Background to this inspection
Updated
23 October 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.
This inspection took place on 9 and 10 September 2015 and was announced with 48 hours’ notice. The inspection was carried out by one inspector.
The provider was not asked to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Prior to the inspection we reviewed information we held about the service, we looked at previous inspection reports and the notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law.
During the inspection the provider supplied information relating to the people using the service and staff employed at the service. We reviewed people’s records and a variety of documents. These included nine people’s care plans and risk assessments, three staff recruitment files, the staff training, supervision and appraisal records, visit schedules, accident and incident records, medicine and quality assurance records and surveys results.
We spoke with seven people who were using the service, three of which we visited in their own homes, we spoke to five relatives, the registered manager, the area manager, a director and five members of staff.
After the inspection we contacted six health and social care professionals who had had recent contact with the service and received feedback from two.
Updated
23 October 2015
The inspection took place on 9 and 10 September 2015, and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection. This was the first inspection since the provider had registered under Meritum Integrated Care LLP.
Meritum Integrated Care LLP (Folkestone) provides care and support to adults in their own homes. The service is provided mainly to older people and some younger adults. At the time of this inspection there were approximately 86 people receiving support with their personal care. The service provided care and support visits to people in Folkestone, Hythe and surrounding areas.
The service is run by an established registered manager, who also undertakes work at other services owned by the same provider. 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.
People told us they received their medicines when they should and felt their medicines were handled safely. However we found shortfalls in some areas of medicine management. Risk assessments did not always reflect the support staff gave people with their topical medicines. The system for returning medicine records to the office for auditing was not always effective. There was a lack of guidance or procedures relating to some areas of medicine management. This meant people were not fully protected against the risks of medicine management.
Most risks associated with people’s care had been identified and staff were taking action to reduce such risks, but there was not always sufficient guidance in place for staff to help ensure people remained safe.
People were not fully protected by recruitment procedures. Staff files did not contained all the required information as full employment histories or gaps in employment histories had not always been recorded.
People were involved in the initial assessment and the planning their care and support and some had chosen to involve their relatives as well. However care plans varied greatly in the level of detail and most we viewed required further information to ensure people received care and support consistently and according to their wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan. Care plans were reviewed periodically, but not all of them were up to date and reflecting people’s current needs.
There had not been any accidents since the service had registered, but there was a clear procedure for reporting and dealing with any accidents and incidents to reduce the risk of further occurrences. People felt safe using the service and when staff were in their homes. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.
People had their needs met by sufficient numbers of staff. People received a service from a small team of staff. Staffing numbers were kept under constant review. New staff underwent an induction programme, which included relevant training courses and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role.
People were satisfied with the service they received. One person said, “As a service we find it quite all right”. People felt staff had the right skills and experience to meet their needs. One person said, “We have a very qualified carer who has worked a long time with older people and does a good job”. Senior staff monitored staffs practice during unannounced checks on their practice within people’s homes. Staff felt well supported and attended group meetings with their manager.
People told us their consent was gained at each visit. People had also signed their care plan and an agreement to confirm their consent to their care and support. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection. Some people had Lasting Power of Attorneys in place and some others chose to be supported by family members when making decisions. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.
People were supported to maintain good health. People told us how observant staff were in spotting any concerns with their health. The service made appropriate referrals and worked jointly with health care professionals, such as community nurses and dieticians.
People felt staff were very caring. People said they were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach and knew people and their support needs well.
People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Staff had built up relationships with people and were familiar with their personal histories and preferences.
People told us that communication with the office was good and if there were any queries they called the office who responded. People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided. Negative feedback that had been received had been acted on. People felt the service was well-led. There had been changes in the senior staff team, but new arrangements were in place to ensure the service ran smoothly.
The provider had a set of aims and objectives. Their aim was to provide a service to meet the needs of people by promoting a standard of excellence which embraced the fundamental principles of good care practice that was witnessed and evaluated through patience, conduct and control of quality care. Staff were aware of the aims and objectives and felt they followed them through into their practice.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.