Background to this inspection
Updated
7 November 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 19 and 20 September 2018 and was announced. The provider was given 24 hours’ notice. This was so that we could be sure the registered manager or a representative was available when we visited and that consent could be sought from people to receive home visits from the inspector.
The inspection was carried out by one inspector on both days. Phone calls to people were completed by an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. They had experience in dementia care and care at home services. We visited the office location on the first and second day to see members of the office and management teams and to review care records and policies and procedures.
Before the inspection we reviewed all the information we held about the service. This included notifications the service had sent us. A notification is the means by which providers tell us important information that affects the running of the service and the care people receive.
We had not 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. We gathered this information at inspection.
We visited two people and discussed their experience of the service. We had telephone conversations with seven people and eight relatives. After our inspection we spoke with a community nurse about their experience of the service.
We spoke with the director of operations, group head of quality, head of quality and training, two quality officers, administrator, care co-ordinator and seven members of the care team.
We reviewed five people’s care files, medicine records, three staff files, minutes of meetings, complaints and audits.
Updated
7 November 2018
The inspection took place on the 19 and 20 September 2018 and was announced. When we last inspected the service in January 2017 we found a breach in regulation. Systems and processes were not being operated effectively to prevent abuse of people as information had not been shared with the appropriate agencies. We received a provider action plan in April 2017 telling us they were now meeting the legal requirement. At this inspection we found that improvements had been made.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service primarily to older adults. At the time of our inspection there were 68 people receiving a service from the agency. The service had been registered for providing nursing care but was not providing this at the time of our 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. The registered manager was not present during our inspection but arrangements were in place for senior staff to provide any information needed.
The service had failed to comply with their condition of registration as they had moved address in January 2018 before their current location had been registered with the Care Quality Commission. The new address was registered with CQC on the 10 August 2018.
People and their families described their care as safe. Staff had been trained to recognise signs of abuse and understood their role in reporting any concerns both internally and to external agencies. Staff had also completed equality and diversity training and respected people’s individual lifestyle choices. Assessments had been completed that identified risks people lived with and staff understood the actions needed to minimise the risk of avoidable harm including preventable infections. Medicines were administered safely by trained staff who regularly had their competencies checked.
Staff had been recruited safely ensuring they were safe to work with vulnerable adults. Staffing levels met people’s needs with office staff also trained to provide care when needed. Effective processes were in place to manage unsafe practice. Incidents, accidents and safeguarding's were used to reflect on practice and lessons were learnt when things went wrong.
Assessments had been carried out prior to a person receiving care and support and this information had been used to create person centred care plans reflecting the persons care needs and choices. People had their eating and drinking needs understood and met as staff were knowledgeable about peoples likes, dislikes and routines. People were supported to access a range of health and social care services when needed, including district nurses and specialist mental health workers. People had an opportunity to be involved in end of life planning and had their cultural and religious diversity respected.
Staff had completed an induction and had ongoing training and support that enabled them to meet people’s needs and carry out their roles effectively. Opportunities for professional development included staff completing national diplomas in health and social care.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. A complaints process was in place and people felt if they raised concerns they would be listened to and actions taken.
People and their families spoke positively about the care team describing them as kind and caring and told us they felt involved in decisions about their care. People had their privacy, dignity and independence respected. Staff had a good knowledge of people, their past histories, hobbies and interests and had the skills to meet people’s individual communication needs.
The culture of the service was open and transparent which enabled people, their families and staff to be involved and share views about the service. Robust quality assurance processes were in place that effectively monitored service delivery and regulation compliance highlighting areas of improvement and achievement. Links with other organisations such as Skills for Care meant that the service was able to keep up to date with best practice guidance and new innovations.