Pinnacle Caring Services Limited

The service did not have a registered manager. The registered provider had full oversight of the service and supported the inspection process.

People’s experience of using this service and what we found

The registered provider had not reviewed and kept their policies and procedures up to date to reflect best practice guidance. Audit systems were in place but had not been consistently completed to ensure areas for development and improvement were identified in a timely manner.

Medication was managed safely. Staff who managed medication had completed the required training and had their competency regularly assessed. Staff had access to best practice guidelines to support their practice. Medication administration records (MARs) were fully completed. We have made a recommendation about the auditing of medication.

People were supported by staff that had been safely recruited and had received training to support them in their role. There were enough staff to meet people’s needs and people told us regular staff visited them and had got to know them well.

People’s needs were assessed before they were supported by the service. Each person had a care plan that included their preferences and routines. Care plans were person centred and held sufficient information to guide staff on how best to meet people’s needs. People told us staff were kind, caring and attentive. Staff had a clear understanding of how to meet people’s individual needs. Staff supported people in the least restrictive way possible and in their best interests.

Staff had received training on how to keep people safe. They told us they felt confident to raise any concerns they had about people’s safety.

Staff had received infection control training and followed good practice to minimise the risk of infection being spread. People’s privacy and dignity was respected, and their independence promoted to the full. People spoke positively about the service and the staff that supported them.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 11 October 2018) and there were two 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 regulation 18 however; improvements were still required to regulation 17.

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.

Pinnacle Caring is registered to provide personal care and support to people who live in their own homes. The agency office is based in Blacon, Chester and provides support to people within their local area. At the time of our inspection the service supported 10 people.

The service did not have a registered manager. The service has been without a registered manager for six months. A new manager had been appointed at the time of our inspection but had not commenced work. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers they are 'registered persons'. The registered persons have a legal responsibility to meet the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we found a breach of regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered providers audit systems had failed to identify areas for development and improvement that included DBS check, mandatory refresher training and supervision for staff. In addition, the registered provider had not undertaken regular reviews of daily care records.

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

Staff recruitment systems were not consistently robust to ensure only suitable staff were employed to work with the vulnerable people they supported. The service had a high turnover of staff and were undergoing further recruitment at the time of our inspection.

Support and supervision was not consistently undertaken in line with the registered provider’s policy and procedure.

All staff had undertaken an induction which included shadowing more experienced staff at the start of their employment. Staff had all completed essential training however they had not consistently completed refresher training in line with good practice guidelines.

The registered provider had a medicines policy and procedure in place. Staff had all undertaken medicines training however had not all completed annual refresher training in the subject. Staff had not had their medicines competency assessed. We received confirmation that this had been undertaken since our inspection visit.

Staff had a good understanding of safeguarding people from abuse. There were policies, procedures and systems in place to protect people from abuse.

People had their needs assessed prior to them using the service. A care plan and risk assessments were prepared using the information gained through assessments. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. People told us that staff understood their individual needs.

People told us that staff treated them with kindness and were caring. They said that their privacy and dignity was consistently respected.

People told us that staff supported them with their food and drink needs. They described being offered choice and we saw guidance was available for staff to follow to meet people's individual dietary needs.

The registered provider had up-to-date policies and procedures that were available to staff to support their role and employment. Policies included complaints that people and their relatives could follow to raise any concerns or complaints they had.

The Care Quality Commission as required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we found. We saw that the registered provider had policies and guidance available for staff in relation to the MCA. Staff demonstrated a basic understanding of this and had all completed training.