Boyce Care

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. We were supported on the inspection by the registered manager and the senior management team.

There were appropriate numbers of staff available. People who required one to one care from staff always received this. People said that they felt safe. Staff ensured that people were protected against the risk of abuse and told us that they would not hesitate in reporting any concerns. Robust recruitment of staff took place before they started work.

Detailed risk assessments took place in relation to people’s individual needs. The environment was checked in relation to potential risks to people. In the event of an emergency there were plans in place to protect people. Accidents and incidents were acted upon and steps taken to reduce the risks.

People’s medicines were managed safely and appropriately by staff. People had access to pain relief when they needed it. People’s nutritional and hydration needs were managed to ensure they received the most appropriate care. People were supported to lead healthy lives.

People were supported and encouraged to eat healthily and had access to nutritious food. Health care professionals were involved with the care of people and people were supported to attend health care appointments. People’s needs were assessed fully before they started to receive care at the service.

Training and supervision were provided to staff which ensured that the most appropriate care was being provided to people. We saw through observations that staff were knowledgeable and effective in the care they provided. Staff were effective in sharing information in relation to peoples’s care.

The Mental Capacity Act 2005 (MCA) is a legal framework about how decisions should be taken where people may lack capacity to do so for themselves. Staff had received training around (MCA) and how they needed to put it into practice and staff were knowledgeable in this. There were people at the service who had the capacity to make decisions about their care and staff respected this. Where people were being restricted, applications were submitted to the local authority in line with the legal requirements.

Staff showed care and empathy towards people. It was clear that staff had good relationships with people and understood what was important to them. Staff showed patience, dignity and respect and people responded well to staff.

People received individualised care and were able to make choices around how they wanted their room to look and how they wanted their care to be delivered. People were supported to be independent and to make their own choices.

Care plans were detailed and specific to each person. There was guidance for staff on how best to provide the support people needed. Staff were aware of what care needed to be provided. People were supported to participate in activities that they enjoyed.

People were supported to make a complaint if they needed to. Complaints were investigated and improvements made where needed.

People and staff were complimentary of the management and the support they received. Staff worked well as a team and felt supported and valued.

Steps were taken to review the delivery of care with actions to make improvements. Methods the provider used included surveys, audits, staff meetings and spot checks.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The registered manager had informed the CQC of significant events including significant incidents and safeguarding concerns.

Further information is in the detailed findings below

The inspection took place on 10 November 2016 and was announced.

There was a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run. The registered manager (who was also the provider) was not present during our inspection. Instead we were assisted by the manager.

Risks to people were identified and action taken to reduce the risk of harm. Accidents and incidents were recorded to look for trends.

Recruitment processes carried out were not always in line with the agency’s policy. Medicines systems did not always follow the agency’s policy or best practice. The manager acted on these shortfalls following our inspection.

The manager was not always aware of their responsibility in relation to notifying CQC of safeguarding incidents. However staff were knowledgeable on safeguarding and the signs to look out for, together with how they should report any concerns.

The manager told us there was on-going recruitment to the agency. Although people told us that they never experienced a missed call, staff said at times arrangements to cover people’s calls were disorganised as there were insufficient staff available. We noted from staff rotas that some staff regularly worked for several days without a break.

Staff were unaware of the principals of the Mental Capacity Act (2005). Mental capacity assessments had not always been carried out for people and where decisions had been made there was no evidence of best interest discussions. Staff did not have a good understanding of the Mental Capacity Act.

Staff received training to support them in their role however we found some essential training, such as first aid was overdue for some staff. Immediately following the inspection the manager was able to demonstrate to us that staff had been booked onto the relevant refresher courses.

People were supported to eat a healthy and varied diet. People attended a cooking club held at the agency’s office which enabled them to learn basic cooking skills. Where people had specific health needs these were recognised by staff and appropriate health care professionals were involved in their care.

People told us they were cared for by staff who were kind. Observations during our inspection told us that staff had developed good, close relationships with people. Staff displayed compassion when people needed reassurance and respected people’s individual wishes and choices. People had access to a wide range of individualised activities which responded to their interests, such as attending college, a cinema club or a music session.

Support plans for people were written in a person-centred way and included detailed information about people and guidance for staff where needed.

Should people wish to complain information was available to them on how to do so. People and their relatives were provided with the opportunity to give their feedback on the service. Committees and forums had been established so people could make suggested improvements and suggestions made were listened to and acted upon.

Staff were involved in the running of the agency as meetings were held. Staff told us they felt supported by the management team and could approach and talk to them if they had any concerns.

Regular quality assurance audits were carried out to monitor the quality of the service provided and action taken where shortfalls were identified. In the event of an emergency there was a contingency plan in place to help ensure that people who required it, continued to receive care.

During our inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made some recommendations to the provider. You can see what action we told the provider to take at the back of the full version of the report.