27 July 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.
The inspection site visits took place on 10, 15 and 17 May and were announced. We gave the service 48 hours’ notice of the inspection visit because the location provides a domiciliary care service and we needed to be sure that they would be in. The inspection was completed by one inspector.
Before our inspection we reviewed information we held about the service, which included any information shared with the CQC. We contacted the local authority and Healthwatch for feedback. Healthwatch is a consumer group who share the views and experiences of people using health and social care services in England. This information contributed to our understanding of the service and planning of the inspection.
A Provider Information Return (PIR) is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. Our inspection commenced prior to the PIR submission closing date. The provider sent this information following our inspection and this was reviewed.
During the inspection we spoke with six members of staff which included the registered manager, training and quality assurance managers and care workers. We also spoke with four people who used the service and three people’s relatives. A healthcare professional shared their views about the service with us.
We looked at three people's care plans and risk assessments and a selection of medication administration records. We reviewed recruitment, training, supervision and appraisal records for four members of staff. We considered records relating to the running of the service which included meeting minutes, quality assurance and policies and procedures.
27 July 2018
Elderflower Homecare is a domiciliary care agency which provides support to people living in their own homes in and around the area of Boroughbridge. The provider is registered to support people with a wide range of needs including people who have dementia, physical disabilities, sensory impairments and older and younger adults. The service supported 57 people at the time of our inspection.
We inspected the service on 10, 15 and 17 May 2018. We gave 48 hours’ notice of our inspection as we needed to be sure somebody would be in the office.
There was a registered manager in post who was also the owner of the company.
Checks to monitor the safety and quality of the service had been carried out. Whilst these checks highlighted and addressed some issues they had not consistently noted and addressed the issues we found with documentation during our inspection.
People who used the service told us they felt safe. Staff received safeguarding training and understood the signs of abuse and how to report any concerns. Overall people received support with their medicines as needed, although protocols to describe when ‘as and when needed’ medicines were required were not always in place. Risk assessments were completed however they were not always updated when people’s needs changed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Capacity assessments had not always been completed when there were concerns about a person’s ability to understand and consent to the way support was provided. The registered manager agreed to ensure these were completed. Staff sought people’s consent and promoted their choice. The staff maintained contact with healthcare professionals and sought their input and guidance when needed. The staff team were supported through one to one supervisions and an annual appraisal of their performance.
Without exception, we received positive feedback from people and their families about the staff team. They were described as kind and caring and that they had built good relationships with the people they supported. People’s dignity was upheld and staff treated them with respect. Information about advocacy support was available when needed.
People received support in accordance with their individual needs and their needs, likes and preferences were recorded. People received support to attend activities of their choosing. People received end of life support and staff responded to their changing needs. However, end of life care plans were not in place for staff to understand people’s preferences and wishes.
Staff attended team meetings which were an opportunity for further learning. The registered manager and management team were keen to ensure their knowledge was up-to-date and maintained links with community organisations. The registered manager sought people’s views on the support and organisation by way of a feedback form. The feedback provided was positive.
Further information is in the detailed findings below.