30 September 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.
The inspection took place on 2 and 8 August 2017. This was an announced inspection. We gave the provider 48 hours’ notice of the inspection as this is a domiciliary care agency and we wanted to ensure the manager was available in the office to meet with us.
The inspection was carried out by one adult social care inspector and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. We phoned people using the service and their relatives to ask them their views on service quality.
Prior to our inspection, we reviewed information we held about the service, including previous reports and notifications sent to us at the Care Quality Commission (CQC). A notification is information about important events which the service is required to send us by law. We contacted the local authority about their views of the quality of care delivered by the service. We looked at the information sent to us by the provider in the 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.
There were over 70 people receiving personal care support from the service and 50 members of staff, at the time of our inspection. During our visit to the office we spoke with the manager, one field supervisor, one care coordinator, human resources officer and four care staff. We looked at eight people’s care records including their care plans and care delivery records, and seven staff personnel files including recruitment, training and supervision records, and staff rosters. We also reviewed the service’s safeguarding, accidents / incidents and complaints records. Following the inspection we spoke to nine people using the service and four relatives, and liaised with the registered manager via emails.
We reviewed the documents that were provided by the manager (on our request) after the inspection. These included reviewed training matrix, new risk assessment and medicines administration templates, policies and procedures and care records for some people.
30 September 2017
This was a comprehensive unannounced inspection that took place on 2 and 8 August 2017. Kamino Homecare Limited is a domiciliary care service registered to provide personal care to people in their own homes. At the time of inspection, the service was providing personal care to over 70 people living with dementia, mental health condition and physical disabilities, older people and younger adults.
This service was last inspected on 12 May 2016 where it was rated Requires Improvement. At the last inspection breaches of legal requirements were found. This was because the service did not carry out mental capacity assessments for people living with dementia and cognitive impairment and thereby did not act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice. The service did not assess and mitigate individual risks identified as part of the care and support plan and followed unsafe and improper management of medicines. We also made recommendations in relation to organising MCA staff training and assessing staff knowledge and competency, and developing and implementing effective management systems to assess and evaluate care provision. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.
At this inspection, we found that the provider had not fully followed their plan which they had told us would be completed by the 26 June 2016 and overall, we found that the provider had not addressed the breaches of the abovementioned regulations and there were repeated breaches in relation to safe care and treatment.
The service had a registered manager who has registered with the Care Quality Commission (CQC) to manage the service. At the time of inspection, the registered manager was out of the country and had submitted us with the required notification of their absence. The provider had appointed a new manager in June 2017 who was undergoing registration process with CQC and was managing the service in the registered manager’s absence. 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.
The provider had made some improvements since the last inspection but they were not sufficient and there were on-going concerns in relation to providing need for consent and safe care and treatment. We also found the provider had not met recommendations made in relation to staff training and good governance.
The provider had not identified and assessed all the risks involved in supporting people and providing safe care. The risk assessments and associated care documents did not give staff comprehensive information on how to support people safely whilst meeting their individual health and care needs. The provider did not maintain accurate medicines administration records (MAR) for people who were supported with medicines administration and prompting.
Not all staff received adequate induction and role specific training before they started working with people. Staff received supervision and appraisal but the records showed that these were not always regularly completed.
Complaints and safeguarding records did not give full details regarding how they were resolved and the investigation outcomes. The data management and monitoring systems to assess the quality and safety of care delivery was ineffective. The provider was not auditing systems and processes related to care delivery including daily care logs and MAR. Some staff recruitment checks were not verified as per the provider’s policy. People’s care plans did not make reference to their mental capacity to make their own decisions.
People and their relatives told us staff were kind and helpful and treated them with dignity and respect. People were mostly happy with staff’s timekeeping and generally received care from the same team of staff. People were provided with companionship services as and when required. People were happy with nutrition and hydration support and received support accessing health and care services when requested.
Staff told us they enjoyed working with the provider and were well supported by the management. They knew types and signs of abuse and the importance of reporting concerns of abuse and neglect. Staff understood people’s right to make decisions; they asked their consent before providing care and gave them choices.
The provider sought feedback from people on the quality of care on a quarterly basis. The feedback mainly had been positive and the provider used the negative comments and feedback to improve their service such as informing people when staff were running late.
We found the registered provider was not meeting legal requirements and there were overall three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, staff training and supervision, and for systems and processes to improve the quality and safety of the services including accurate records.
You can see what action we told the provider to take at the back of the full version of the report.