Vision Care Services

Vision Care Services is a domiciliary care service which provides care and support for people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the start of the inspection the service was supporting 196 people with personal care. Due to changes implemented by Bradford Council by the end of the inspection the service was supporting 149 people.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Medicines were not being safely managed. Risks to people were not always consistently or effectively managed. We found multiple risk assessments were not in place for people where needed. Staff had not received all the necessary training to enable them to provide safe and person-centred care appropriate to people’s specific medical conditions.

People were being safeguarded from the risk of abuse as staff were reporting concerns and these were being acted on by management.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

Care plans were detailed relating to people’s preferences for care call activities, however where people had specific health needs the care plans did not provide guidance to staff on how these conditions affected people or how they should support them safely.

People and relatives told us they were very happy with the care being provided by the service.

The service was working effectively with external professionals.

Right Culture:

The provider did not have safe and effective systems in place to monitor, review and improve the quality of care provided. The shortfalls found on inspection had not been identified by the provider during their internal audit processes.

We were not assured lessons were being learnt due to ineffective audit systems.

Staff were compliant with infection prevention and control measures and procedures, and the provider had sufficient supplies of personal protective equipment.

The provider was very proactive with gaining feedback from people, relatives and staff and engaged with them regularly to review their view of the care being received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 20 November 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vision Care Services on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to medication management, staff training, managing risks and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Vision Care Services is a domiciliary care agency. It provides personal care to people living in their own homes the community. It provides a service to adults, older adults, people living with dementia, people with physical and/or sensory impairments, people with learning disabilities and people living with mental health conditions. At the time of the inspection, personal care and support was being delivered to 138 people.

Our last inspection took place on 14 June 2017 and at that time we found the service was not meeting two of the regulations we looked at. These related to safe care and treatment (medicines management) and good governance. The service was rated ‘Requires improvement.’ On this inspection we found improvements had been made.

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.

Staff were recruited safely and there were enough staff to take care of people. Staff received appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and received formal supervision where they could discuss their ongoing development needs, although these needed to be more regular.

People who used the service and their relatives told us staff were helpful, kind and caring. Staff explained how they respected people’s dignity. This was confirmed by people we spoke with.

Care plans were easy to follow and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any identified risks. People felt safe with staff and appropriate referrals were being made to the safeguarding team when this had been necessary.

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. The service was compliant with the legal requirements of the Mental Capacity Act 2005 (MCA) and people’s consent was sought prior to staff delivering care and support.

Staff liaised with a range of health and social care professionals to ensure people’s healthcare needs were being met. Medicines were managed safely and people were receiving medicines as prescribed.

Staff knew about people’s dietary needs and preferences.

Records showed complaints received had been dealt with appropriately.

Everyone spoke highly of the registered manager and said they were approachable and supportive. The provider had systems in place to monitor the quality of the service. People who used the service and staff were asked for their views and these were acted upon.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

Vision Care Services is a domiciliary care service regulated to provide personal care in people’s own homes.

At the time of our 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.

The management of medicines was not safe as the systems for recording the administration of medicines were not sufficiently robust. Gaps and inconsistencies in the recording meant the registered provider could not evidence people received their medicines as prescribed. Protocols for the use of ‘as and when required’ medicines and body charts for the use of topical creams and lotions were not used.

The registered provider did not have systems in place to regularly and routinely review staff arrival and departure times. We saw evidence of staff not staying for the full duration of their scheduled visit.

The nominated individual carried out monthly audits which looked at medication, complaints and safeguarding. However, some of the concerns we found during this inspection, particularly concerning the safe management of medicines and visit times had not been identified.

Staff told us their routes were well planned and they had sufficient travel time between visits. People gave mixed feedback regarding the consistency of staff who carried out their visits as it was not always the same staff who provided their care.

People and their relatives felt safe receiving this service. Staff had received safeguarding training and knew how to recognise and report abuse. The recruitment procedures used by the registered provider meant steps were taken to reduce the risk of unsuitable individuals working with vulnerable adults. Risks to people had been identified and assessed in order that levels of risk could be minimised. Staff knew how to respond to emergencies and an out of hour’s service was found to be effective.

People and their relatives shared positive feedback regarding the caring attitudes and values demonstrated by staff who carried out their visits. People told us staff respected their privacy and dignity. The registered provider demonstrated people’s equality; diversity and human rights were upheld.

Care plans were individualised and contained relevant and up-to-date information in order for staff to provide effective care. We saw evidence of regular reviews, including where this was not planned and in response to specific events. People’s mental capacity had been assessed. Staff gave people choices in their daily routines and consent to care had been recorded. Care records showed people were supported to access healthcare services. People’s food and drink needs were met, although one relative shared a concern with us that a staff member had offered a sausage which they had attempted to cook using the microwave.

Staff received an appropriate induction which adequately prepared them for their role. Ongoing support was provided through a programme of supervision. Staff appraisals had commenced before our inspection. Training records showed staff received training in areas considered mandatory by the provider on an annual basis.

Staff felt well supported by the management team as they were able to phone or visit the office to pick up equipment or ask for advice. Monthly team meetings were held and the management team had a system to ensure staff attended these as often as possible. Monthly satisfaction checks with people receiving this service and staff were found to be very effective. Staff spot checks were taking place to help assess the quality of the service provided.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.