Background to this inspection
Updated
14 March 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection site visit was completed by one inspector. A second inspector assisted with telephone calls to gain feedback on the service from those people that used it and their relatives.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission who was also the provider. This person was legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 72 working hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 13 February 2020 and ended on 19 February 2020. We visited the office location on 17 February 2020.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service and two relatives about their experience of the care provided. We spoke with four members of staff including the registered manager, the care coordinator and two care assistants.
We reviewed a range of records. This included three people’s care records and the medication records for two of these people. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with one further relative.
Updated
14 March 2020
About the service
Georgina House is a domiciliary care agency that provides care and support to people living in their own homes. At the time of this inspection the service was providing support to 19 people.
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
Lack of governance systems and knowledge of regulatory requirements had meant people who used the service were at risk of receiving care not of the expected quality. Lack of audits had meant the provider was unaware of most of the concerns we identified at this inspection. Where they were aware of poor visit call times, there had been a delay in rectifying this and was ongoing at the time of this inspection. The provider had failed to notify CQC of specified events they are required to by law. At the time of the inspection, the provider had also failed to display the rating from their last inspection on their website; this was rectified shortly after this inspection.
People did not receive a rota so was unaware of which staff would be supporting them and when. Call times for people varied considerably and this meant people were unable to plan their day. Not enough staff were adequately deployed to ensure people received calls at the same specified time each day and this caused them anxiety. Robust checks on staff’s suitability for the role were not in place. Some incidents had occurred which put people at risk and the provider had not reported these to the appropriate stakeholders including the local authority’s safeguarding team. The processes the provider had in place to help protect people from the risk of abuse were not fully effective.
People’s needs had not been assessed in a holistic manner and not all their needs and associated risks had been planned for. Formal reviews of people’s care needs and the service they received were not in place. However, due to people being supported by a small and stable staff team, their personal and emotional needs were met as staff knew them well. 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 and people told us this.
People’s nutritional and healthcare needs were met, and they received their medicines as prescribed. They were protected from the risk of infectious diseases and received information in accessible formats. Staff treated people with respect and kindness, maintained their dignity and encouraged their independence. A complaints policy was in place in the events concerns were raised.
Staff felt supported and morale was good amongst the staff. They received regular supervisions and attended regular meetings which were open arenas for discussion, sharing information and testing knowledge. Mandatory training was not up to date. However, people told us staff were effective and they received a variety of additional training; all had qualifications in health and social care. The service worked with other agencies to meet people’s individual needs.
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 good (report published 26 July 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
At this inspection we have identified breaches in relation to staffing, governance, safeguarding and notifying CQC of specified events.
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.