10 October 2016
During a routine inspection
Executive Care provides a domiciliary support service within Milton Keynes and surrounding areas. The service enables people to live independently in their own home.
The service had a registered manager in post. 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 and associated Regulations about how the service is run.
At the last comprehensive inspection on 18, 24, 27 August and 1 September 2015, we asked the provider to take action to make improvements to care plan and risk assessment documentation and in reporting statutory notifications to the Care Quality Commission (CQC).
This was in breach of Regulation 12 (1) (2) (a) (b) of the HSCA (RA) Regulations 2014 and Regulation 18 (1) (2) (e) of the (Registration) Regulations 2009.
We received an action plan from the provider telling us how the relevant legal requirements would be met. We carried out a focused inspection on 13 May 2016 to follow up on their actions and found that they had been completed. We could not improve the ratings from requires improvement, at the focused inspection, because to do so required consistent good practice over time.
The provider had carried out risk assessments to identify potential hazards for people using the service and staff. Risk assessments for moving and handling, pressure area care and nutrition were regularly reviewed to identify changes in people’s needs and they were amended accordingly.
People’s care, treatment and support was set out in a written care plan that described what staff needed to do to make sure personalised care was provided. The care plans contained sufficient detail to inform staff on the type of support people needed to maintain their health and well-being.
The provider had reported safeguarding concerns to the local authority safeguarding team and to the CQC to safeguard people from abuse or improper treatment. They had also kept CQC informed of other events at the service as required by law.
Internal quality audits, surveys and reviews, were used to monitor the service provision. However robust records were not always maintained on the actions taken by the provider, in response to the audit findings. The registered manager told us they planned to put action plans, with timescales in place. This would ensure that robust records were available to demonstrate the actions they had taken to continually drive improvement of the service.
Staff recruitment procedures ensured that only suitable staff were employed to work at the service. However robust records were not always maintained regarding checks carried out on car drivers using their vehicles for work purposes. Having proof of current insurance and MOT certificates held on file, would demonstrate the provider’s commitment to continually manage the staffs’ on-road risks.
Staff understood their roles and responsibilities to safeguard people and to report any concerns. The provider had informed the Local Authority in relation to safeguarding concerns.
Where the provider had taken on the responsibility systems were in place to manage people’s medicines safely. Medicines audits were regularly carried out to check that people consistently received their medicines safely.
People were involved in making decisions about their care; where they lacked the capacity to make their own decisions, decisions made in their best interests were made in line with the Mental Capacity Act (MCA) 2005.
Staff received appropriate training and systems were in place to ensure that staff received regular supervision and support.
People were encouraged to eat and drink sufficient amounts to maintain good nutrition and hydration. Staff contacted the relevant healthcare professionals in response to any sudden illness or emergencies.
Relationships between staff and people receiving support consistently demonstrated dignity and respect at all times. Staff took the time to explain things to people and provided them with sufficient information before carrying out any care tasks.
People using the service and their relatives were involved in planning their care and the staff were knowledgeable of people’s needs. Systems were in place to seek feedback from people using the service on the quality of the care they received. The provider had a complaints procedure and complaints made to the provider had been responded to appropriately.
The registered manager had an open door policy and was available to people using the service, their relatives and staff. Communication between the provider and the staff was effective and staff felt supported in their development.