Archived: Always There (Nottingham)

This is the summary of what were found:-

Is the service safe?

People who used the service said they felt safe with the people who cared for them. A relative of a person who used the service said, 'I can leave them to do their job while I go to the shops.'

We found the provider had commenced reviews of care and had updated the care plans to ensure people were safe and their individual needs were met.

Staff we spoke with told us they had received relevant training in how to administer medication safely and correctly. One staff member said, 'Medication training was part of my induction. I have also completed a refresher course.

We saw a robust recruitment procedure was in place and relevant checks had taken place to ensure appropriate skilled staff were employed.

Is the service effective?

People who used the service told us the staff cared for them in a caring and effective way. One person said, "The staff support my needs and do what I ask ."

Another person told us they felt the service had improved. They said, 'We used to have many missed calls, but in the last six months they have been very few. The staff always contacts me if they are running late.

Is the service caring?

People who used the service told us the staff attended to their needs. They said they felt staff were caring and respectful. One relative of a person who used the service we spoke with told us their family member made choices and preferences know to the agency and they accommodated this wherever possible.

Is the service responsive?

We found the care coordinators had improved systems in place to monitor and coordinate people's care accordingly. There were systems in place to ensure each call was met.

We found systems were in place to make sure staff rota's were appropriate to the person who used the service's needs. Such as the time they take their medication. It was recorded on the rota the time and duration of the call and notes to make sure the person took their medication at the stated time.

We found although the provider had a complaint system in place, they did not respond or record concerns raised as per their own complaints policy and procedure. This meant the service was not always responsive when addressing complaints.

Is the service well led?

We found a new manager of the service was in place and staff told us they had confidence that information would be shared in a more efficient way with them.

We saw systems were in place to ensure staff were kept up to date with relevant information to help them with in their roles. One staff member said, 'We have team meetings, news letters and telephone contact with the field supervisor to make sure any changes to a person's needs are updated.'

People we spoke with told us they had noted a big improvement to the way the service was run.

We saw different audits were undertaken to measure the quality of the service and to ensure the service was run well.

We found medication audits had taken place. A named person was responsible for the audits. They made sure any audits undertaken regarding medication were robust and covered the requirements of the service policies and procedures. We saw the provider had incorporated medication competencies into staff supervision and the field care staff completed spot checks to monitored care workers performance to ensure they delivered people's care and medication according to their needs and as prescribed by the GP.

We spoke with six people who used the service and eight members of staff.

One person told us they were happy with their current care arrangements. Another person said 'I am quite satisfied with the care; I am told when the care worker is going to be very late.'

We found monitoring systems in place to ensure calls were covered. We saw policies and procedures were in place to cover missed or late calls and staff told us they were aware of these policies.

We found staff rotas were more robust and the continuity of staff was meeting people's needs. However communication within the office still needed improvement.

We found improvements had been made to the way medication was delivered and recorded, but this was not sufficient to demonstrate that staff had fully understood the importance of administering and recording correctly

We revisited the service on 13 September 2013 due to concerns that sufficient improvements had not been achieved since our last visit.

We spoke to five people who used the service and looked at care records that were stored in three people's homes. We also spoke to six members of staff and one relative.

People told us they were happy with the care they received, but had concerns that staff were arriving late for their calls. One person said, 'I don't know where I am with them.' A relative told us the care worker had turned up late to provide care for their family member and they (the relative) had already provided the care.

The service had recruited a number of staff since out last visit in August 2013. We found the recruitment procedure of these staff was not robust and we were concerned that suitable staff had not been recruited.

Systems that were in place to monitoring the quality of the service were not effective.

We revisited the service on 20 June 2013 and 22 August 2013 and found improvements had been made, but not sufficient to achieve full compliance. The provider supplied evidence to demonstrate why this had not happened.

We spoke to six people who used the service and looked at the care plan documents that were stored in their homes. All the people we visited and spoke with were complimentary about the staff.

Care plans were person centred and detailed the person's requirements.

There had been a number of concerns raised regarding the administering of medication. We found there had been improvements made since our visit in November.

Concerns were raised regarding the number of qualified and suitable staff to meet people needs.

We spoke with seven members of staff who told us they felt communications had improved.

We saw people who used the service and staff were able to comment on the service and how it was being run.

We found records were being stored correctly and reviews had taken place for all staff files. There were systems in place to ensure the records were maintained accurately and stored accordingly.

We spoke to five people who use the service and two relatives they told us they felt they and their families were treated with dignity and respect and they had made their own choices regarding their care. People said they had been involved in compiling their care package and had discussions with the staff about the help they required. They were not aware that they had a care file in their home. One person said, "I have no information regarding my care." We found some concerns regarding care files during our visit. The information held at the office was very limited. The person in charge told us they were addressing this issue.

People said they felt safe in their homes and trusted the people who cared for them. One person said, 'The staff are very good and caring."

There was a recruitment process in place, but it was not always followed. The information they received was not acted upon in a safe and appropriate way.

We found evidence that some people who used the service were responsible for taking their own medication and others had to be prompted. We found concerns during our visit. Not all staff were trained to complete the appropriate medication records.

We found records were not always reviewed, or kept accurate and fit for purpose. The person in charge said there had been audits undertaken and gaps had been found. They said work was in progress and they were working with the local authority and improvements were being made.