14 December 2018
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 21 November 2018 at the office. We spoke to people, relatives and staff by phone on 22, 23 and 24 November 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service; we needed to be sure that someone would be in.
The inspection team consisted of two adult social care inspectors and an 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. The expert-by-experience had knowledge of older people's services including dementia.
We reviewed information we held about the service, such as notifications, information from the local authority and from Healthwatch. Healthwatch is an independent consumer champion which gathers information about people's experiences of using health and social care in England.
The registered provider had 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.
During the inspection we spoke with the registered manager and the provider. We looked at a variety of documentation including; care documentation for six people, six staff files, meeting minutes, policies and procedures, medicine administration records and quality monitoring records. We also spoke with 9 people, five relatives and 19 members of care staff, over the phone.
14 December 2018
This inspection took place on 21, 22, 23 and 24 November 2018. We visited the office on the 21 November and between 22 to 24 we made calls to people, relatives and staff. At the last inspection in July and August 2017 there was two breaches, we had concerns around inaccurate care records and the lack of information relating to the mental capacity act, and analysis on incidents to look for patterns and trends of the service. At this inspection we found the provider had improved in all areas and were no longer in breach.
Welcome Independent Living provides personal care for older people and people living with dementia. At the time of our inspection Welcome Independent Living provided personal care for 73 people.
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.
People were asked for consent before care was provided to them. Where people lacked capacity to make certain decisions for themselves, their care records contained evidence that decisions had been made in their best interests. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.
The service worked closely with community health professionals to support people with their health needs. People’s care records evidenced they received medical attention when they needed it, to promote their health.
People told us they felt safe. There were mixed views from people and their relatives around if there was enough staff available to meet there needs and if they arrived on time and stayed for the duration of the visit. We spoke to the registered manager about this who told us they had employed more staff and used a tool to show how long staff stayed at each visit. This was evident in the documentation we saw.
Staff understood what it meant to protect people from abuse. They told us they were confident the management team would take any concerns they raised seriously. The registered manager made appropriate referrals to the local safeguarding authority when this was necessary.
Medicines were recorded appropriately and procedures were in place to ensure people received their medicines as prescribed. However, we spoke to the registered manager about the reporting on the medication administration records (MAR) chart and how to ensure this was robust. This was implemented on the first day of inspection.
Procedures for recruiting new staff had recently been improved to help make sure the staff employed at the service were of suitable character.
Staff received a range of training which was effective. Staff told us they were happy with the training they received and felt it supported them to do their roles.
People told us the staff were kind and caring. We saw staff had spot checks and this showed evidence staff were compassionate and caring to people.
Staff were overall supervised by the management team; an appraisal had been completed for some staff, others were booked in for December to ensure all staff had received one this year.
People, their relatives and the staff all spoke kindly of the registered manager. Staff told us they could always approach the registered manager if they needed support or if they had any concerns. The registered manager, the deputy managers and the provider completed regular audits of the service to make sure action was taken and lessons learned when things went wrong. This meant systems were in place to support the continuous improvement of the service.
Further information is in the detailed findings below.