6 September 2016
During a routine inspection
All Care (GB) Hounslow provides a range of services to people in their own home including personal care. People using the service had a range of needs such as learning disabilities and dementia. At the time of our inspection 39 people were receiving personal care in their home. The care was mainly being funded by people’s local authority and a small amount of people were paying for their own care.
This was All Care (GB) Hounslow’s first inspection at this location since registering on 20 May 2015.
There was no 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. The previous registered manager had left the service in May 2016. An acting manager was running the service at the time of our inspection. They had made an application to be registered and were told that their application was being processed.
Not all the risks to people’s wellbeing and safety had been assessed, and there were no detailed person-specific plans in place where challenging behaviour had been identified as a risk.
People’s individual needs had been assessed and recorded in their care plans prior to receiving a service, and were regularly reviewed. However, the staff did not fully understand and meet the needs of people living with the experience of dementia.
The provider had systems in place to monitor and assess the quality and effectiveness of the service, however these had failed to highlight some of the risks to people’s health and wellbeing, and to the staff who provided care to people.
The provider was not always aware of their responsibilities in line with the requirements of the Mental Capacity Act (MCA) 2005 and the deprivation of liberty (DoL), and we saw that none of the staff had received training in this. The provider had not ensured that appropriate actions were taken when people using the service had been identified as unable to make decisions about their care.
Care workers received an induction and shadowing period before delivering care and support to people. They received training the provider identified as mandatory, but this did not include training specific to some of the people who used the service such as those living with the experience of dementia.
There were systems in place to ensure that people received their medicines safely and all staff had received training in the administration of medicines. The manager told us that medicines audits were undertaken in people’s homes, however, we did not see any evidence of these in people’s records, and there were no recent medicines administration record (MAR) charts at the service for us to look at.
Feedback from people and their relatives was mostly positive, although some people said that care workers were sometimes late. Most people told us they had regular care workers but at the weekends they often had different ones. However, everybody we spoke with said the care workers were very good and that they trusted them.
People’s needs were assessed by the local authority prior to receiving a service and support plans were developed from the assessment. Most people told us that they knew and had met the manager or the field supervisor, and had taken part in the planning of their care. Everybody using the service said that they were happy with the level of care they were receiving from it.
There were procedures for safeguarding adults and the care workers told us they were aware of these. Care workers knew how to respond to any medical emergencies or significant changes in a person’s wellbeing.
The service employed enough staff to meet people’s needs safely and had contingency plans in place in the event of staff absence. Recruitment checks were in place to obtain information about new staff before they supported people unsupervised.
People’s health and nutritional needs had been assessed, recorded and were being monitored. These informed carers about how to support the person safely and in a dignified way.
There was a complaints procedure in place which the provider followed. People felt confident that if they raised a complaint, they would be listened to and their concerns addressed.
We made a recommendation in relation to the training of staff.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the safe care and treatment of people, safeguarding, person-centred care and good governance. You can see what action we told the provider to take at the back of the full version of this report.