27 February 2015
During a routine inspection
This was an announced inspection carried out on the 27 February 2015.
Cachet Care Services provides personal care and support in people's own home. The office is situated on one of the main roads, close to Bolton town centre.
There was a registered manager in place. 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.
At the last inspection carried out in November 2013, we did not identify any concerns with the care and support provided to people by the service.
People who used the service and relatives told us they felt safe and trusted staff to come into their home to provide care and support. One person who used the service told us; “They are spot on, champion and everything. It’s a pleasure to meet them. They are excellent at time keeping.” Another person who used the service said “I’ve been using them since 2012, I think the service is excellent. I have had others so I can say. They are very good at time keeping, or if they are late, they give me a ring to let me know they will be a bit late.”
During our inspection, we checked to see how the service protected people against abuse. We found suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse.
We reviewed a sample of six recruitment records, which demonstrated that staff had been safely and effectively recruited.
We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure the service was safe. We looked at a sample 10 medication administration records (MAR) which detailed when and by whom medicines were administered. We found accurate records were maintained without any signature gaps in any of the records we looked at.
We looked at the training staff received to ensure they were fully supported and qualified to undertake their roles. New staff explained to us the comprehensive induction course they were expected to undertake on joining the service.
Staff told us they received regular training including refresher training, which we confirmed by looking at staff training records. We looked at future scheduled training which was organised by the deputy manager. This included obtaining National Vocation Qualifications (NVQ) in social care and training in medication, food hygiene and first aid.
Staff told us they felt valued by the service, were supported in their role and received regular supervision. One member of staff told us; “I had personal problems last year, the understanding and flexibility was fantastic, absolutely no pressure. I feel very supported in my role.”
We looked at the way the service managed consent to any care and support provided. We found that before any care and support was provided, the service obtained consent from the person who used the service or their representative. We were able to verify this by speaking to people who used the service and speaking to staff.
We found that written consent had also been obtained within care files, which included a signed agreement between the client and the service. Written consent had also been obtained before the service administered medication.
We spoke with staff to ascertain their understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. Apart from one member of staff who had received training with another organisation, all staff we spoke with stated they had not received any training and had limited or no knowledge of the legislation. We confirmed from viewing training records that staff had not received any training provided by the service. We spoke to the registered manager about these concerns, who was able to reassure us that training would be scheduled during the year.
People and relatives consistently told us the service was professional, kind and caring. One person who used the service said “They are very caring and respectful, they are like family.” Another person told us; “They are very compassionate and caring, I can’t fault them.”
During our visits to people’s homes, we observed the interaction between staff and people who used the service. We noted that staff were caring and affectionate to the people they supported.
Staff told us people were taken out on social outings and encouraged to socialise with other people who used the service. We spoke with a member of staff who was responsible for coordinating social outings for a number of people who used the service. This included visiting two luncheon clubs each week which was organised by a local church.
People and relatives told us they were involved in making decisions about their care and were listened to by the service. They told us they had been involved in determining the care they needed and had been consulted and involved in reviews of care.
Staff told us that the service discussed peoples’ needs to see if improvements in the service could be made. One member of staff said “We do have staff meetings where we discuss ideas and suggestions in relation to people’s individual care. We discuss how improvements can be made to the care they receive.”
The service policy on compliments and complaints provided clear instructions on what action people needed to take. The details of the complaints process was contained with a ‘service guide’ and included contact details for CQC and Local Government Ombudsman.
Each and every person we spoke with told us that the service was well run and singled out the registered manager for praise in respect of the leadership they provided. One relative who used the service said “The manager is top class and aims to provide top quality care and leads very well.”
Staff told us that the management expected high standards and that an open and transparent culture was promoted by the service. We found the management structure of the service provided clear lines of responsibility and accountability. Staff we spoke with had a good understanding of their roles and responsibilities.
We found that the service did not record regular audits to monitor the standard of service delivery, such as medication audits and competency / spot checks on staff. However, we were able to confirm that staff were regularly monitored by the registered manager who also sought feed-back from people who used the service about the quality of care received.
The service had policies and procedures in place which covered all aspects of the service delivery. The policies and procedures included safeguarding, medication, data protection and health and safety. Staff were expected to sign to confirm they had read and were familiar with individual policies.
We found the service had been accredited with Investors in People recognition. Investors in People is a management framework for high performance through people.