Blossom Home Care Ltd

People’s experience of using this service: At our previous inspection we identified shortfalls in the management of risk and the provider’s governance system. At this inspection, we found that improvements had been made.

People and relatives were positive about the care which was provided. One relative told us, “They have been wonderful – without them my mother would not be at home.” Staff talked about caring for people like members of their family. They told us they would be happy for a friend or relative to use the service because of the standard of care provided. Several people and relatives considered that, at times, communication with office staff could be improved. We passed this feedback to the registered manager for their information.

People told us that they felt safe with the staff who supported them. Staff were knowledgeable about the action they would take if abuse was suspected.

There was an ongoing recruitment programme in place. Most people told us that they saw the same care staff, although there were occasions when different care workers attended the call. Care visits were at least 50 minutes long which helped enable staff to provide person-centred care which was responsive to people’s needs.

A range of audits and checks were carried out to assess the quality and safety of the service. Our findings at this inspection confirmed that an effective quality monitoring system was now in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires improvement (last report published 21 May 2018).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Not everyone using Blossom Home Care Ltd receives a regulated activity; the Care Quality Commission (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.

We inspected the service between 13 and 22 March 2018. The inspection was announced. We gave the service 5 days’ notice of the inspection site visits because we needed to be sure the registered manager would be available. At the time of our inspection, the service was supported 56 predominantly older people with personal care.

At the last inspection in November 2016, we identified breaches of regulation relating to safe care and treatment and the governance of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-Led to at least good.

During this inspection, some improvement had been made, but we identified on-going concerns about how risks were assessed and managed. Sufficiently detailed risk management plans were not consistently in place to guide staff on how to safely meet people’s needs. They did not always provide clear instructions about how to respond in the event of an emergency. This placed people who used the service at increased risk of harm.

Audits had not been consistently effective in monitoring and ensuring improvements were made. This is the second consecutive time the service has been rated Requires Improvement. It showed us sufficiently robust action had not been taken in response to concerns raised at our last inspection.

We identified two breaches of Regulation relating to safe care and treatment and the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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 registered manager was supported by the directors, one of whom was the provider’s nominated individual, a deputy manager, field care supervisor, care coordinator and administrator in the management of the service.

People who used the service provided generally positive feedback about the service and management. Staff told us they felt management were supportive and approachable.

People received their prescribed medicines. Audits were being used to identify and address shortfalls and errors in recording on medicine administration records. We made a recommendation about reviewing best practice guidance and implementing protocols for ‘when required medicines’.

Recruitment checks were completed to help ensure suitable staff were employed. Sufficient staff were deployed to meet people’s needs. The registered manager had systems in place to monitor and address issues with reliability and punctuality. Work was on-going to retain staff and improve the consistency of care for people who used the service.

Staff used gloves, aprons and sanitising hand gel to minimise the risk of spreading infections.

Staff understood their responsibility to identify and respond to safeguarding concerns. Accidents and incidents were reported, recorded and analysed to identify any patterns or trends and prevent similar reoccurrences.

People told us staff were kind, caring and maintained their privacy and dignity. Staff supported people to make decisions and respected people’s choices.

Staff provided person-centred care. They knew people well and understood how best to support them to meet their needs. Care plans contained varying levels of person-centred information about people’s likes, dislikes, hobbies and interests. The registered manger was in the process of reviewing and updating care plans and risk assessments and showed us new paperwork they intended to implement in response to our concerns.

Staff received an induction, theoretical and practical training and on-going support through supervisions, appraisals and spot checks.

Staff supported people to make sure they ate and drank enough. There were systems in place to respond when people were unwell so they received appropriate medical attention.

Consent to care was sought in line with relevant legislation and guidance on best practice. This meant people’s rights were protected.

The provider had a system to gather feedback and respond to complaints about the service. People told us they felt able to raise concerns if needed.

The service was registered with the Care Quality Commission (CQC) on 7 September 2015 and had not previously been inspected.

Blossom Home Care Ltd is a domiciliary care service that provides support to younger and older adults in the local area of Northallerton. Support could be for sensory impairment, dementia, mental health and learning disabilities. All care is carried out in peoples own homes. At the time of inspection the service was providing care to 60 people.

There was a registered manager in place who had registered with the Commission on 4 August 2016. 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.

We found that accurate records were not kept of the administration of medicines. Medication administration records (MARs) had not been completed by staff when medicines had been administered. MARs did not clearly record all the required information about the prescribed medicines that were to be administered.

Risks to people arising from their health and support needs were not always assessed, and plans were not in place to minimise them. Risk assessments were not specific to the person.

People who were receiving end of life care had no plans in place documenting their individual preferences and wishes.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe. Staff were able to tell us about different types of abuse and the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing procedures and all said they felt confident to report any concerns without fear of recrimination.

A number of recruitment checks were carried out before staff were employed to ensure they were suitable. The induction process was not extensive or robust enough to support and educate staff.

Staff received training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. However records showed that the induction process did not provide sufficient shadowing hours in people's homes for new staff and staff we spoke with confirmed this. Not all staff had received practical moving and handling training. We were told this was booked to take place in the next couple of weeks.

We have made a recommendation about the staff induction process.

Staff received support through regular supervisions. Staff felt confident to raise any issues or support needs they had at these meetings.

The registered manager conducted spot checks on staff practice regularly.

Staff had a working knowledge of the principles of consent and the Mental Capacity Act and understood how this applied to supporting people in their own homes. Evidence of consent was sought.

We found there was sufficient staff employed to support people with their assessed needs and to sit and chat with them. We were told that staff were kind and respectful; and staff we spoke with were aware of how to respect people’s privacy and dignity.

Care plans were not always person centred. Generic care plans had been produced and were used for all people who used the service and contained very little person centred information. Care plans were not updated in a timely manner to reflect current needs. One person did not have a full care plan in place.

The registered provider had a clear complaints policy that was applied when issues arose. People and their relatives knew how to raise any issues they had. All complaints were investigated with a full outcome for the complainant.

Staff felt supported by the registered manager and the registered provider.

The registered provider had developed systems to monitor and improve the quality of the service provided but these were not used effectively or to their full potential by management. Audit of daily records, medication records and food and fluid charts did not happen in a timely manner. Some records were left in the person’s home for up to six months without any checks being made.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These referred to safe care and treatment and good governance. You can see what action we told the registered provider to take at the back of the full version of the report.