26 November and 10 December 2015
During a routine inspection
We inspected Careline Homecare (Middlesbrough) on 26 November and 10 December 2015. This was an announced inspection. We informed the registered provider at short notice (48 hours before) that we would be visiting to inspect. We did this because we wanted the registered manager to be present at the service on the day of the inspection to provide us with the information that we needed.
The service is registered to provide personal care to people living in their own homes. The service can provide care and support to older people, people with mental health conditions, people with a learning disability, physical disability or those people who are at end of life. Careline Homecare (Middlesbrough) also provide a rapid response service. The aim of the rapid response is to provide care and support to those people in their own homes whose informal care and support package has broken down unexpectedly and who may have had to go into a hospital or care home because they were unable to manage at home. This service is also provided to people who are discharged from hospital. Healthcare professionals contact the service when a person is identified as needing rapid response. Staff at the service respond by visiting the person at home within two hours of the initial call. This service is provided to people for up to 10 days and then the person is reassessed and their ongoing needs determined.
The home 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.
Systems were in place for the management of medicines so that people received their medicines safely. Care Records we reviewed contained lists of people’s medicines, how they should be administered and what time they should be taken. However we did see some gaps on medicine administration records. Some improvement was also needed for the record keeping of those people prescribed anticoagulants and a second staff member needed to check and countersign medicine records to confirm they were correct.
Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. However some records needed further detail to ensure care and support was delivered in a way that they wanted it to be.
There were enough staff employed to provide support and ensure that people’s needs were met. However people did tell us they would like to receive a rota in advance informing them the name of care staff who would be visiting.
There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice.
Prior to the commencement of the service staff from Careline completed environmental risk assessments of the person’s home. Safety checks looked at the gas and electricity points, equipment to be used and general environment checking for clutter and falls risks. This meant that the registered provider took steps to ensure the safety of people and staff.
There were risk assessments in place for people who used the service. The risk assessments and care plans had been reviewed and updated on a regular basis. Risk assessments covered areas such as mobility, medicines and falls. This meant that staff had the written guidance they needed to help people to remain safe.
Staff told us that the registered manager was supportive. Most staff had received regular and recent supervision. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. Records indicated 86% of staff had received an annual appraisal within the last 12 months. The registered manager told us the remaining appraisals would be completed over the next few weeks.
The majority of staff were up to date with training Staff told us they had received training which had provided them with the knowledge and skills to provide care and support. Any outstanding training had been arranged for early January 2016 to ensure that all staff were up to date with all training. Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
The registered manager and staff we spoke with had an understanding of the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. The registered manager told us that staff had been trained in the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances.
People and relatives told us that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people.
People were provided with their choice of food and drinks which helped to ensure that their nutritional needs were met.
Staff at the service worked with other healthcare professionals to support the people. Staff worked and communicated with social workers, occupational therapists, hospital staff as part of the assessment and ongoing reviews.
The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.
There were systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.