Archived: RV Care Limited Surrey

The service was run by a registered manager, who was present on the day of the inspection visit. 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 and associated Regulations about how the service is run.

The registered manager had not always ensured that there were robust procedures in place to monitor, evaluate and improve the quality of care provided. There were systems in place to obtain feedback from people; however they were not always used within the providers stated timeframe.

Some people’s human rights were not always protected. Where people may have lacked capacity to make some decisions about their care, their next of kin had made decisions without the legal right to do so. Staff were heard to ask peoples consent before they provided care.

Risks to people were not always managed. There were inconsistencies in the recording and management of risks. The registered manager had a system in place for reviewing incidents and accidents that happened but actions taken were not always recorded. The regional manager had identified this in their quality assurance checks.

Most people self-administered, obtained and stored their own medicine. However the registered manager on the day was to begin supporting three people with prompting and administering medicines. The registered manager had not ensured that the staff were competent to administer these medicines.

People were not always protected from avoidable harm. The registered manager did not always recognise when there maybe potential safeguarding concerns for people. We have made a recommendation. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

Staff were not always recruited safely. They had a DBS check in place, however there were some gaps in the recruitment records of staff, for example some files lacked a photograph, other gaps in employment history.

The service did not always support people to maintain their health and well-being. There were inconsistencies as to how staff supported people to access relevant health and social professionals. We have made a recommendation.

People told us that they thought that staff had the right training and skills to support people. However, there were inconsistencies with staff being supervised, as some staff received regular supervision whilst for others it was infrequent.

People received personalised care. However there were inconsistencies in how this was recorded in people’s care plans. Some care plans contained sufficient information to guide staff in what support was needed, whilst others lacked detail and personalisation. We have made a recommendation.

People told us that they know how to make a complaint. One complaint had been received in the last year, and this had been dealt with in line with the service policy.

People told us that staff were kind and caring. Staff knew people’s likes and preferences and told us about the individual needs of people. Staff respected people’s privacy and dignity.

People were involved in their care and had signed their care plans.

There were sufficient staff in place to keep people staff. People told us that late calls were rare. When calls were late people said staff always called them to explain why and that they would be there soon.

Staff knew how to respond in an emergency. The service had a business continuity plan in place which told staff how to support people if there was an emergency.

People did not always know who the registered manager was. The regional manager told us that people had details of how to contact the registered manager in their handbook. People told us that the thought the co-ordinators were approachable. Staff told us that they felt supported by the registered manager.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what we told the provider to do at the back of the report.

Our inspection of this domiciliary care service helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and that their privacy and dignity were respected by staff.

Medication management at the service had changed since the last inspection. The provider told us that medication prompts or administration was no longer provided.

People were not put at unnecessary risk but had access to choice and remained in control of decisions about their care and lives.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care.

Both people that we spoke with were supported by their family and did not need an advocate.

Is the service caring?

We spoke with two people who were supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, people told us, 'The staff are always on time as they do not need to travel.' Another person said 'I have four people who support me and they are all lovely and very kind.'

When we spoke with staff they told us they genuinely cared about the people they supported.

People's preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. The two people we spoke with had never made a complaint. The manager had not received any complaints or concerns during the past year.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. For example, there had been a recent medication review and changes had been made. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the agency and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times

Everyone was extremely satisfied with the service they received. Their comments included 'It is excellent in every way' and 'I do not know what I would do without them.'

We found that people's consent had been sought both verbally and written in relation to the provision of their care. There was guidance available to staff if people lacked the capacity to make a specific decision.

We saw evidence that people's needs had been assessed and they had written care plans. People told us that they were very happy with the care they received.

Staff had not clearly recorded in people's care plans or records which medicines people had been prompted to take.

The provider had not ensured that all staff had completed their infection control training as part of their induction and some staff were not up to date with this training. Not all staff had completed Mental Capacity Act 2005 training.

There was an effective complaints process in place.

We found people had been provided with information about the service provided and their own care. People had received an assessment of their care needs and their views had been sought with regard to the care they required. People had signed their agreement with the content of their care plan.

We observed people had been treated with dignity and respect by the staff. Care had been provided in accordance with people's individual needs. One person told us 'staff take me to medical appointments'.

Staff had received training with regard to how to safeguard people from abuse and were able to access relevant guidance. One person told us they felt confident staff would act if they had safeguarding concerns.

We saw there were recruitment policies and procedures in place and they had been followed.

There were processes in place to monitor the quality of the service provided and people told us they felt able to express their views about the service.