Background to this inspection
Updated
5 April 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 8 and 14 February and was announced.
The inspection was carried out by one adult social care inspector and an expert by experience who made telephone calls to people and relatives to gain their opinions and views of the service. An expert by experience is a person who had personal experience of using or caring for someone who used this type of service.
Before the inspection we reviewed other information we held about the service and the provider. This included previous inspection reports and statutory notifications we had received from the provider. Notifications are changes, event or incidents the provider is legally obliged to send to CQC within required timescales. We also contacted the local Healthwatch, the local authority commissioners for the service, the local authority safeguarding team and the clinical commissioning group (CCG). Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
Before the inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This was completed and returned within the required deadline.
During our inspection we spoke with the registered provider, deputy manager, service coordinator, two supervisors and four care workers. We also spoke with four people who used the service and four relatives of people who used the service.
We viewed a range of records about people’s care and how the service was managed. These included the care records of four people, the recruitment records of four staff, training records and records in relation to the management of the service.
Updated
5 April 2017
This inspection took place on 8 and 14 February 2017 and was announced. We gave 24 hours’ notice of this inspection because the service is a domiciliary care agency and we needed to be sure there was someone in the office available to assist the inspection.
The service was supporting 59 people at the time of this inspection. The service had a registered manager. 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.
At the time of the inspection the registered manager was not actively managing the service. The registered provider supported the deputy manager during the inspection.
During this inspection we found the registered provider had breached the regulations. The registered provider had failed to ensure the safe handling of medicines. Staff were not recording the administration of topical medicines in line with national guidance. Staff had not had their competency to apply topical medicines checked.
We found staff training was not up to date. The registered provider had commissioned an external contractor to provide training in all subjects deemed mandatory. For example, food hygiene, moving and assisting. We found a programme of training already in place with training booked in on a monthly basis.
We found some records pertaining to the management and running of the service were not available due to the registered manager not being in the service. No other member of the management team were able to access these records.
Recruitment practices at the service were thorough, appropriate and safe so only suitable people were employed.
Systems were in place to identify, assess and manage individual risks to people. Staff had received training in the safeguarding and Mental Capacity Act 2005 (MCA) at induction and had or were due to receive refreshers. Staff were clear about their responsibilities to recognise and report any incidents of abuse and were able to describe how the MCA impacted on their roles. For example, attending best interest meetings.
Staff told us they felt supported and received regular supervision and annual appraisals to discuss performance and personal development. Supervisors told us they undertook spot checks to observe and confirm care workers were supporting people appropriately.
People’s dietary needs were respected with support given where necessary. Care plans were personalised and reviewed regularly. Relatives felt involved in their family member’s care and attended review meetings. Relatives made many positive comments about the service.
Processes were in place to consult with people before their package of support commenced. Consultations took place with supervisors and plans of support were completed with the person and if necessary relatives.
People’s care records and risk assessments showed us that people were encouraged to be as independent as possible. People’s healthcare needs were acknowledged and contact was made with other health care professionals when necessary.
We saw that systems were in place for recording and managing safeguarding concerns, complaints, accidents and incidents. People and relatives knew how to make a complaint.
The service sent out annual surveys to people to gain their opinions and views on the service. We found several compliments card and letters received by the service outlining relatives and people’s satisfaction with the service they had received.
Staff told us they felt the service was open and approachable. Regular meetings were in place for staff to raise concerns and issues, on a regular basis. Personal records were held in line with Data Protection.
You can see what action we told the provider to take at the back of the full version of the report.