8 August 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.
The inspection was announced. We gave the service 48 hours’ notice of the inspection visit because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.
On 18 July 2018, we spoke with people and their family members during telephone conversations. Inspection site visit activity took place on 19 July 2018. It included a visit to the location to speak with the registered manager and to review care records, policies and procedures and carried out face to face interviews with staff. The inspection was carried out by one adult social care inspector and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before our inspection we reviewed all the information we held about the service, including previous inspection reports. We also examined notifications received by the Care Quality Commission. We contacted the local authority safeguarding and commissioning teams and Healthwatch. Healthwatch are a consumer group who champion the rights of people using healthcare services.
We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection we spoke with the registered manager, the operations manager, a supervisor, and five care staff. We spoke with nine people who used the service and seven relatives over the telephone.
We looked at six people’s care plans, risk assessments, three staff files, policies and procedures, surveys, meeting minutes, the scheduling system and associated processes.
8 August 2018
This inspection took place on 18 and 19 July 2018 and was announced. We gave the provider 24 hours’ notice of the inspection to ensure we could meet with staff and speak with people using the service in their own homes.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults and younger disabled adults. On the day of our inspection there were 60 people receiving the regulated activity of personal care. This was the first inspection of the service since the registration of the service changed in 2017.
Not everyone using the service receives regulated activity; The Care Quality Commission (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.
The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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. The registered manager had extensive experience of working in the social care sector.
Notifications of significant events were submitted to us in a timely manner by the registered manager.
Medicines administration was safe. This was regularly audited and staff competencies monitored by senior staff.
People were supported to take risks safely and personalised risk assessments were in place to ensure people were protected against a range of risks.
Staff had received safeguarding training and were able to describe types of abuse and what they would do to report concerns and protect people.
Staff recruitment was carried out safely with robust safety checks in place for new staff.
New staff received induction training and were accompanied and supported by dedicated mentors called ‘care coaches’ to enhance their induction and extend it if necessary.
People were supported to have choice and control over their own lives from being supported by person centred care. Person centred care is when the person is central to their support and their preferences are respected.
There were sufficient staff to meet people’s needs safely, with travel time included and supervision checks undertaken to ensure staff completed care visits as agreed.
Staff were trained in safeguarding, first aid, moving and handling, the Mental Capacity Act, infection control and food hygiene. Additional training was in place or planned in areas specific to people’s individual needs.
Staff had a good knowledge of people’s likes, dislikes, preferences, mobility and communicative needs. People we spoke with gave us positive feedback regarding staff and how their needs were met.
People were supported to maintain their independence by staff that understood and valued the importance of this.
Care plans were sufficiently detailed and person-centred, giving members of staff and external professionals relevant information when providing care to people who used the service. Care plans were reviewed regularly with the involvement of people who used the service and their relatives.
The registered manager displayed a sound understanding of capacity and the need for consent on a decision-specific basis. Consent was documented in people’s care files and people we spoke with confirmed staff asked for their consent on a day to day basis.
Health care professionals, including GP, dietitians or specialist consultants were involved in people's care as and when this was needed and staff supported people with any appointments as necessary.
Staff, people who used the service, relatives and other professionals agreed that the registered manager led the service well and was approachable and accountable. We found they had a sound knowledge of the needs of people who used the service and clear expectations of staff. They had plans in place to make further improvements to service.
A programme of audits was carried out by the registered manager and these were effective at improving the service.
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.
Infection control measures were in place for staff to protect people from the risk of infection through training, cleanliness and protective clothing where required.
People and their relatives were able to complain if they wished and were knowledgeable of how to complain or raise minor concerns.
People who used the service and their representatives were regularly asked for their views about the support through questionnaires and feedback forms.
Information was made available to people in different formats if required and a communication and accessible information policy was in place.