8 March 2019
During a routine inspection
Pegail Care Limited is a domiciliary care agency providing personal care to people in their own homes. At the time of inspection there were 31 people using the service.
People’s experience of using this service:
Feedback from people was generally quite poor with particular reference to the timing of care visits and management of the service. People reported experiencing late visits and some had missed visits. Poor communication between themselves and the management team around the timing of the visits and dealing with people’s concerns also impacted on people’s experience of using the service.
There were systems in place to respond to complaints but people were not always satisfied with how their complaints were dealt with. Lessons had not always been learned as the complaints and safeguarding alerts showed ongoing failings which had not been addressed. Whilst there was evidence of the service engaging with people to invite their feedback on the service, for example, sending out annual satisfaction surveys. This along with other quality assurance mechanisms had not been effective at picking up on concerns and failings to make required improvements.
Risks to people had been assessed, however these lacked detail and were not always tailored to reflect people’s individual needs, particularly with regard to people’s health conditions.
We made a recommendation about risk assessment and management.
Staff received training in how to administer medicines but we noted inconsistencies in how staff competence was assessed. The current electronic system of recording and auditing medicines was not robust and required strengthening.
We made a recommendation about safe medicine management.
At our previous inspection we found unsafe recruitment practices in place which meant the service was in breach of regulation 19. At this inspection we found staff were recruited safely and the service was no longer in breach.
Staff had received training in safeguarding and knew how to recognise and report abuse. The care manager understood their safeguarding responsibilities and had shared concerns with the local authority appropriately.
A positive feature of the service was the fact that people were supported by a regular group of four to five care staff. This meant people benefitted by being cared for by staff with whom they were familiar.
Staff completed training in infection control and had access to protective clothing to prevent the spread of infection. There was a system in place to record and manage any accidents and incidents.
Staff were provided with training, supervisions and appraisals. However, we received mixed feedback from people about the knowledge, skills and abilities of staff. Staff received training in the mental capacity act and understood how to help people make their own decisions.
We made a recommendation about staff skills and training.
Not all people had an assessment when they joined the service. People's choices were not always explored and documented. Late care visits meant that peoples routines and preferences were not always respected. Where care plans were in place these lacked detail to support a person-centred approach. Regular reviews of people’s care were not completed. This meant that people were not always included in decisions about their care and support.
We made a recommendation about the assessment and care planning and review process.
Staff supported people with eating and drinking, however care plans for nutrition and hydration lacked detail. Staff were vigilant in noticing and reporting concerns about people health and the service worked with other health and social care professionals to manage these concerns.
We received mixed feedback regarding the qualities of the staff team. Most people said staff were kind and caring and treated them with dignity and respect. However, some people felt staff could be friendlier and be mindful to ensure people’s privacy was maintained.
Staff were aware of the importance of promoting people’s independence and were able to describe how they helped people to do this.
Staff completed end of life care via online training and the service had recently funded three carers to attend a three-day course on how to support people well at the end of their lives.
We made a recommendation about documenting people’s end of life preferences.
Staff were involved in the running of the service and attended monthly staff meetings. Staff told us they felt listened to and included. Staff felt well supported and enjoyed working at the company.
Previously the service was found to be in breach of regulation 18 (registration regulations) for failing to submit statutory notifications. This failure had been addressed and the service was no longer in breach of this regulation.
Rating at last inspection:
Requires Improvement with two breaches of the regulations. (report published in January 2018)
Why we inspected:
This was a planned inspection based on the rating at the last inspection. The overall rating is Requires Improvement.
Follow up:
We will continue to monitor the service through the information we receive.