Archived: Zion Domiciliary Care Agency

Updated 11 December 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was an announced inspection which was carried out by one inspector and took place on 8 & 9 October 2015. The provider was given 48 hours’ that the inspection was going to take place. We gave them notice to ensure there would be senior management available at the service’s office to assist us in accessing information we required during the inspection.

Before the inspection we reviewed all the information we held about the service. We looked at notifications the provider was legally required to send us. Notifications are information about certain incidents, events and changes that affect a service or the people using it. We also looked at all the information we have collected about the service.

The registered manager told us they had received the Provider Information Return (PIR) but did not return it to the Care Quality Commission (CQC) by the requested submission date. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We visited two people in their homes. We spoke with two people and one relative by telephone; two care workers, a care co-ordinator and the registered manager. We looked at seven care records, five staff records and records relating to the management of the service.

Updated 11 December 2015

Zion Domiciliary Care Agency provides care to adults living in their own homes who have a range of needs including learning disabilities.

The registered manager has been in post since June 2015. 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.

People said staff were caring, kind and knew them well. We heard comments such as, “Yes, the (staff) are definitely caring”, “They (staff) care about me as a person. Knowing that they care is important”, “Staff are very kind and ask if I’m okay” and “At the beginning there were some care workers that were not but now they generally seem to be caring.”

We observed a staff member interacting with a person in a respectful way. There was a jovial conversation between them. The person told us they had developed a good connection with the care worker. People said they were involved in the planning of their care however, one person said they did not have a copy of their care plan.

People said they felt safe with Zion Domiciliary Care Agency and knew what to do if they felt unsafe. We heard comments such as, “Generally I am safe and quite secure.” Staff attended relevant training and knew how to protect people from abuse. Most people felt there were enough staff. This was because they always had the required number of care staff to attend to their care needs. A review of staff rotas showed there was adequate staff covering shifts.

People gave mixed comments in regards to staff being knowledgeable and skilled to do their jobs. Whilst most people thought staff were experienced and skilled, other people mentioned issues with care workers not understanding the English language. Staff received appropriate induction, training and supervision.

Spot checks were carried out to ensure staff followed the service’s procedures. Where areas of concern were identified, appropriate action was taken.

People’s care needs and risk assessments were not regularly reviewed. One person commented, “Since I was released from hospital they (staff) haven’t visited to review my care.”

Care records reviewed contained no information in regards to people’s preferences or wishes in regards to end of life care. People said the service had not discussed end of life care with them.

We have made a recommendation about the service seeking people’s preferences in relation to end of life care, base upon best practice.

People were supported to have sufficient food to eat and drink. Care records contained people’s nutritional needs; what their food preferences were and what support they required. The service worked with other health professionals to ensure people’s health needs were met.

Staff were aware of the implication for their care practice in regards to the Mental Capacity Act 2005 (MCA). Where people were not able to make specific decisions, care records showed who had legal powers to make important decisions on their behalf. We noted the service did not carry out its own mental capacity assessments. This meant mental capacity assessments undertaken were not time and decision specific. We have made a recommendation for the service to seek guidance on undertaking mental capacity assessments based upon the MCA.

People said they knew how to make a complaint and felt comfortable to do this. Staff knew how to handle complaints and confidently spoke about the procedures they would follow. This was in line with the service’s complaints policy.

People gave positive feedback in regards to how well the service was managed but also spoke about where there could be further improvements. For instance, training for staff where English was not their first language and communication in regards to what was happening in the service.

Quality assurances systems in place to monitor and improve the quality and safety of the services provided was not being used effectively. There was no evidence of analysis and communication to let people and staff know the results of the surveys and any actions the service was going to take. Audits of care plans failed to pick up one person did not have a copy of their care plan and formal reviews of people’s care were not regularly being undertaken.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.