Archived: Kells Domiciliary Care and Nursing Agency

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 take into account any wider social care provided.

At our last inspection on 10 October 2016, we identified breaches of regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to risk assessments that failed to provide staff with guidance on minimising the risks; lack of documented person centred care; staff not having received an appraisal; and a lack of management oversight regarding monitoring the service. At this inspection we found that the provider had addressed the breaches regarding person centred care planning, risk assessments and staff appraisal. However, the provider had not adequately addressed the breach around regulation 17 relating to good governance.

We found that there were no regular audits completed to ensure good managerial oversight of the service. Two audits had been completed since the last inspection. However, these were general and failed to provide adequate reassurance of good governance. Medicines were informally audited but this was not documented. Significant information regarding a person’s care had not been documented.

There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider. The registered manager was not present during the inspection as he was on leave. The inspection was supported by the training manager.

Risk assessments were in place that gave staff information on how to minimise people’s personal risks.

Relatives told us that they felt their relative was safe and supported by the service. Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report to if people were at risk of harm.

Staff were aware of infection control procedures and the service provided personal protective equipment (PPE) such as gloves and apron to staff for when assisting people with personal care.

Staff had regular supervision and annual appraisals that helped identify training needs and improve the quality of care.

People were supported to have their medicines.

Staff were recruited safely and there were systems in place to ensure that staff were appropriate for the role.

Relatives told us that they felt that staff were kind and caring and treated their relative with respect.

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 and relatives were involved in planning their care. Care plans were person centred and included information on how people wanted their care to be delivered as well as their likes and dislikes.

At this inspection we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service had recently moved location. This was the first inspection at the current address. The service was last inspected 17 September 2013 at the previous location and was meeting all the regulations inspected. 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 present during the inspection.

Risk assessments did not give staff guidance on how to mitigate risks. Risk assessments failed to provide staff with appropriate information with regards to the people they were taking care of.

Care plans were not person centred and did not state people’s likes, dislikes or how they wanted their care to be provided. Care plans were brief, often several sentences and did not provide staff with an appropriate level of knowledge to be able to work with people.

Staff received regular supervision. However, this was not adequately documented. Staff did not receive yearly appraisals.

Medicines audits were not completed. Staff had received training on medicines administration and people were supported to take their medicines safely.

People were involved in decisions about their care. Where people were unable to have input, people’s families were consulted.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions outlined in the Mental Capacity Act 2005. However, the service worked with people living with dementia and there were no records of mental capacity assessments around decision making.

People received a continuity of care. The provider always tried to ensure that the same care workers looked after people. This promoted good working relationships with people who used the service.

People and relatives said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity. People were encouraged to be as independent as possible.

We found that there was an open culture that encouraged staff and people to discuss issues and ideas, through team meetings and informal discussion.

There was a complaints procedure that people and relatives knew how to use.

The service operated an on-call system for any issues that arose out of hours. People and relatives told us that there was always someone available to help.

Overall, we found breaches in regulations 9, 12, 17 and 18. Where there were breaches of regulations, you can see what action we told the provider to take at the back of the full version of the report.