Archived: Guinness Care At Home Hampshire

Guinness Care at Home Hampshire is a domiciliary care agency providing personal care to people in their own homes or people in supported living services. At the time of us inspecting 35 people received personal care as the regulated activity.

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

Risk assessments contained detailed guidance on how to respond to risks associated with people's care needs. Staff understood how to identify and report any safeguarding concerns.

Medicines were appropriately stored and disposed of. People received their medicines when they needed them. Staff had received training in how to administer medicines safely.

Staff had received robust training and on-going development to support them in their role. They had received an effective induction and strong on-going development that related to people's needs.

Staff knew the requirements of the Mental Capacity Act 2005 (MCA). The provider had effective arrangements and plans in place to ensure people's liberty was not restricted without authorisation.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Good leadership was seen at all levels. Relatives told us the senior staff and manager were approachable and took any concerns raised seriously.

The provider had robust quality assurance systems in place to support and drive improvement.

The culture of the service was positive and open. People and staff felt the service was well managed and were confident in the provider's systems and policies to deliver good quality care. Regular quality assurance checks by the quality assurance manager and representatives from head office was carried out to ensure people's needs were being met and maintained.

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

Rating at last inspection

The last rating for this service was requires improvement (published 16 March 2020) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Guinness care at home on our website at www.cqc.org.uk.

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.

Guinness Care At Home Hampshire is a domiciliary care agency (DCA). The service provides personal care services to people in their own homes or people in supported living arrangements. At the time of our inspection 59 people received personal care as the regulated activity.

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.

The policies and systems in the service supported people to have choice and control of their lives. However, these policies were not always followed which meant people were not always supported to have maximum choice and control of their lives. The registered manager had not always followed legislation in terms of seeking consent.

Medicines management was not based on current best practice. Risks to people were not always managed safely. The systems in place to monitor the quality of service were not always effective.

People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable.

People's care plans contained personalised information which detailed how they wanted their care to be delivered. Staff knew people and expressed care and affection for them when speaking with us. People were supported by kind and caring staff who worked hard to promote their independence and sense of wellbeing.

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 December 2018) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found not enough improvements had been made and or sustained and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches in relation to the oversight and governance of the service, medicines and risk management and consent.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of the inspection, the service was providing care and support to 72 people. Each person received a variety of care hours, depending on their level of need. The Care Quality Commission (CQC) only inspect the services being received by people provided with ‘personal care’; such as help with tasks related to personal hygiene and eating. Where this is provided, we also take into account any wider social care provided.

Inspection activity started on 29 October 2018 and ended on 6 November 2018. This inspection was announced. We gave the provider 48 hours’ notice of our inspection as we needed to be sure key members of staff would be available.

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.

This was the first inspection of the service since it was registered with the Care Quality Commission.

Quality assurance processes were in place; however, they had not identified the areas of concerns we found during this inspection relating to the safe management of medicines, risks to people, staff knowledge of people’s care plans, reviews of care documentation, timeliness of care calls and the impact of office staff shortage.

Medicines were not always managed safely. Administration of people’s medicines was documented in an unclear and inconsistent manner. The registered manager was not clear of the correct recording process that staff should be following when using medicines were not administered.

Where individual risks to people were identified, these were not thoroughly documented and there was a lack of information for staff to minimise the risk of harm.

There were not enough staff deployed to ensure that people received care and support in a safe and timely manner.

Staff were not always familiar with the information in people’s care plans, to ensure they were delivering care and support in line with people’s preferences and needs.

There was a shortage of office staff which impacted upon their responsibilities to complete management tasks and provide consistency of communication with people.

People did not always have choice and control over how their care was delivered. People were not always informed if there was going to be changes to their care calls.

There were appropriate recruitment procedures place to ensure that new staff members employed were suitable to support people in the community.

Staff had received training in safeguarding and undertook their responsibilities to identify and report signs of potential abuse.

There were robust processes in place to protect people from the risk of infection and staff wore personal protection equipment (PPE) appropriately.

New staff received a robust induction period before they worked independently with people, which included training in key areas and shadow shifts with a senior member of staff. Existing staff received regular refresher training and were encouraged to enrol onto additional training courses.

People were supported to access healthcare services when needed and staff acted appropriately where people’s health needs changed.

Although people had the capacity to make decisions about their care and support, people’s rights were protected in line with the Mental Capacity Act 2005 and staff sought people’s consent appropriately.

Staff had developed positive relationships with people and their families and treated them in a kind, compassionate and respectful manner.

Staff took action to protect people’s dignity and privacy at all times and encouraged people to be independent with all aspects of their daily routines where possible.

Information about people’s end of life wishes was not recorded, however the registered manager and staff were aware of their responsibilities to ensure people’s end of life choices were followed.

The service had a clear process in place to deal with complaints and we saw that concerns were dealt with in a timely and effective manner.

Staff received regular updates about changes in the service and felt valued in their role. Staff were recognised for doing a good job and were notified if they received positive feedback from the people they supported.

The provider supported the registered manager and was engaged in running the service. There was a positive and open culture and the vision and values of the service were actively promoted.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.