Background to this inspection
Updated
21 March 2017
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.
This inspection took place on 11 January 2017 and was announced. We gave the service 48 hours’ notice of the inspection because it is small and we wanted to ensure that the registered manager would be available.
Before the inspection, the provider completed 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. We also checked for any notifications made to us by the provider, any safeguarding alerts raised about people using the service, and the information we held on our database about the service and provider.
The inspection was carried out by one inspector and an Expert by Experience, who is someone who has personal experience of using or caring for someone who uses this type of care service. Their involvement was limited to phoning people using the service for their views.
During the inspection, we spoke with three people using the service, two people’s relatives, two care staff, the care coordinator and the finance officer.
During our visit to the office premises we looked at three care plans (known by the service as ‘job descriptions’) for people using the service along with other records about people’s care including visit schedules, medicines records and care delivery records. We also looked at the personnel files of two staff members and records about the management of the service such as staff visit rotas and complaint records. We then requested further specific information about the management of the service following our visits.
Updated
21 March 2017
This inspection was announced and took place on 11 January 2017. We gave the provider short notice of the inspection as we needed to make sure we were able to meet with the registered manager, access records and gain permission from people using the service to telephone them or their representatives.
The last inspection of the service was carried out in February 2014. No concerns were identified with the care being provided to people at that inspection. Since then, the service has moved office address.
The service is a homecare agency based in Colindale, Barnet. It specialises in providing care and support to people with physical and/or learning disabilities. At the time of this inspection, the agency was providing a regulated care service to eight people living in their own homes.
The service had a registered manager at the time of the 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 2008 and associated Regulations about how the service is run. However, the registered manager was not present as we were informed at the start of the inspection that they had just resigned from their role. At the time of drafting this report, the provider had not informed us of the name of a replacement manager.
The office coordinator was ensuring the day-to-day running of the service in the absence of the registered manager, but was not in a position to provide effective long-term leadership. We found that some processes to ensure the smooth running of the service were slipping behind schedule, and so there was ineffective governance at the service.
Whilst the service risk assessed the care and support provided to people, the assessments were not kept consistently up-to-date and in some respects omitted relevant information. This did not help to ensure people’s safety when receiving care.
Whilst staff received training for most aspects of their roles, the quality of their supervision and support was not consistently of a standard needed to ensure that people received effective care.
The provider was not ensuring that all relevant aspects of The Mental Capacity Act 2005 were being implemented, particularly as staff had not been trained on how the Act applied to their care and support of people.
People using the service and their representatives generally provided positive feedback about the service. We found the service to be caring and responsive.
People’s views were of primary importance in establishing what service was to be provided. Their care plans (known in this service as ‘job descriptions’) guided staff on addressing people’s needs and preferences. The plans were mostly up-to-date. People were well-supported in terms of health and nutrition.
People were listened to, and their views were acted on where possible. The service learnt from people’s concerns and complaints.
People decided which staff attended to them. They were supplied with the same staff member or small team of staff, which helped positive and caring relationships to develop.
In many ways, people received a safe service. Staff recruitment processes were robust, but the service had not successfully recruited enough staff to ensure they could always provide people with planned care visits. They informed people in advance when this occurred.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were about failing to ensure safe care, failing to ensure appropriate staff support for their care roles, failing to establish and implement procedures for working in line with The Mental Capacity Act 2005, and failing to oversee and govern the service effectively. You can see what action we told the provider to take at the back of the full version of the report.