21 and 29 April and 6 May 2015
During a routine inspection
The first part of this inspection was unannounced and took place on 21 April 2015. Two further days of inspection took place by appointment on 29 April and 6 May 2015. The service was newly registered at this location in January 2015 and this was the first inspection.
24 Hour Home Care Services Ltd employs care workers to provide live-in care to people living in their own homes and domiciliary care to adults who require personal care whilst living in their own homes. There were nine people using the live-in service and 14 people receiving domiciliary care at the time of our inspection.
24 Hour Home Care Services Ltd had a registered manager. 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 feedback we received from people and relatives was that 24 Hour Home Care Services Ltd provided a personalised, caring service. People said that care workers were kind and helpful. One relative told us, “They are very helpful and go the extra mile”. All of the people we met told us that care workers always stayed for the required amount of time, met their needs and could be flexible when needed. One care worker told us, “I see myself as a professional extension of the family. I provide all the personal care so that she can retain her privacy with her family.”
There were plans in place to provide care workers should any live-in or domiciliary care workers become unavailable at short notice. All of the care workers we had contact with confirmed there was always someone available to provide advice and support should they need it.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to ineffective management and systems. We found no evidence of poor care delivery. You can see what action we told the provider to take at the back of the full version of the report.
People’s medicines were not managed safely. Medicines were not administered safely because care workers had not received suitable training and their competency to give medicines had not been assessed. People’s needs regarding the help they needed to take their medicines or apply prescribed creams had not been properly assessed and planned for and there were no instructions for staff to follow. This meant that people were at risk of not receiving the correct medicine, in the correct quantity, at the correct time.
Systems to manage risk and ensure people were cared for in a safe way were ineffective. Risk assessments were not always undertaken or regularly reviewed when they had been done. Some risk assessments identified hazards and concerns but no action had been recorded to show that risks to people had been reduced or managed. This meant that people’s safety and well-being was not always protected.
The agency did not have an effective system in place safeguarding adults from abuse. Policies did not contain sufficient information to easily enable alerts to be raised. The agency had failed to recognise two incidents as potential abuse and had therefore not made alerts or protected people from further abuse.
Suitable steps had not been taken to ensure that staff were suitably trained and supervised. This meant that people were not always cared for by staff who had been supported to deliver care and treatment safely and to an appropriate standard.
All care workers had undertaken training in the Mental Capacity Act 2005. However, the learning from the course and the agency’s policies and procedures were not properly implemented. This meant that people’s consent to receive care and treatment was not properly recorded. Where people did not have capacity to make decisions, the agency had accepted the consent of relatives where they had no evidence that these people had the legal right to make such decisions.
Care planning systems were not robust. Some assessments had not recognised specific care needs and no care plans had been created. Some people’s needs had changed and care plans had not been reviewed and amended. This meant that care workers were providing care and meeting needs that had not been fully assessed and planned for.
Management arrangements and systems at the agency did not ensure that the service was well-led. Quality monitoring systems were not used effectively. None of the shortfalls found at this inspection had been identified by the agency.