Archived: Way Ahead Support Services

Way Ahead Support Services is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service supported 12 people. There had been a recent change to the registration of the service. The provider divided the original service which offered a domiciliary care service and a supported living service, into two separate services in October 2016. This service is the domiciliary care service, which continues to be provided under the original registration.

The original service was last inspected on 22 and 23 February 2016, where we found they were meeting the Health and Social Care Act 2008 and associated Regulations, however there were issues which required improvement in the safe and well led questions. The service had been rated as requires improvement, because we found between the period July 2015 to January 2016, when there had been no registered manager at the service, there had been a lack of oversight by the provider. This was because it was not clear which senior manager was responsible for fulfilling the absent manager's duties. Systems were not put in place to ensure information about important events was shared appropriately within the service and not all safeguarding incidents had been referred to appropriate agencies. Some information about important events was not analysed by senior managers and learning could not take place across the service to minimise future risks.

At this inspection we looked to see if the provider and registered manager had responded to make the required improvements. Whilst we found some areas of improvement had been made, we also found some of the same issues continued to require improvement.

The registered manager had been in post since 29 March 2016 at the original service. 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. Following the split into two separate services, the manager continued to be registered for both services. The new manager joined this service, the domiciliary care service, on 10 October 2016 and had taken over the day to day running of the service. They were in the process of applying to be registered and to take over the role of the current registered manager. Therefore the report will refer to the registered manager and the manager of the service.

People told us they felt safe using the service and staff understood how to protect people from abuse. However not all events which called into question people’s safety had been consistently recorded and reported to managers for analysis, in order to reduce the risks to people’s safety. Some identified risks had not been recorded and assessed in full on people’s care plans. There was no consistent process to identify, report and analyse missed calls.

People received their medicines as prescribed and the provider checked staff were suitable to deliver care before they started working with people at the service.

The registered manager and the manager were dedicated to providing quality care to people. Staff told us they felt supported and they were encouraged to share ideas to make improvements to the service. There were some processes to ensure good standards of care were maintained for people. However, audits were not always effective because they did not always identify events or risks which called into question people’s safety.

There were sufficient numbers of suitably skilled staff to meet people’s individual needs, however some people told us staff who were not regular did not know as much about their care needs. Staff received an induction and a programme of training to support them in meeting people’s needs effectively.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the principles of the MCA, where people had capacity to make their own decisions, these were respected and consent was gained before staff provided personal care.

People's nutritional needs were taken into account and people were supported to make referrals to other healthcare professionals when their health needs changed.

People told us staff were kind and caring and had the right skills to provide the care and support they required. Care plans contained relevant information for staff to help them provide responsive care to meet people’s changing needs. Staff treated people in a way that respected their dignity and promoted their independence.

People were involved in planning how they were cared for and supported. Care was planned to meet people’s individual needs and preferences and care plans were regularly reviewed. People were happy with the service. They knew how to complain and were able to share their views and opinions about the service they received.

We visited the offices of Way Ahead Support Services on 22 and 23 February 2016. The inspection was announced. This was to ensure the manager and staff were available when we visited, to talk with us about the service.

The service is required to have 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 2008 and associated Regulations about how the service is run. At the time of this inspection, the service did not have a registered manager in post and had been without a registered manager since July 2015. There was a new manager who had been in post since January 2016, who was in the process of applying to become the registered manager.

People told us they felt safe using the service and staff understood how to protect people from abuse. Not all safeguarding incidents had been referred to appropriate agencies, since the previous registered manager had left in July 2015, however the new manager had developed a new system to track safeguarding incidents in future. Staff recorded accidents and incidents, on people’s support plans. There were other processes to minimise risks associated with people’s care to keep them safe. This included the completion of risk assessments and checks on care workers to ensure their suitability to work with people who used the service.

There were enough staff to deliver care and support to people. Staff received an induction and a programme of training to support them in meeting people’s needs effectively. People told us staff were sometimes late or did not attend care calls. There was no consistent process to identify missed or late calls, or to investigate the reason for them.

Staff understood the principles of the Mental Capacity Act (MCA). They respected people’s decisions and gained people’s consent before they provided personal care. It was not clear on people’s records if they required support to make decisions. However people’s records showed their families and other health professionals were involved when they did not have capacity to make their own decisions, and any decisions made were in their best interests.

People told us staff were kind and caring and had the right skills and experience to provide the care and support they required. Staff treated people in a way that respected their dignity and promoted their independence.

Care was planned to meet people’s individual needs and preferences and support plans were regularly reviewed. Support plans and risk assessments contained relevant information for staff to help them provide the care people required. People were involved in planning how they were cared for and supported.

People knew how to complain and were able to share their views and opinions about the service they received. Staff felt well supported by the senior management team and were confident they could raise any concerns or issues, knowing they would be listened to and acted on.

There were some processes to ensure good standards of care were maintained for people. However during the period where there had been no manager in place, there was a lack of oversight by the provider because it was not clear which senior manager was responsible for fulfilling the missing manager’s duties. Systems were not put in place to ensure information about important events was shared appropriately within the service. Therefore during this period some information about important events was not analysed by senior managers and learning could not take place across the service to minimise future risks. The new manager had recognised these issues and had taken steps to make improvements since starting their role in January 2016.