This inspection took place on 23 February 2017 and was announced, The service was last inspected in February 2016 where one breach of the legal requirements was found. This was because people were not protected from the risks associated with the unsafe use and management of medicines. At this inspection we found that the provider had made some improvements to the recording and management of medicines but further improvements were needed to ensure people received their medicines safely. Knowles Home Care Limited is a domiciliary care agency providing personal care to people in their own homes living in Leicester. At the time of our inspection there were 11 people using the service who had a wide range of needs including dementia and complex health needs.
The service had a registered manager. 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, relatives and staff had confidence in the day-to-day management of the service. Although people using the service and staff described the management as good, we identified some inconsistencies in the way the service was managed. The provider did not have robust arrangements in place to check on the quality and safety of people's care. We found no evidence that quality assurance checks and audits had been undertaken and used to promote learning or continuous improvement of the service. The provider was unable to demonstrate good governance of the service.
Staff had a good understanding of safeguarding (protecting adults from abuse) and whistleblowing, including how to report concerns and actions to take to keep people safe.
Potential risks had been assessed, such as risks associated with people's care and support and their living environment. Staff had a good understanding of how to reduce the risk of harm to people. Risk assessments did not always record the measures in place to control the potential risks or provide staff with the information and guidance they needed to keep people safe.
People were cared for by staff who were reliable and had been safely recruited through the provider's recruitment procedures. Staff arrived on time and stayed for the time allocated.
Where required, people were supported to manage their medicines. Further improvements were needed to checks and audits of medicine records to ensure people received their medicines safely.
Staff were mostly trained and supported to undertake their role and responsibilities. People and relatives had confidence in the abilities of staff. Staff training records did not demonstrate that staff training had been regularly refreshed to ensure staff were provided with opportunities to keep their knowledge and skills up to date.
Staff followed the requirements of the Mental Capacity Act 2005 (MCA). People were asked for permission before receiving care and staff respected their right to refuse. People were involved in making decisions about their care. Mental capacity assessments did not consistently detail the support people needed to make specific decisions.
People's care plans included information about specific health conditions. Staff supported people to maintain their nutritional health and well-being.
People were appreciative of staff who were caring and helpful. Staff treated people with respect and promoted their dignity, privacy and rights when they provided care. People's care was provided in a timely and personalised manner. Staff ensured people's known wishes and choices for their care was upheld and worked in partnership with family, friends and other who were important to the person.
People had been involved in developing care plans following an assessment of their needs. People told us care was provided in line with their wishes and preferences. Staff who we spoke with were knowledgeable about people's needs. Care plans did not always include sufficient information for staff in terms of how people liked their support to be provided. Although people told us they were able to make changes to their care informally, care plans were not formally reviewed to ensure that they reflected people's current needs and wishes.
People and relatives knew how to complain, although no complaints had been made since our last inspection visit. People felt confident their concerns would be listened to and acted upon.
Staff felt involved in the running of the service and had opportunities to share their views about people's care. Communication systems were in place between the area manager and the registered manager to keep the registered manager up to date. However, the registered manager was not fully aware of what improvements were needed in the service and these had not been made in a timely manner. The overall management of the service was being overseen by the area manager. The registered manager told us they had arranged to work from the registered office more frequently to bring about the required improvements within the service.