Archived: Cathedral Homecare

When we last visited the service on 24 May 2017, we found there was a breach of Regulation 17 HSCA RA Regulations 2014 relating to good governance. Quality assurance systems had not been effective at identifying the shortfalls we found during our inspection. Staff feedback had not been acted upon or addressed. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective and Well Led.

At this inspection we found the provider was no longer in breach of this regulation, action had been taken to ensure they met with all required regulations.

This service is a domiciliary care agency. This service provides care at home to older adults living with a range of health conditions and needs to live independently in their own houses and flats in the community. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, 49 people were receiving personal care and support as part of their care package.

Cathedral Homecare Ltd had a registered manager at the time of this inspection. 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 received safe care. Staff understood their responsibilities to keep people safe from harm. Safeguarding policies and procedures were in place and staff understood their duty to report potential risks to people’s safety.

People received their medicines as prescribed and risk assessments were in place to manage any risks. Guidance was in place for the service to take appropriate action when things went wrong. Lessons were learnt and then improvements made where needed to improve the service.

Staffing levels ensured that people's care and support needs were safely met and safe recruitment processes were in place.

Staff induction training and on-going training was provided, both internally and externally, to ensure staff had the skills and knowledge needed to undertake their roles. Staff were well supported by the provider and the registered manager, with regular supervision meetings taking place.

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 support this practice. People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and they were helped to make decisions which were in their best interests.

Staff supported people to access healthcare professionals when needed and supported them to maintain a healthy lifestyle. The service worked with other organisations to ensure people received person-centred care and support.

Staff treated people with kindness, dignity and respect and spent time getting to know individuals and their wishes.

The provider had systems in place to monitor the quality of the service and had a process in place that ensured people could raise any complaints or concerns.

The service was being well led by a staff team that supported each other to meet people’s needs. Senior staff, the registered manager and the provider were readily available to speak with people using the service, to relatives and also to members of staff.

The service had 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.

The service is registered to provide personal to people in their own homes. At the time of our inspection 58 people were using the service.

During this inspection we identified areas that required improvements to ensure people received care that was safe, effective, responsive and well-led. We identified one breach 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.

Staff were not given adequate information to protect people from risks associated with the delivery of their care. Risk assessments were not in place for people and records lacked information on how to mitigate risks posed to people in order to keep them safe.

Safeguarding incidents had not been reported and investigated fully at the service. There was a gap in staff training in relation to safeguarding vulnerable adults from the risk of abuse and in relation to the Mental Capacity Act 2005.

The registered manager did not understand the requirements of the Mental Capacity Act 2005 (MCA) and staff did not always understand what was meant by mental capacity, despite some people using the service having conditions which may have affected their mental capacity. We have made a recommendation to the provider about the MCA.

Medicines were being safely administered at the service although there were no protocols in place for medication given on an as and when needed basis.

Staff reported being rushed in their work and told us that they lacked time for travel between calls. People using the service told us that their carers arrived on time but some felt that they appeared rushed in their work.

We found that some incidents which had taken place at the service had not been reported to the relevant agencies as required by law.

There were some quality monitoring systems in place at the service, however, risks to people's care had not been adequately assessed and the provider had failed to take action in relation to staff feedback about call times.

Staff reported that they could contact the management if they needed to and there were systems in place to ensure staff were supported.

People were protected by safe recruitment practices. There was a robust recruitment process in place.

People were treated with respect and staff were able to describe how they delivered care to meet people's individual needs. People's health and well-being was monitored and recorded by staff delivering care to people.

Staff were kind and caring towards people they supported and delivered care to ensure people's privacy and maintain their dignity.

There was a clear set of organisational values and objectives in place that staff were made aware of.