30 October 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.
Inspection activity started on 6 September and ended on 11 September 2018. The inspection was announced. The provider was given 48 hours’ notice because the location provides personal care support to people living in the community and we needed to be sure someone would be available at the office location. The inspection was carried out by one adult social care inspector. Following the inspection site visit, an Expert by Experience contacted people who used the service and relatives to gain their views on the service provided.
As part of planning our inspection, we contacted the local Healthwatch and the local authority safeguarding and quality performance teams to obtain their views about the service. Healthwatch is an independent consumer group, which gathers and represents the views of the public about health and social care services in England. We reviewed information we held about the service, including the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to tell us about within required timescales.
The provider sent us their Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used this information to help plan for the inspection.
During the inspection we reviewed a range of records. These included four people's care records containing care planning documentation, daily records and eight people’s medicine records. We looked at four staff files relating to their recruitment, supervision, appraisal and training. We reviewed records relating to the management of the service and a wide variety of policies and procedures.
During the inspection we spoke with five people who used the service and four relatives to gain their views on the service provided. We also spoke with five members of staff including the registered manager, who is also the provider, and the care manager who had responsibility for the day to day management of the service.
30 October 2018
The inspection started on 6 September and ended on 11 September 2018. The registered manager was given two days’ notice of our inspection.
Eldercare 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 to older adults, some of whom may be living with dementia. At the time of inspection 29 older people used the service. One of the directors, who was also the registered manager, was present throughout the inspection.
At our last inspection the provider was found to be in breach of four regulations. These were Regulation 12 Safe care and treatment, Regulation 18 Staffing, Regulation 19 Fit and proper persons employed and Regulation 17 Good governance.
We asked the provider to take action to make improvements to their quality monitoring systems and processes and ensure they kept complete, accurate and contemporaneous records to ensure they complied with Regulation 17 Good governance. This action has been completed.
Following the last inspection, we met with the provider to asked what they would do and by when to improve the key questions; Is the service Safe? Is the service Effective? Is the service Caring? Is the service Responsive? Is the service Well-led? to at least good.
Risk assessments had been improved to ensure they captured all risks relating to each individual. They had been reviewed an updated when changes in people’s need occurred.
Safe recruitment processes were now in place and had been followed. Pre-employment checks had been completed and an induction process followed.
Medicines had been managed safely. Staff had been provided with appropriate training and observations to assess staff competencies within this area had been conducted. Medicine administration records were now collected and audited on a monthly basis to ensure any areas of concern were identified and actioned as soon as possible.
Safeguarding training had been provided and staff we spoke with knew how to raise concerns. They were confident the management team would deal with any concerns raised appropriately.
There were enough staff available to meet people’s needs and attend planned care visits. People were supported by a consistent team of staff and pre-admission assessments had been completed to ensure the service could meet people’s needs before a package of care was accepted.
A comprehensive training plan was in place to ensure staff had the skills and knowledge to fulfil their roles. An extensive range of training had been provided since the last inspection. Regular one to one supervisions and appraisals had taken place. Staff told us they felt supported.
People were supported to access health professionals when needed and to maintain a healthy balanced diet of their choice.
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. People had signed their care plans to consent to the support they were receiving.
People’s independence was promoted by staff. Care plans had been further developed to ensure they contained person-centred information and provided clear guidance of the level of support that people required. These had been regularly reviewed to ensure they remained up to date.
People’s end of life wishes had been discussed and recorded. Advanced care plans provided staff with information about aspects of the person’s life that was important to them.
Complaints had been recorded and responded to in accordance with the provider’s policy and procedure. A concerns log had also been introduced to ensure informal concerns raised were addressed accordingly.
Effective quality assurance processes were now in place which were used to highlight any shortfalls in the service. Record showed that when shortfalls had been identified, action had been taken to address concerns.
Feedback from people had been sought on a regular basis to encourage continuous improvement. People told us they could contact the service at any time and were confident any feedback they provided would be listened to.
Following the last inspection, the provider had reviewed their management structure and implemented changes. People, relatives and staff spoke positively of the new management team, their performance and improvements made to the service provided.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.