Background to this inspection
Updated
30 October 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We gave the service 48 hours’ notice of the inspection visit because we needed to be sure the manager, staff and people we needed to speak to were available.
The inspection took place on the 11 July 2018. It included visiting the site office, and visiting and speaking to one person at their home. We also spoke with people and a relative by telephone prior to the site visit so that we could further understand their experiences. The inspection team consisted of one inspector and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Prior to the inspection, we gathered and reviewed information we held about the service. This included notifications from the service and information shared with us by the commissioning local authority. We had not requested that the provider send us a Provider Information Return (PIR) on this occasion. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection we spoke with five staff and the manager. We looked at five people’s care plans, three staff files, staff training records, policies and procedures, quality assurance documentation and information and policies in relation to people’s medicines. We spoke with four people using the service and one relative during the inspection process. We have included their feedback in the main body of the report.
At the last inspection on 14 June 2017, the service was rated Requires Improvement. At this inspection we found the service remained Required Improvement.
Updated
30 October 2018
The inspection took place on the 11 July 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service. We wanted to be sure that someone would be in to speak with us and that we could meet with people using the service.
Care Your Way is a domiciliary care agency registered to provide personal care and support services to a range of people living with physical disabilities, sensory needs and people living with dementia. It provides care to people living in their own houses and flats.
At the time of our inspection the service was supporting 11 people who were receiving a regulated service. Not everyone using Care Your Way receives a regulated activity; CQC only inspects the service being received by people provided with personal care; help with tasks related to personal hygiene and eating.
At the last inspection on 14 June 2017, the service was rated Requires Improvement. A breach of legal requirements was found. Following the last inspection, we asked the provider to complete an action plan to show what they would do to meet the legal requirements in relation to the breach of Regulation 17 of the Health and Social Care Act Regulated Activities Regulation 2014. This was in relation to the governance of care and risk planning, management of medicines and staff training. They provided an action plan on 4 August 2017 detailing what they would do and by when to meet the breach.
We undertook a comprehensive inspection on 11 July 2018 to check whether the required action had been taken, improvements made and the breach met. Many improvements had been made, however we found some new areas for improvement and a further failing of the provider to comply with legal requirements. This report discusses our findings in relation to this.
A registered manager had not been in post since October 2015 and Care Your Way was therefore not meeting a condition of registration to have 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. A potential new provider was preparing to take over the service and a manager was appointed in February 2018. Both the potential new provider and the manager had begun the process of registering with the Care Quality Commission (CQC).
The service had made improvements since the last inspection to the management of quality assurance systems, care and risk planning and management of medicines, continence and staff training. People’s care plans and risk assessments had been reviewed and the manager and care co-ordinator carried out regular audits as well as contacting people regularly to discuss and monitor their needs. Changes in needs or concerns shared by people, their relatives or staff were addressed in a timely way and clear guidance for staff to ensure they could meet people’s needs. Staff training was updated and planned for, where required staff had received competence training in relation to manual handling and medicines administration including the use of PEG tube, to support administration of medicines. However, we have identified other issues relating to the governance of medicines that suggest the improvements made, require more time to be embedded fully.
Quality assurance systems and processes were still being embedded. Staff had a good understanding of the needs of people. However, in relation to the recording of one person’s care planning and medicines guidance the quality assurance systems had not ensured that staff practice was fully informed when administering the person’s ‘as required’ medicine.
The management arrangements of the service were still being established. However, there were known lines of responsibility and accountability and the values discussed and demonstrated by the manager were reflected in their staff team’s descriptions of what was important to them. One staff member told us, “I have respect for people, my relative had carers. It’s important to treat people as we would want to be treated.” The manager was committed to supporting people with dementia to gain as much community presence and independence as they could achieve. The service had an open transparent culture, where complaints and surveys were encouraged and acted on.
People and relatives told us they felt the service was safe. One person told us, “I have no complaints, they are very helpful, I do feel safe with them.” People were protected from the risk of abuse because staff understood how to identify and report it and were confident if they raised concerns that they would be taken seriously.
There were good systems and processes in place to keep people safe. Risks and accidents were assessed and staff received guidance on what actions to take to mitigate risk and ensure people and staff’s wellbeing at the service site and in the community. People were supported by staff that knew them well. People’s health was promoted and they had assistance to access health care services when they needed to. One person told us, “The regular staff see me that often, they know me well, they know if I am unwell and help me.” Staff had a good understanding of the needs of people living with dementia.
Safe recruitment practices were followed when new staff were employed. There were sufficient suitably skilled staff available to meet people’s needs. Staff received an induction and training to ensure they had up to date guidance on how to carry out their roles and responsibilities. One person told us, “They are very good, I am very comfortable with their care, I think they help me to maintain my independence.” Staff told us they felt well supported through supervision, appraisal and regular contact with the manager and care co-ordinator.
The service and staff considered people’s capacity and worked in line with the Mental Capacity Act (MCA) 2005. People’s capacity to make decisions was assessed and staff recognised the importance of respecting people’s choice and self-determination. People told us they could make choices and felt listened to and independent. One person told us, “Each day I make all my own choices, food, clothes, the care helps me to maintain independence.” People’s right to privacy, to be different and to be treated with dignity was respected.
People and their relatives told us the service was caring and kind. One person told us, “The carers could not improve, they are friendly, respectful, in fact they are excellent.” Staff adapted their communication to fully understand people’s needs and choices in respect to all areas of their lives including what they ate and drank. People were supported to access the necessary adaptations and equipment they needed to live as independently as they could. A relative told us, “One staff member is particularly good, although my relative does not speak or respond, they still talk to my relative and you can see my relative is listening, and sometimes reacts to the staff member.”
We found areas that needed improvement and a further failing of the provider to comply with legal requirements. This is therefore the second consecutive time that the service has been rated Requires Improvement.