Archived: Castle Care Wessex

Updated 25 June 2016

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 agency, and to provide a rating for the agency under the Care Act 2014.

This inspection took place in the service office on 12 and 21 April and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure the registered manager would be available for the inspection. It also allowed us to arrange to visit people receiving a service in their own homes. It was carried out by an adult social care inspector.

We visited five people in their own home on 19 April but only four were able to speak with us. During the visits we met two relatives, two members of staff and a visitor. We looked at people’s care plans kept at their homes. We also telephoned one person, two relatives, two members of staff and one health and social care professional. Whilst we were in the office we spoke with the registered manager and operations director.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the agency, what the agency does well and improvements they plan to make. We looked at the information in the PIR and also looked at other information we held about the home before the inspection visit. During our inspection we spoke with the registered manager in more detail about their PIR and we saw an evidence file of further information.

We spent time at the main office of the service where we reviewed three care plans, five staff personnel files, records of staff training, accident and incident file, complaints and compliments files and quality monitoring records.

Updated 25 June 2016

Castle Care Wessex is a small home care agency which provides personal care across the South West to people in their own home. In August 2015 it became part of Berkeley Home Health after being a family run care agency. The main office is located in purpose built premises within a small business complex just outside of Frome. On the day of the inspection there were fifteen people receiving support from the agency.

This inspection was announced and took place on 12, 19 and 21April 2016.

The agency had a registered manager who was in post before the provider became part of Berkeley Home Health. 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 told us they felt safe but risks to people’s safety were not identified in their care plan or risk assessments. Medication was not safely being administered and staff had not always received training. Errors were apparent on the medication administration records of one person and medicine was not always given in line with people’s care plans. Protective clothing was not always being worn by staff where appropriate and whilst supporting people with personal care to prevent infections spreading.

People were not always supported by staff who had the correct checks completed or a risk assessment to demonstrate they had considered keeping people safe from being cared for by unsuitable staff.

Staff told us there were enough staff to cover the visits and had time to travel between them. Staff told us they had a good induction and lots of training. However, some training had not been identified to meet the needs of a person with additional health needs. The registered manager had not kept their train the trainer qualification up to date with current legislation and regulations around administering medication.

There were detailed care plans for all individuals including specific information for each visit. These plans had a person centred approach to them and captured the people’s voice. This meant people were central to their care and any decisions made. However, sometimes there were too many versions of the care plan which could cause confusion about which was the most current. The needs of the people were reflected within the plans; most of the time they were responsive to people’s changes. Staff had a good knowledge of the people they were supporting and their needs.

There were limited quality assurance procedures in place to keep people safe and they were mainly informal. When shortfalls had been identified by the provider and registered manager measures had been put in place to rectify the issue. However, the registered manager and provider had not picked up all the concerns we found. However, they were resolved as soon as they were informed and, when required, put measures in place to address the risks.

Staff and the registered manager had understanding about people who lacked capacity to make decisions for themselves. However some people potentially had fluctuating capacity because of their diagnosis and complex needs but the Mental Capacity Act Code of Practice had not always been followed when people’s capacity was in question. People’s capacity had not always been considered when decisions such as administering medicine were part of their personal care.

Staff were aware of their responsibility to protect people from avoidable harm or abuse and had received training in safeguarding. They knew what action to take if they were concerned about the safety or welfare of an individual and told us they would be confident reporting any concerns to a senior person, the provider or whom to contact externally. The provider had put a confidential phone line in place to encourage staff to report concerns. The registered manager understood when they were responsible for informing the local authority and CQC about safeguarding.

The agency made contact with other health and social care professionals to help with people’s care; this was important because many people had complex needs. Staff supported and respected the choices made by people. People’s cultural and religious differences were respected.

People were always informed if a member of staff was delayed and running late and they were regularly seen by the same members of staff. Staff encouraged people to be as independent as possible and provided companionship when it was required.

People and their relatives thought the staff were kind and caring and we observed positive interactions. The privacy and dignity of people was respected and people were encouraged to make choices throughout the visits we went on.

People knew how to complain and there were good systems in place to manage the complaints. The registered manager demonstrated a good understanding of how to respond to complaints and completed them in a timely manner.

The registered manager and provider had a clear vision for the agency and had some systems in place to communicate this.

We made a recommendation that the agency finds out more about national guidance in relation to the Mental Capacity Act.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.