Background to this inspection
Updated
18 March 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
One inspector completed the office visit. One inspector and an assistant inspector made phone calls to people using the service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses, flats and specialist housing.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We intended to give the provider 48 hours notice of this inspection. This is because we needed to be sure that the provider or registered manager would be in the office to support the inspection. When we gave notice, we were told that the computer systems were being changed and this would impact on the inspection. We therefore gave the provider one week’s notice of our inspection.
What we did before the inspection
The provider was asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used all of this information to plan our inspection.
During the inspection
We visited the office on the 30 January 2020. We reviewed a range of records. This included the relevant part of six people’s care records and two staff recruitment files. We considered a variety of records relating to the management of the service, including policies and procedures. We spoke with five staff members and the registered manager in the office.
We phoned people to talk about their experience of the care provided. We spoke to six people who used the service and eight relatives. We also phoned five staff. This meant we spoke to ten staff in total.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
18 March 2020
About the service
Workwise is a domiciliary care agency. The service supports people receiving personal care in their own home. At the time of the inspection, 96 people were receiving support with personal care. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
‘As needed’ medicines were not managed safely, medicine records did not provide clear guidance to staff. Care plans guided staff on how to meet people’s daily routines and preferences. However, care plans lacked detail on people’s individual health conditions and how staff should respond to these. The registered manager has told us that they intend to resolve this.
Staff had made decisions for people who experienced confusion. However, documentation of people’s ability to make decisions had not followed the principles of the mental capacity act. Systems were in not fully place to clearly assess and support people’s decision making if needed. This puts people at risk of their decision making abilities not being effectively assessed.
The registered manager and staff were aware of their responsibilities and worked hard to create a good quality service. We identified concerns with medicine records, care plans and mental capacity assessments. We also identified concerns with the end of life policy and there was no evidence that people had been asked about their end of life wishes. The registered manager’s oversight and auditing of these areas had not identified these concerns. The concerns highlighted on inspection were responded to promptly and evidence sent that changes were being made. We will review the impact of this at our next inspection.
People told us that they felt safe at the service. Good hygiene practices were followed to keep people safe from the risk of infection. Incidents were reviewed, and action taken to keep people safe.
There were enough staff at the service and staff arrived at calls in a timely way. Some missed calls had occurred at the service, which meant staff had not arrived at the person’s house as expected. The registered manager had reacted appropriately to each circumstance and advised they were working to ensure this did not reoccur.
Most people told us that regular staff attended. These staff knew their needs well and had built a good relationship. People told us that when these staff had annual leave of sickness, new staff were sent to them. People reported that care was still a good quality however these new staff did not know their needs as well. This can have an impact on people who cannot communicate their needs as clearly.
Staff were well trained and received a structured induction to their role. Staff were safely recruited to ensure they were of good character. People were supported to eat and drink a balanced diet. Professional referrals were made if needed. These referrals had a positive impact on people’s well-being.
Staff were caring and kind to people. People were involved with making decisions about their care. Dignity was at the forefront of the service values. The service worked hard to reduce people’s loneliness. Free transport, and social activities were arranged for people. Those people that did not wish to go out, were supported with activities in their home. The service supported people’s complex communication needs with the use of accessible information.
Rating at last inspection
The last rating for this service was Outstanding (published 15 June 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.