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Boldglen Limited Medway Swale Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 10 August 2018

The inspection took place on 12 and13 June and 3 July 2018. The inspection was announced.

This service is a domiciliary care agency. It provides personal care to any adults who require care and support in their own houses and flats in the community. Not everyone using Boldglen Limited Medway Swale receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of inspection, although the service supported approximately 250 people in total, approximately 120 people were receiving personal care in their own homes.

A registered manager was employed at the service by the 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.

At our last inspection on 11 March 2016, the service was rated as ‘Good’. At this inspection, we found that there were now areas that required improvement. This is the first time the service has been rated Requires Improvement.

Individual risks were not always identified to ensure measures were put in place to help keep people safe and prevent harm. Environmental risks inside and outside people’s homes were documented to keep people and staff safe from identified hazards.

Some areas of the management of people’s prescribed medicines needed improvement to ensure safe administration by staff at all times. Gaps were evident in medicines administration records (MAR). Guidelines and information about the medicines people took were not available.

A safeguarding procedure for staff to follow should they have concerns about people was available to staff. People told us they felt safe and knew who they would talk to if they did not.

Staff followed safe practice to control the risk of infection and always had enough equipment such as disposable gloves and aprons available to wear.

The provider and registered manager followed safe recruitment practices to make sure only suitable staff were employed. Enough staff were available to be able to run an effective service and be responsive to people’s needs. People told us they always, had the same staff supporting them; staff were on time when visiting; always stayed for the full time they were allocated.

Staff had suitable training at induction when they were new as well as continuing regular updates. Staff were supervised by a manager regularly to check their competency and offer support.

People told us they made their own decisions and choices. The registered manager understood the basic principles of the Mental Capacity Act 2005 and made sure their processes upheld people’s rights.

Although many people did not require the assistance of staff with their nutrition and hydration needs, some people did require this support. People and their relatives told us they were happy with the support given by staff and it worked well.

Many people did not require the assistance of staff to look after their health care needs as they either managed this themselves or had a relative or friend to help. Where support was required, people told us staff were observant and offered advice or to make appointments with healthcare professionals.

The positive and caring approach of staff was clear from the responses of people and their relatives, telling us how happy they were with all the staff who supported them. People told us they had regular staff providing their care and support so had got to know them well, creating confidence and trust. People were given a service user guide at the commencement of their care and support with the information they would need about the service they should expect.

An initial assessment was undertaken of people’s personal care needs so the registered manager could be sure they had the staff resources with the appropriate skills available to support people. People had a care plan to detail the individual support they required as guidance for staff. The information in the care plan was basic and did not always provide the level of information needed to ensure care and support was consistent. Assessments and care plans did not record the personal information necessary to provide a holistic guide to people’s support.

The provider had an up to date complaints procedure. No complaints had been made and people told us they had no need to complain but knew what to do if they did.

Although the provider had some systems in place to monitor the quality and safety of the service, these were not always used effectively to identify where improvements were needed and take action.

The provider sought people’s views of the service on an annual basis and regularly during their care plan reviews. Feedback was primarily positive. The registered manager had taken action when people had raised an issue that required improvement.

We received good feedback from people and their relatives about the running of the service, particularly about their regular care staff.

Staff were positive about the support they received from the provider, the registered manager and the office team.

During this inspection, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.

Inspection report


Inspection areas

Safe

Requires improvement

Updated 10 August 2018

The service was not always safe.

Individual risks were not always identified to help protect people’s safety. Risks to the environment were checked to keep people and staff safe.

The administration of people’s prescribed medicines within their home was not always safe, some areas needed improvement.

Staff knew their responsibilities to keep people safe by following the safeguarding procedure and reporting any concerns they had.

Robust recruitment practices were in place to safeguard people from unsuitable staff. Sufficient staff were available to provide the support required.

Inspection report


Effective

Requires improvement

Updated 10 August 2018

The service was not always effective.

People had an initial assessment to determine the care and support they required from staff, the information needed was not always documented. Individual care plans that were in place did not record the detail needed.

Staff were supported through a supervision and observation process. Suitable training was provided to develop staffs’ skills appropriately.

People had control over the choices and decisions they wished to make.

Staff provided the support people required with their health needs and the preparation of meals and fluids.

Inspection report


Caring

Good

Updated 10 August 2018

The service was caring.

People made only positive comments about the staff who supported them, finding them kind and caring.

People and their relatives were involved in their assessment. Staff knew people and their relatives well.

People were given a guide about the support they received and the standards they could expect from the staff.

People experienced care from staff who respected their privacy, dignity and independence.

Inspection report


Responsive

Requires improvement

Updated 10 August 2018

The service was not always responsive.

Care plans were not always person centred, providing the information necessary to understand the individual and their circumstances.

Although no complaints had been made, the complaints procedure gave people the information they needed to know should they wish to raise a complaint.

Inspection report


Well-led

Requires improvement

Updated 10 August 2018

The service was not always well led.

Some monitoring processes were in place to check the safety and quality of the service. These had not been effective in identifying areas that required improvement.

Feedback was sought according to the providers processes.

Staff were supported by regular staff meetings where the provider often attended as well as the registered manager.

Inspection report