The inspection team consisted of one adult social care CQC inspector. On the day of our inspection 65 people used the service. We spoke by telephone, with a total of 11 people who used the service or, where appropriate, their representative or family member. We also spoke with four care workers, the deputy manager and the registered manager. We reviewed records relating to the management of the home which included client visit records, incident records and staff training records. We looked at nine people’s care plans and records relating to staff supervision and appraisals. We viewed five records relating to people who received personal care, referred to as homecare clients, and four relating to people who received complex care.New information of concern had been brought to our attention. This was in relation to the delivery of safe care to people, staff training, staffing levels, accuracy of people’s records, and monitoring of the quality of the service. We considered these concerns as part of our inspection.
We considered all the evidence we had gathered under the outcomes we inspected. We used this information to answer the five questions we always ask; is the service caring, responsive, safe, effective and well led?
This is a summary of what we found.
Is the service safe?
Some areas of the service were safe. People who use the service told us they felt safe when receiving personal care in their homes from the care workers. One person told us "I feel very safe and am confident in the care provided.” We found there were enough qualified, skilled and experienced staff to meet people’s needs safely.
We found the provider had systems in place to identify, assess and manage risks to people’s health, safety and welfare. The provider had reviewed people's risk assessments to reflect changes in their needs.
Is the service effective?
The service was effective in most areas. We found issues affecting people’s care and welfare had been identified, and appropriate measures had been implemented to improve people’s wellbeing. For example, accidents and incidents had been recorded and reviewed to ensure issues and trends had been identified, and actions taken to reduce the risk of repetition.
We found that all staff had been suitably supported to complete and refresh all mandatory training required by the provider. However, not all staff had attended an appraisal meeting. None of the staff had received regular individual supervisory meetings to discuss issues, concerns and aspirations to promote their development and understanding of their role and responsibilities. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff.
People and relatives we spoke with were complimentary about the care received. One relative told us “The staff are very knowledgeable, they understand X’s needs.” Another relative said “They (the provider) are a very reliable and effective service.”
We found people’s care plans and other records relevant to the management of the service were accurate and fit for purpose. People’s records and confidential staff information were stored securely.
Is the service caring?
People were supported by kind and supportive staff. People and relatives told us that staff were very caring. One person told us “The care X(a staff member) provides is proper care. X actually cares about me.”
People told us the care workers gave encouragement when supporting them. People were able to do things at their own pace and were not rushed. One person told us “The team are very caring. They do not rush me.” Another person said “Staff let me do as much for myself as possible. They have helped me to have a normal life, to be more independent.”
The compliments folder we looked at recorded responses from people and their relatives. We saw feedback was positive. People rated staff support and care highly.
People told us they were always asked if they were happy with the care they were receiving when staff visited or during a review of their care plan. There were processes in place to ensure people and their relatives could provide feedback to the provider about the quality of the service received. Overall, where shortfalls or concerns were raised these were addressed.
Is the service responsive?
The service was responsive because relatives we spoke with confirmed they had been listened to and provided examples of improvements made to the service following their feedback. One person told us “They (the provider) are very flexible. They will change the visit times to meet my needs.” Another person said “I can speak to carers directly if I have any problems. I feel listened to because these problems are then resolved by the staff.”
We saw people’s and relative’s feedback was sought during quality spot check visits, regular telephone calls and surveys. We found the provider was responsive to comments from people.
People knew how to make a complaint and who to go to if they were unhappy. We looked at how complaints had been dealt with by the provider, and found that the responses had been thorough, and timely. People told us that when they had informed the provider of any concerns these had been addressed promptly, to their satisfaction.
Is the service well-led?
We spoke with people and their relatives who told us that they felt the service was well led. One person told us “This is a well led organisation. They are keen to make everything ok.” A relative said “This service is well led. Communications from the office are very good. ” People and their relatives told us they could speak with managers when they wished to, and stated that managers were approachable. The staff were very satisfied with the leadership and the management of the service. The registered manager and deputy manager were present at the service daily, and an on call service ensured 24 hour contact for staff if they had concerns or required management guidance.
Audits of the service had been completed to ensure that the quality of the service provided had been monitored and met the required standard. The provider did ensure the feedback of all people who used the service, their relatives and staff were regularly sought to improve the service. The provider showed us examples of actions taken in response to comments from people. This meant the provider had acted on feedback received from some people to improve the service.
However, we found the service was not always well led. This was because there was no system in place to monitor the actual duration of each staff visit to people’s homes. Monitoring was necessary to ensure actual visiting times reconciled with those identified as a requirement by the local authority and provider to ensure the care delivered met people’s identified needs. In three people’s records we looked at we noted occasions when staff visit times were actually less than the time identified as a requirement. This meant people may not have received all of the care required to meet their identified needs to ensure their health, safety and welfare.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to ensuring systems are in place to identify assess and manage risks relating to the health, welfare and safety of people that may arise from situations such as discrepancies between actual and required visiting times.