At our last comprehensive inspection on 1 February 2017 we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of the regulations for good governance. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-led to at least good. During this inspection, the service demonstrated to us that improvements had been made and that it was no longer in breach of this regulation. However, further improvements were still needed and we have made a recommendation that the provider continues with the improvements relating to their quality assurance processes.
This inspection took place on 13 March 2018 and was announced.
This service is a domiciliary care agency. It provides personal care to 33 people living in their own houses and flats in the community. It provides a service to older adults, younger adults and people who are living with a physical disability.
There was 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.
Individual risks relating to people’s health and wellbeing were not fully documented. Risk assessments did not contain sufficient guidance for staff about how risks can be managed and mitigated. Where risks had been identified, guidance provided in the risk assessments did not demonstrate how people were affected individually by the risk. However, staff knew people’s individual risks and how to minimise known risks.
Environmental risks in people’s homes were assessed and documented. This included guidance about what to do in the event of a fire and how to manage incidents with the water and gas supply to people’s homes.
Staff knew their responsibilities in relation to keeping people safe. Staff knew how and who to report concerns of abuse too. Staff had also attended training in safeguarding.
There were enough staff to meet people’s care needs and people received their visits on time.
Safe practices were in place for the recruitment of staff. Appropriate references and a clearance from the Disclosure and Barring Service were obtained before staff started working at the service.
People’s medicines were managed in a safe way and people’s medicines administration record charts showed that people were given their medicines as prescribed. Staff received training in the management of people’s medicines and their knowledge and practice in this area was regularly assessed.
Assessments of people’s care needs took place before they started to use the service and people’s care needs were reviewed on a regular basis.
Staff received training relevant to their role and received regular supervision from the management team. An induction programme was in place for new staff where they would shadow more experienced members of staff.
People were supported to maintain a healthy nutritional intake and staff were aware of people’s individual needs relating to their food and fluid intake.
Referrals to other healthcare professionals were made in a timely manner where there were concerns about a person’s health or wellbeing.
The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff understood the principles of the MCA and had received training in this subject.
Staff treated people in a kind and caring way. People were cared for in a way that maintained their dignity and staff were respectful of their privacy. Confidential documents about people’s care were stored in a safe way.
People and their relatives were involved in the planning of their care. People were given choices about how they would like their care to be delivered and their preferences around this were respected. The service was responsive to people’s needs and visits could be rearranged at short notice.
When people transferred between services, there were measures in place to ensure that information about their health care needs was passed on to other relevant healthcare professionals who would be taking responsibility for providing people with their care.
There was a complaints policy in place and people knew who they would make a complaint to. People also felt comfortable in raising a complaint if needed.
Staff felt supported by the management and attended regular meetings. Communication from the management team with people who used the service and staff was open and frequent.