation about the management of some medicines.
People said they trusted staff and that they gave them confidence and they felt safe at all times in their care. Staff had received training in how to safeguard people and demonstrated a good understanding of what constituted abuse and how to report any concerns swiftly so that people could be kept safe. We have made a recommendation about the agency obtaining the local authority safeguarding protocols.
The agency had sufficient numbers of staff available to provide each person with a main carer and to cover any leave such as illness and annual leave. The provider was aware of how many additional hours the agency could provide, before the need to recruit additional staff. New staff were all trained in National Vocational Qualification or Qualification Credit Framework level two. These are nationally recognised qualifications which demonstrate staff’s competence in health and social care. They underwent an in-house induction programme which included assessing their knowledge in key areas and shadowing experienced staff. People felt that staff had the right skills and experience to meet their needs. Staff’s performance was monitored during unannounced checks on their practice by the management team. Staff were supported through regular supervision, staff meetings and informal conversations.
Staff were aware of people’s health needs and the agency liaised with health professionals and family members when appropriate. Staff had received training in the Mental Capacity Act 2005 and supported people to make their own decisions and choices. The MCA 2005 provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. The registered manager knew that when people were assessed as not having the capacity to make a decision, a best interest decision should be made involving people who know the person well and other professionals, where relevant.
People said they were supported by regular staff who knew them well. They said that all staff and members of the management team were kind, caring and compassionate. People said they were always treated with dignity and their privacy was respected. The agency was a small family business and had received a number of compliments about their caring nature.
People felt fully involved in the initial assessment and the planning of their care and support. They told us they were put first in the process and that they were at the heart of how their care was planned. As people had one main staff member to support them, staff were very knowledgeable about their likes, dislikes, choices and preferred routines. People were visited each month by a member of the management team to review their care plan and discuss any changes required.
People were informed of their right to raise any concerns about the service, but said that they did not have any concerns or complaints. The agency was proactive in responding to people’s requests before they escalated into a complaint.
Effective systems were in place to assess and monitor the quality of the service. This included feedback from people who used the service and from staff. Everyone 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 and friendly. There was good communication throughout the whole staff team.
We found two 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.