Impeccable Healthcare Services Limited

At our comprehensive inspection on 30 and 31 May 2017, we found breaches of regulations as appropriate systems were not always in place to ensure that people’s medicines were managed safely, adequate management plans were not developed to ensure risks were managed safely, and the quality of the service was not effectively monitored and assessed. Following that inspection, the provider wrote to tell us the actions they would take to address our concerns. At this inspection we found that the provider had completed these actions and complied with the regulations.

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.

People’s medicines were now managed safely. People were given their medicines as prescribed by healthcare professionals and the support people required to take their medicines was documented in their care plans. Staff had completed medicines training and their competency had been checked to ensure they had appropriate knowledge and skills to support people manage their medicines safely.

People were now protected from avoidable harm because risks to people had been identified, assessed and had appropriate management plans in place. The provider now had appropriate systems in place to assess and monitor the quality of the service including regular visits to people’s homes and audits. The provider had implemented an electronic call monitoring system which was used to monitor staff attendance and to ensure people’s needs were met.

The provider had policies and procedures in place to protect people from the risk of abuse and staff knew of actions to take if they had any concerns of abuse by reporting and recording it. The provider followed safe recruitment practices to reduce the risk of unsuitable staff working at the service. There were appropriate numbers of staff available and deployed to ensure people’s needs were met. People were protected from the risk of infection because staff followed appropriate infection control protocols such as washing of hands to prevent the spread of diseases. Where accident or incidents occurred, this was reported and recorded appropriately to drive service improvement.

Before people started using the service, their needs were assessed to ensure they would be met. Where required healthcare professionals were involved in these assessments to ensure they adhered to best practices. 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 supported this practice.

People were supported to have good health, to eat and drink sufficient amounts for their wellbeing and access healthcare services where required. The provider worked in partnership with other health and social care services to ensure people had adequate support when moving between services or using multiple services. Staff were supported through induction training and supervision to ensure they had the knowledge and skills required to perform their roles.

People were supported by staff that were kind and caring. People were given choices and were involved in making decisions about how they would like to be supported. People’s privacy and dignity was respected and their independence promoted. People’s needs were met because staff followed the guidance in their care plan. Staff understood the requirement of the Equality Act and supported people without discrimination. People were supported to participate in activities that interest them.

The provider had a complaint policy in place which provided information to people and their relatives on how to make a complaint. Complaints were addressed in line with the provider’s procedures to ensure people were satisfied with the service. Where required people were supported at their end of their life. People’s communication had been assessed and information was presented in formats that supported their understanding.

The provider had an effective out-of-hours system which people, their relatives and staff used to contact the management team in the event of an emergency. People’s views were gathered through annual surveys, telephone monitoring checks and homes visits to improve on the quality of the service. The provider worked in partnership with key organisations such as the local authority to provide an effective service. There were systems in place to support continuous learning and improve the quality of the service.

The provider worked within the requirements of the Health and Social Care Act 2008 (Regulated Activates) Regulations 2014 and submitted notifications of significant events at the service. The provider had displayed their CQC rating both at their office location and on their website. Staff were happy working at the service and felt supported in their role. Regular team meetings were held to provide updates, training and gather feedback to improve on the service.

At this inspection we identified breaches of regulations because the arrangements for the management of people’s medicines were not robust. Whilst people received their medicines, medicine administration records (MAR) entries which did not specify the dose to be taken, or the strength of medicine to be given. Assessments on staff had not been conducted to ensure they were competent to administer medicines. The support people required with their medicines was not documented in their care plans.

We also found the provider had not taken action to ensure risk assessments included appropriate guidance for staff about how identified risks should be managed safely.

The provider did not have an effective system in place to assess and monitor the quality of the care people received. They had not maintained a manual or electronic call monitoring (ECM) system record to show that they had monitored visits to people homes to ensure they received visits at the agreed times, including when they were running late had been followed up effectively and identify any patterns to address.

You can see what action we told the provider to take in respect of these breaches at the back of the full version of the report.

Staff developed people’s care plans to meet their individual needs. However, they did not record people’s preferred time for calls in their care plan and staff maintained a flexible approach to call times.

There was a registered manager in place. 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 and their relatives told us they felt safe with the staff. The service had clear procedures to recognise and respond to abuse. All staff completed safeguarding training. The service had a system to manage accidents and incidents to reduce reoccurrence. The service had enough staff to support people and carried out satisfactory background checks of staff before they started working

The registered manager held regular staff meetings, where staff shared learning and good practice so they understood what was expected of them at all levels. Staff said they enjoyed working for the service and they received good support from the registered manager.

The provider involved people and their relatives, where appropriate, in the assessment, planning and review of their care. Staff supported people in a way that was caring, respectful, and protected their privacy and dignity. The provider sought the views of people who used the service.

The service provided an induction and training to staff. Staff were also supported through regular supervision and spot checks to help them undertake their role.

People’s consent was sought before care was provided. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and acted according to this legislation.

Staff supported people with food preparation where required, in order to maintain a balanced diet. People’s relatives coordinated health care appointments to meet people’s needs, and staff were available to support people to access health care appointments if needed.

The service had a clear policy and procedure for managing complaints. People knew how to complain and told us they would do so if necessary. The service had maintained a complaints log, which showed that when concerns had been raised, senior staff investigated and responded in a timely manner to the complainant.