We carried out an unannounced comprehensive inspection of this service on 16 and 17 December 2014. We identified a number of breaches in the regulations relating to person-centred care, safe care and treatment, complaints handling, good governance and notification procedures.
Following this visit, we asked the provider to send us an action plan by 1 May 2015 describing the actions they were going to take to meet the legal requirements and what they intended to achieve by their actions. After a further request for this information we received the provider’s action plan on 26 May 2015.
Due to the significant number of breaches we found during our previous visit, we undertook another full comprehensive inspection on 24 July 2015 to check that the provider had followed their plan of action and to confirm they now met legal requirements. This inspection was announced.
During our inspection on 24 July 2015 we noted improvements had been made to the care planning process and risk assessments had been fully completed and updated. The provider had introduced Health Action Plans for people using the service though these lacked important information such as the details of health professionals involved in people’s care and a record of healthcare appointments. The registered manager had improved the quality of monitoring systems though we identified shortfalls in this area in relation to medicines management.
Hope Care Agency provides support and personal care for adults and children. At the time of our visit six people were using the service.
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. The registered manager was not available at the time of our visit.
The service received the majority of its referrals via email or telephone from social workers based in the London boroughs of Barnet and Ealing. A care manager from the agency visited people in their own homes to carry out an initial assessment and create a plan of care. This process ensured that people’s individual care and support needs were able to be met by the service before a package of care was organised and care staff allocated.
Care plans were developed by consulting with people and their family members. Where people were unable to contribute to the care planning process, staff worked with people’s relatives and representatives and sought the advice of health and social care professionals to assess the care needed.
A range of risk assessments had been completed. These included assessments covering issues such as falls prevention and guidance around food, nutrition and personal care.
The staff we spoke with knew about people’s interests as well as their day to day lives at home with their families. People’s independence was promoted and staff understood the importance of respecting people’s privacy and dignity.
There were policies and procedures in place to protect people from harm or abuse. However, records were not always available in staff files to demonstrate that staff had attended relevant safeguarding training and staff were not always able to demonstrate a clear understanding of safeguarding.
People were supported at mealtimes to access food and drink of their choice. Staff were required to support people to prepare simple meals of their choice or reheat and serve food prepared by family members. Most staff had completed training in food hygiene and preparation. Staff had guidance about how to support people with known healthcare needs, such as diabetes although we saw evidence that staff were not always following these guidelines.
Staff were required to record arrival and departure times and all tasks completed in people’s daily log books. We saw evidence that daily logs were completed. However, information around medicines prompting was inconsistent and medicines administration charts were not available or not completed meaning we were unable to check whether staff were completing this task appropriately.
There were protocols in place to respond to any medical emergencies or significant changes in a person’s well-being. However, the administrative person managing the service on the day of our visit seemed unfamiliar with the provider’s policies and procedures as to how to respond to an emergency situation.
We received positive feedback from family members about the registered manager and staff.
People told us they were aware of how to make a complaint. There was a complaint’s log and procedures for managing complaints were evident.
There were arrangements in place to assess and monitor the quality and effectiveness of the service and use these findings to make ongoing improvements. However, we found shortfalls in this process relating to medicines.
We made a recommendation in relation to meeting people’s nutritional and health needs.
We made a recommendation in relation to meeting people’s nutritional and health needs.