Archived: Home Help Petersfield

The focus of the inspection was to answer five key questions;

Is the service safe,

Is the service effective,

Is the service caring,

Is the service responsive

And is the service well-led?

As part of this inspection we visited four people who use the service and we spoke with a further six people, four people’s relatives and one person’s representative. We spoke with the provider, the nominated individual, compliance manager, the registered manager of the provider's second location Apuldram, the deputy manager, staff trainer and five care staff. We reviewed records relating to the management of the service which included, nine care plans, daily care records and four staff records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes and people who receive care in their own home. The nominated individual was aware of the recent changes to the guidance which meant more peoples situations would now qualify for consideration to ensure they were not being deprived of their liberty. They planned to provide guidance and training for staff in relation to this.

The provider needed to update their safeguarding and whistleblowing polices to reflect best practice and provide staff with relevant information. The provider had not given appropriate consideration at the time to an issue that may have been a safeguarding matter. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safeguarding.

At our last inspection we found there was a lack of guidance in people’s care plans. We found that there was now clear information on people’s care plans with regards to the level of support they required with their medicines. However, people's medicine risk assessments lacked clarity. There was a lack of detail in relation to people’s prescribed creams and eye drops. The system to check that medicine administration records (MAR) sheets had been signed was not robust. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to medicines.

We found that the provider had failed to provide a MAR sheet for one person, to ensure that there was a clear audit trail of the administration of their medicines. Care plans did not always contain up to date information with regards to people’s care calls. The provider had not always ensured that accurate records had been maintained in relation to people’s care. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to records.

There was insufficient analysis of the staffing levels required to meet people’s identified needs. There had been insufficient staff employed by the provider to ensure that people’s calls had always been attended, which meant that people did not always get the care they were assessed as needing. One person’s relative told us that the care was “Overall fine, but we were badly let down when staff did not attend.” We have taken action to ensure that the provider becomes compliant in relation to staffing.

The provider had ensured that appropriate checks had been undertaken in relation to staff before they had commenced work.

Is the service effective?

The provider had introduced forms for people to sign that they consented for the care provided, however not all people had completed them. One person told us “No I haven’t signed a consent form.” Where people lacked the capacity to consent, the correct legal processes had not always been followed to ensure that their rights were protected. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to seeking people’s consent.

The provider had taken action to ensure that people’s care plans provided staff with information about people’s care needs and preferences. One person’s relative told us “Staff are caring and follow the care plan.”

We found evidence that not all relevant staff had received the required training to provide one person’s specialist care. The provider’s business continuity plan had failed to ensure that the needs of those most at risk from not having their care provided were protected. We have taken action to ensure that the provider becomes compliant in relation to people’s care and welfare.

Is the service caring?

The service provided by staff was caring. The majority of people we spoke with were pleased with the care provided by staff. One person’s relative told us “Staff are caring.” One person told us “Staff understand my needs, it is like a friend coming in.”

Is the service responsive?

The service had not always been responsive to people’s needs. People told us that the provider had failed to provide extra care calls when these had been requested. We saw evidence that the provider had failed to take appropriate action in relation to a complaint. The provider had sought people’s feedback on the service but had not taken action to fully addressed the issues identified. We have taken action to ensure that the provider becomes compliant in relation to assessing and monitoring the quality of service provision.

Is the service well-led?

The service had not been well led. There was no registered manager in post and the service was being overseen in the interim by the nominated individual. The need for all staff to deliver care meant that the deputy manager was unable to spend sufficient time on their management duties. There was a lack of systems in place to monitor the quality of the service. We have taken action to ensure that the provider becomes compliant in relation to assessing and monitoring the quality of service provision.

All the people we spoke with were generally happy with the service provided. One person told us, ‘I look forward to them coming’ ‘I can’t think of anything they could do better’. Another person said, ‘they are brilliant…my carer knows every single thing about me, they encourage me to be independent…they respect my choices, they always ask me before they start my care, they ask me how I feel’.

However we found that there were not adequate arrangements in place to make sure that staff acted in accordance with legal requirements where people lacked capacity to consent to their care.

People’s needs were assessed prior to their care starting, but we found that the care plans and risk assessments were not always sufficiently detailed about the key risks to a person’s health and welfare and how these should be managed.

We found that staff were trained in medication management and there were suitable arrangements in place to record the administration of people’s medicines. However we found staff did not always have clear guidance about the level of support the person required with their medicines.

The service had suitable staff recruitment and selection processes in place and were carrying out the relevant checks when they employed staff.

We found that there were not adequate arrangements in place for assessing and monitoring the quality of the service. Although there had been systems in place to check the quality of care given, these were not currently being used by the service due to difficulties recruiting team leaders.

In this report the names of two registered managers (Lesley Johnsen and Miss Jacqueline Theresa O'Byrne) appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a registered manager on our register at the time. At the time of our inspection the provider did not have a registered manager in post, but had just appointed a new manager who we were advised would be applying to become registered manager.