26 July 2016
During a routine inspection
The service mainly provides care and support for people in visits at key times of the day to help people get up in the morning, go to bed at night and give support with meals. This includes supporting people with dementia care needs.
At the time of our inspection 19 people were receiving a service. These services were funded either privately or through Cornwall Council.
There was 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 registered manager was also the owner and provider of the service and is referred to as the provider in this report.
We carried out this announced inspection on 26 July 2016. We told the provider four days before that we would be carrying out this inspection. This is in line with the current methodology for inspection of domiciliary care agencies, to ensure the provider would be present at the office of the service at the time of the inspection. The service has not been inspected before at its current location.
Information regarding people’s specific care and support needs including any risks were mostly communicated verbally to the care staff by the provider. The provider did not always record, in people’s care files, all the information staff needed to care and support people safely.
Care plans contained information about people’s past history and their current care and support needs. However, the care plans did not always contain sufficient information to direct and inform staff on how to meet those needs in accordance with the individual's preferences and choices.
Risks to people and staff had been identified. For example, environmental and moving and handling risks. However, such risks had not been fully recorded once assessed and staff were not provided with written guidance on how to reduce the specific risks to people and themselves.
A Caring Touch held policies and procedures that had not always been updated to take account of changes in practice. Information provided in some polices was not accurate.
Recruitment processes were not robust. Two staff, who had been working for the service for several months, did not have appropriate references that had been taken up by the provider before they commenced working alone in people's homes. Induction training and support provided to new staff was not recorded.
A supervision policy held by the service, stated staff would receive recorded supervision every three months, with an appraisal every year. Staff told us they felt well supported but did not receive formally recorded support in line with this policy.
People told us they had not had any missed visits and were very happy with the service they received. However, the provider did not have a process for monitoring when people received their scheduled visits. The provider was reliant on the person, their family, friends or neighbours to raise a concern if a visit had been missed or was late.
Staff had not received recent training in how to recognise and report abuse. The service did not have an accurate up to date safeguarding policy and procedure available for staff to refer to. Staff were not clear about how to report any concerns they may have outside of the service. However, staff were confident that any allegations made to the provider would be fully investigated to help ensure people were protected.
The service provided care and support to people who were living with dementia. The provider had an understanding of the Mental Capacity Act 2005(MCA). The provider was clear on how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. People’s capacity to make decisions for themselves was assessed in their care files. However, there was no MCA policy or guidance available for staff to refer to. Not all staff had been provided with training and updates on this legislation.
A Caring Touch did not have a regularly recorded quality assurance system in place to make sure that any areas for improvement were identified and addressed. However, the provider visited all the people who used the service regularly and spoke with them informally about their views and experiences. People told us that they had not had any cause to raise a concern but if they did they were confident it would be addressed quickly.
There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. The service was flexible and responded to people’s changing needs. People we spoke with told us they felt safe using the service and told us, “I feel perfectly safe and trust them (staff),” and “I am happy with the service I get.”
People were confident that staff could meet their individual needs and told us, “The staff know what they are doing,” and “I am confident with my carers they are very reassuring.” Relatives told us, “We are totally satisfied with the standard of care provided” and “They (staff) are very accommodating and receptive to the needs of (the person).”
Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were kind and compassionate and treated people with dignity and respect. People and their relatives spoke well of staff, comments included, “They (staff) are lovely, very friendly and supportive of both of us,” and “They always ring us if there are any delays or changes, very good.”
Staff told us there was good communication with the provider of the service. Staff comments included, “I can always speak with (the provider) at any time” and “I feel very well supported.”
A healthcare professional who worked with the service in the community told us, “My views are very positive, we get on very well, the staff and manager are very helpful. The care they provide for the person I know has been very successful.”
We found breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the owner to take at the end of the full version of this report.