Archived: Chesterford Homecare

There was a registered manager in place who had been registered since the last inspection and was present at the 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.

The service had its last comprehensive inspection in September 2017 and we identified a number of concerns and rated the service ‘requires improvement.’ We asked the provider to take action in response to our findings. At this inspection we found that the provider had addressed the concerns that we identified.

At our last inspection quality assurance systems had not always been effective in recognising and rectifying issues and where people’s views about the service had been obtained there had been no analysis of the feedback. At this inspection we found that audits on practice and on documentation had been undertaken on a regular basis and the information used to drive improvement at the service. People’s views about their experience of using the service had been obtained, the results analysed and actions taken to address the issues identified. The results showed that people had confidence in the service and the quality of care provided. People’s comments, including both positive and negative had been published along with the actions taken which demonstrated an openness and transparency.

At our last inspection we found that the systems in place for the recruitment and selection of staff were ineffective and recruitment checks had not routinely been carried out before staff started their employment. At this inspection we found that improvements had been made and appropriate checks were undertaken on staff prior to their employment to ensure they were suitable to work with people using the service.

At the last inspection we found that not everyone had an up to date care plan which guided staff as to their care and support needs. Risks to people’s wellbeing had not always been clearly identified and actions taken to minimise these. At this inspection we found that improvements had been made. People's needs were assessed prior to the commencement of care and the information used to develop a detailed and informative care plan to guide staff. The care plans were person centred and people’s care needs were regularly reviewed and plans amended as required. Staff were provided with guidance about how risks should be managed and steps that staff should take to reduce the likelihood of harm.

There were sufficient staff employed and people told us that they received care from a consistent team of staff who knew them well. There were clear systems in place for people and staff to seek advice and support out of hours. On the occasions where the service used staff from another agency we saw that they asked the other care agency to provide information on the staff as to their suitability.

There were systems in place for the management of safeguarding concerns and staff were clear about the actions that they should take if they had a concern.

There were procedures in place to guide staff in the administration of medicines and regular audits to check that people were receiving their medicines as prescribed. During the course of the inspection we identified a small number of anomalies with medicines and the registered manager responded to these by strengthening the auditing process.

Staff had received training which provided them with the necessary knowledge and skills. Staff performance was monitored to ensure that they were working to the required standards and regular staff meetings were held. Staff told us that they were well supported and the management of the service was approachable and helpful.

People were supported by staff who were described as being kind and caring. Staff enabled people to make choices and remain in control of the decisions around their care.

People were supported to eat and drink in line with their preferences and needs. Where there were concerns about people’s nutritional intake there was a clear plan in place as to how this should be managed and monitored. People had good access to health care support when they needed it. The agency sought advice appropriately from health professionals when people’s needs changed.

There was a complaints policy in place and people’s concerns were investigated. People told us that they felt comfortable raising concerns.

Management information was collected and analysed to identity areas for improvement. For example, when incidents took place, the registered manager reflected on what happened to ensure that issues were identified, and where appropriate information was shared with staff and people who used the service.

Audley Homecare is registered to provide personal care to people living in their own homes. This included providing live-in-care support. At the time of our inspection, the service was providing care and support to 50 people.

At our last inspection in February 2016, we rated this service as Good. At this inspection, we found that some improvements were required. There was currently no manager registered with the Care Quality Commission (CQC). Since our last inspection a new manager had been appointed. The recently appointed manager told us they were in the process of submitting their application to register with CQC. 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.

Quality assurance systems had not always been effective in recognising and rectifying issues. The registered provider had not carried out regular quality assurance audits to ensure the service was providing good quality care. Where people’s views about the service had been obtained, there had been no analysis of the feedback inn plans to make improvements to the service.

Systems in place for the recruitment and selection of staff were ineffective. This was because the risks to people using the service of inappropriate staff being recruited had not always been considered. Recruitment checks had not routinely been carried out before staff started their employment to ensure they were suitable to work with people using the service.

The care needs of people had been assessed prior to their using the service. However, not everyone had an up to date care plan, which guided staff as to their current care and support needs. Not all risks to people’s health and wellbeing had been clearly identified with actions in place to minimise these. However, work had begun to rectify this as the registered provider was implementing a new system to provide more comprehensive information. People told us they had been involved in the initial planning of their care.

Systems were in place to ensure that people received their prescribed medicines. Medicines were administered by staff who were trained to do this safely. However, we recommend that the registered provider ensure that medicines audits included a check of stock against medication administration records. This would ensure checks were robust enough to monitor that people received their medicines as prescribed and where medicines errors were identified appropriate action was taken to prevent them happening again.

People’s safety had been considered and they were at a reduced risk of harm, as staff understood their roles and responsibilities in relation to action they should take to safeguard people from the risk of abuse. Staff had access to guidance and training, which gave them the information, and knowledge they needed to respond to incidents where they suspected people were at risk of harm, including reporting such incidents to the appropriate authorities.

People were generally satisfied with the service apart from occasional shortages of staff, which prevented them from receiving their planned care. There had been a recent high turnover of staff with insufficient numbers of qualified, skilled and experienced staff available to meet people’s needs. This had resulted in people’s care calls being cancelled and people advised to find another agency at short notice.

Staff received comprehensive induction and training to provide them with the knowledge and skills they needed to meet the needs of people using the service. Training included supporting staff to understand their roles and responsibilities with regards to the Mental Capacity Act 2005. Staff understood the legal requirements to seek consent and provide care and treatment in a manner, which protected and upheld people’s human rights.

There were systems in place to carry out spot checks on staff performance. However, the impact of staff shortages meant these had been not been carried out at the regularity required.

Staff were not always provided with opportunities to contribute to the development of the service. This was because they were not provided with regular planned supervision, access to annual appraisals and regular staff meetings. This meant that staff were not provided with regular opportunities to discuss their work performance, plan their training and development needs and discuss face to face any concerns they might have.

Some people who used the service were supported by staff with meal preparation and where possible people's independence was promoted in this area. Records and people confirmed that they were given choice and were able to make independent decisions about what they had to eat and drink.

People were knowledgeable about the registered provider’s system for receiving and responding to complaints. Complaints and concerns were taken seriously and investigated. However, the overall governance of the service was in need of improvement.

During this inspection, we identified 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 this report.

Audley Homecare is a domiciliary care service providing personal care to people in their own home including live in care. On the day of our inspection there were 12 people using the service.

There was 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’s safety had been considered and at a reduced risk of harm as staff understood their roles and responsibilities. Staff had the required knowledge and knew what action to take to protect people from harm and what action to take if they had concerns regarding the risk of abuse.

There were enough qualified, skilled and experienced staff to meet people’s needs. The manager followed safe recruitment practices.

Staff were provided with regular supervision and staff meetings. Staff had easy access to management support. This enabled staff to be supported in the roles they were employed to perform and provided with opportunities to discuss their work performance and plan their training and development needs.

People were satisfied with the care provided. Everyone we spoke with expressed their satisfaction with the way the service was managed and the support provided by staff. People told us they felt safe and were treated with kindness and compassion. They also told us their dignity had been respected when staff supported them with personal care.

The care needs of people had been assessed prior to their moving into the service. Risks to people’s health and wellbeing were clearly identified and actions were in place to minimise these.

People were provided with opportunities to express their views regarding the quality of the service they received. People were knowledgeable of the provider’s system for receiving and responding to complaints.

The culture of the service was open, transparent and focused on the needs of people who used the service. Staff were supported by the manager who they described as supportive and approachable.

The manager had systems in place to monitor the quality and safety of the service. This included assessment of staff performance, assessment of risks and medicines audits.