Archived: Shirecare

Shirecare is a domiciliary care agency. It provides personal care to people living in their own homes within and around Nottingham and Derby. It provides a service to older and younger adults living with a range of health conditions and needs, to live independently in the community. Not everyone using Shirecare receives a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, 56 people were receiving personal care as part of their care package.

People's experience of using this service and what we found

Improvements had been made to the systems and processes that monitored the quality and safety of the service. Further work was required to implement ways of analysing incidents and late or missed calls for themes and patterns to support any learning opportunities. The registered manager took immediate action during the inspection to address this.

Improvements had been made to how medicines were managed. Action was still required to ensure hand written medicine administration records, were checked and signed by a second staff member to avoid mistakes being made. During the inspection the registered manager took action to address this. Following the inspection, the registered manager confirmed this had been completed and a new system had been introduced.

Whilst every effort was made for people to receive care from regular staff at the times they wanted, a reoccurring theme from people was they had experienced late calls. Three people reported they had experienced a missed call; however this could not be evidenced.

People's needs, preferences and routines were assessed and acted upon. Guidance provided in care plans for staff had been improved upon. However, guidance and information were not consistently detailed.

Risks associated with people’s care needs, including the environment had been assessed and staff had guidance of how to manage any known risks. Staff had received training in safeguarding adults and the registered manager was aware of their role and responsibilities to act on any safeguarding concerns.

Staff recruitment was ongoing and at the time of the inspection, sufficient staff were deployed to meet people's care needs. Robust checks were completed on staff's suitability to provide care before they commenced their employment.

People were protected from the risk of cross contamination because best practice guidance in infection control practice was followed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff received an induction and improvements had been made to the training staff received. Staff had spot checks completed to review their practice to ensure standards were maintained.

People were supported with their health care needs. Staff monitored people's health and care needs and shared information with healthcare professionals when required. Where people required assistance with nutrition and hydration needs, staff had detailed guidance of the support people required.

People were complimentary about staff and considered them to be kind and caring. At the time of the inspection no person was receiving end of life care, however staff had received training in this area of care. People received care and support that respected their privacy and dignity. People's communication and sensory needs were assessed.

The providers' complaints procedure had been shared with people and people received opportunities to share their experience about the service.

The registered manager and provider understood their registration regulatory responsibilities.

Rating at last inspection

The last rating for this service was Requires Improvement (published 31 October 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations. The service has improved to an overall rating of Good. Responsive remains Requires Improvement, further action is required to ensure people receive a service that is consistently responsive.

Why we inspected

This was a planned inspection based on the previous rating.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

This is the provider’s first inspection since registration.

The service had a registered manager at the time of our inspection visit. 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.

People did not consistently receive safe support in the management of their medicines. People’s medicine administration records, did not provide sufficient assurances that people had received their prescribed medicines safely. National best practice guidance in the management of medicines were not fully followed.

Risks associated with people’s needs were not consistently assessed, staff therefore did not always have the required guidance to manage and reduce risks. There was no formal process to review accidents and incidents, this therefore impacted on the provider having clear oversight of any trends and patterns developing.

There were sufficient staff to meet the current care needs of people and recruitment checks were completed, to inform safe recruitment decisions. Safeguarding procedures were in place to inform staff of how to recognise and report safeguarding concerns. Safeguarding refresher training for staff was overdue, but action was being taken to address this by the management team.

Staff followed best practice guidance in relation to the prevention and control of risks associated with cross contamination.

The assessment of people’s needs did not fully consider the protected characteristics under the Equality Act. This was a concern because people may have been exposed to discrimination. Staff had received an induction, refresher training was overdue, but the management team were aware of this and were taking action to address this. Staff had not received supervision and appraisal meetings at the frequency the provider expected.

People were supported with any needs identified with eating and drinking. People’s health needs were monitored and staff supported people where required if they were unwell.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were involved in planning and reviewing their care. However, reviews were not completed at the frequency the provider expected or routinely, when changes occurred. People were supported by staff in ways which promoted and respected their dignity and independence. Information about an independent advocacy service had not been made at the time of this inspection, but the management team agreed to source this information and make available to people.

People’s care plans were not consistently detailed to provide staff with guidance to meet their individual needs. However, people were positive and complimentary about how their care needs were met. The accessible information standard had been considered by the provider. The complaints procedure had been made available. At the time of this inspection end of life care was not provided.

During this inspection, we found two breaches of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.