Archived: Holistic Caring Services

Updated 5 April 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 was planned to check 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.

This inspection took place on 27 February 2018 and was announced. The inspection was announced because this is a small service and we wanted to make sure that we visited at an appropriate time for people receiving care. This was the first inspection since the service was registered.

The inspection was conducted by an adult social care inspector.

Before the inspection we checked the information that we held about the service and the service provider. This included statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We also contacted the local authority who provided information. We used all of this information to plan how the inspection should be conducted.

A Provider Information Return (PIR) was not available for this service. A PIR 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 took this into account when we inspected the service, and made the judgements in this report.

We spoke with one person who used the service, one relative, two care staff, the service manager and an administrator. We also spent time looking at records, including three care records, three staff files, staff training records, and other records relating to the management of the service. We contacted health and social care professionals who have involvement with the service to ask for their views.

Updated 5 April 2018

We carried out an announced inspection on 27 February 2018. At the time of the inspection three people were receiving care.

Centrepoint The Top Suite (trading as Holistic Caring Services) is registered with the Care Quality Commission for the regulated activity of Treatment of Disease, Disorder and Injury. This registration is appropriate to the provision of nursing services. However, the service was providing the regulated activity of personal care. We discussed this with the service manager who was also nominated individual. They agreed to submit an application to add personal care to the registered activities as a priority.

A registered manager was in post. However, the registered manager was not available on the day of the inspection. 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.

Staff were not recruited safely in accordance with the provider’s policy or best-practice. Two of the three files we checked did not contain any evidence that references had been received prior to the person starting work.

A registered manager was in post. However, they were not actively involved in the day to day management of the service. This role was undertaken by the service manager who was also the director and Nominated Individual. This meant that the governance framework for the service was not clear or robust.

The service manager had completed a series of quality and safety audits on a regular basis. However, audit processes were not robust and had failed to identify the lack of references in the staff files that we saw. We made a recommendation regarding this.

The people that we spoke with had no concerns about the safety of services. People were protected from potential harm and self-neglect because staff knew people well and were able to recognise signs of abuse or neglect.

The care files that we saw showed clear evidence that risk had been assessed and reviewed regularly. Risk assessments were sufficiently detailed. Risk was reviewed by staff with the involvement of the person or their relative.

Staff were trained in the administration of medicines but because the services were community-based, they were not always responsible for storage and administration. Some people who used the service were able to self-administer their medicines; others received support from a relative. At the time of the inspection staff were not supporting people with the medicines.

The service manager was clearly aware of the day to day culture and issues within the service. We saw that they knew the people using the service and their staff well.

The service manager was able to articulate a clear vision for the service which maintained its focus on the provision of specialist services for people requiring end of life care. However this focus was not fully reflected in promotional materials or the provider’s statement of purpose.

The service manager worked closely with staff as they delivered care. This supported a culture of open communication.

The staff that we spoke with were motivated to provide high quality care and understood what was expected of them. They spoke with enthusiasm about the people that they supported and their job roles.

Care was delivered in accordance with people’s needs and choices and in conjunction with healthcare professionals. Policies, procedures and other documents made appropriate reference to legislation and standards including the Care Quality Commission’s fundamental standards.

Staff were trained to a basic level in a range of subjects which were relevant to the needs of the people using the service. Subjects included; safeguarding adults, moving and handling, administration of medication, Mental Capacity Act 2005 and equality and diversity. However, there was no evidence that their competency had been formally assessed. We made a recommendation regarding this.

Staff told us they felt well-supported by the service manager and had access to regular supervision. However, the service manager acknowledged that records of supervisions were not always kept. They confirmed that they would address this matter as a priority.

People’s capacity was assessed in conjunction with families and professionals and in accordance with the principles of the Mental Capacity Act 2005. None of the people currently using the service were subject to restrictions on their liberty. However, staff were aware of the need to seek authorisation from the Court of Protection if people’s liberty needed to be restricted to keep them safe.

People’s day-to-day health needs were met by the services in collaboration with families and healthcare professionals.

We did not have the opportunity to observe staff providing care as part of the inspection process. However, people told us that they were very happy with the care and support provided.

The service manager was knowledgeable about each of the people that used the service and each member of staff. People had regular contact with the service manager and were able to contact them using an on-call number if necessary. This meant that the service manager was able to monitor the quality of care through a variety of means.

Where people had difficulty communicating their needs and preferences, staff had additional guidance to support them. For example, one care record explained how the person didn’t use speech, but could understand what was being said to them. The person was able to make their views known through facial expressions and body language.

Because of the nature of people’s care needs, there were limited opportunities to promote people’s independence. However, in one care record we saw instructions for staff to support the person with their independent choice of clothes and to interact with the person during the process.

We asked people about the need to respect privacy and dignity. People told us that staff respected their right to privacy and were mindful of this when providing personal care.

We saw from care records that people and their relatives contributed to the assessment and planning process and were given choice over each aspect of their care. Care plans had been regularly reviewed and signed by the person or their representative.

Because of the nature of the care provided there were limited opportunities to engage people in activities. However, care records contained information on people’s likes and dislikes that staff used in conversation as they provided care.

People were given a number of options if they chose to complain about the service. They could speak directly to staff or the service manager. They could also use the formal complaints procedure. A copy of the procedure was provided to each person when they started using the service.

The service was primarily focussed on meeting the needs of people at the end of their lives. They worked closely with the district nurses and a local hospice to ensure that people had the option to return home with an appropriate package of care in place. The service worked effectively as part of a wider team to ensure that people’s personal care needs were met in accordance with their wishes.

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