Archived: Grade A Care

Updated 14 August 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.

The inspection site visit took place on 26 June 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure someone would be in the office to facilitate the inspection.

The inspection visit was conducted by one adult social care inspector from the Care Quality Commission (CQC).

In preparation for our visit, we considered the previous inspection reports, and discussed the service with the local authority's quality performance officers.

Prior to the inspection the service completed a Provider Information Return (PIR), which 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 also looked at any information we held about the service. We had not received any notifications from the service, a notification is information about important events, which the provider is required to send us by law.

There were eight staff employed at the company and as part of the inspection we spoke to the nominated individual, the registered manager and one staff member. We also visited two people receiving support from the agency in their own home.

We looked at three staff files, two care files and one Medication Administration Record (MAR). We also reviewed other records held by the service including; training information, policies and procedures and audit documentation. We used all this information to inform our judgement.

Updated 14 August 2018

We carried out an announced inspection of Grade A Care on 26 June 2018. The provider was given 48 hours' notice of the inspection because the location is a small, family run domiciliary care service and we needed to be sure someone would be available to facilitate the inspection.

Grade A is a domiciliary care agency in Hindley, Wigan. It provides personal care to people living in their own houses and flats in the community. Not everyone using Grade A receives a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

At the time of inspection, there were seven people receiving a regulated activity from the service.

The service was last inspected in June 2017, when we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regard to regulation 17; good governance. We also made three recommendations in relation to risk assessment documentation, training and reviewing people's care needs within specified time frames.

Following this inspection, the service was rated as requires improvement overall and in the key lines of enquiry (KLOE's); responsive and well-led. The service was rated as good in safe, effective and caring.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; responsive and well-led to at least good. However, the provider failed to submit the requested action plan.

We reviewed the progress the provider had made as part of this inspection and found the provider remained in breach of regulation 17; good governance (two parts). We also identified an additional breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regard to regulation 18; staffing. We also made a further recommendation to review risk assessment documentation. You can see what action we told the provider to take at the end of the full version of this report.

This was our third inspection of Grade A where the rating has not improved from requires improvement. All previous inspection reports can be viewed by clicking the ‘all reports’ button on our website at www.cqc.org.uk. We are currently considering our options in response to this third requires improvement rating in line with our methodology.

At the time of the inspection there was a registered manager in post. 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.

People we spoke with told us they felt comfortable with the staff and had no safety concerns.

At our last inspection we recommended the service sought advice and guidance from a reputable source regarding individual risk assessment documentation. This was because the risk assessments in place did not identify sufficient control measures to mitigate all risks and were not kept under review. At this inspection we found this had not been actioned and the risk assessment documentation was unchanged.

There was a recruitment process in place, but records to demonstrate this had been followed were not sufficiently maintained.

People continued to be supported by staff who understood their responsibilities if they suspected people receiving support from the agency had been abused or mistreated.. Staff were also knowledgeable about how to report accidents and incidents.

Medicines were managed in a safe way with records being completed accurately and all medicines given as prescribed.

There were sufficient staff employed to meet current care commitments and missed visits were not a concern within the service.

There was a basic induction and training in place at the service and one staff member had completed the care certificate. However, staff did not consistently receive supervision at regular intervals or complete an appraisal of their work.

People's rights under the Mental Capacity Act 2005 (MCA) continued to be protected. Care staff supported people to have maximum choice and control of their lives.

The agency is a small family run service so people were supported by a small familiar staff team which promoted continuity of care and people and staff spoke positively of the care provided and the relationships that had developed.

Staff were caring and respected people's privacy and dignity. Staff were provided with enough time on care calls to be able to provide compassionate care. People told us staff visited at the scheduled time and were flexible about staying longer when required.

Staff demonstrated they knew people’s preferences and care needs. We saw there were basic support plans in place to provide initial guidance to staff which had been reviewed.

There was a complaints process in place which had been followed and we saw the service had received compliments from people receiving support.

We found basic quality assurance systems had been implemented but these had not been devised or fully operated to monitor all aspects of service delivery. In addition, it could not be determined when formal feedback had been sought to obtain people's views through reviews or questionnaires. Team meetings had not been maintained but staff confirmed their views were sought and they had regular communication with the registered manager and provider.