Archived: Key Staff

Key Staff is a domiciliary care agency based in Ledbury, Herefordshire. The service supports children and younger or older adults, who may have learning disabilities, autistic spectrum disorder, dementia, mental health care needs or physical disabilities. At the time of our inspection, there were 10 people using the service.

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

Procedures for supporting people to manage their medicines safely were not sufficiently robust or always followed by staff. People’s medicines records were not accurate or complete, increasing the risk of medication errors. Assessments of the risks to individuals, including potential hazards within their home environment, were not completed on a consistent basis. Prospective staff were not always subject to appropriate pre-employment checks to confirm their suitability to provide care in people's homes. People did not always receive a consistent and reliable service from the provider, due to staffing issues.

The provider did not fully promote people’s rights under the Mental Capacity Act 2005. The shortfalls in the quality and safety of people's care did not reflect a caring service. The care provided did not always meet people’s individual needs and requirements. The provider did not have effective systems and processes in place to assess, monitor and improve the quality and safety of people’s care. Staff and some of the people and relatives we spoke with expressed concerns about the overall management of the service, highlighting the need for better organisation.

Staff understood how to identify and report potential abuse involving people who used the service. They took steps to protect people from the risk of infections through, for example, making appropriate use of disposable gloves and aprons. Staff understood how to record and report any incidents or accidents involving people who used the service, in order that the management team could review these reports.

The provider had introduced a formal system of staff supervision and appraisal. Staff received training designed to give them the knowledge and skills they needed to work effectively. People’s individual needs and requirements were assessed before their care started. They had the level of support they needed to prepare their meals and drinks. Staff and management recognised the need to work effectively with community health and social care professionals involved in people’s care. People’s health needs were assessed and plans were in place to manage these.

Individual staff treated people in a caring manner and knew the people they supported well. Staff and management recognised the need to promote people’s equality and diversity in delivering their care. People and their relatives had support to express their views about the care provided. People were treated with dignity and respect by staff.

People’s care plans were individual to them and accessible to staff. They included an assessment of people’s communication needs. The provider had a complaints procedure and people and their relatives were clear how to raise any concerns or complaints about the service.

The management team recognised their responsibility to be open and honest with people and relevant others if something went wrong with the care provided. They took steps to engage people, their relatives and staff in the service.

Rating at last inspection

The last rating for this service was Requires improvement (published 18 September 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches at this inspection. These relate to the provider’s failure to manage risks to people who use the service, the lack of consistent pre-employment checks on prospective staff, staff induction procedures and the ineffectiveness of the provider’s quality assurance systems and processes.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Key Staff is a domiciliary care agency. It provides personal care to people living in their own houses in the community. The service supports children and younger or older adults, who may have learning disabilities, autistic spectrum disorder, dementia, mental health care needs or physical disabilities. At the time of our inspection visit, seven people were using the service. Not everyone using Key Staff 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.

The service is required to have a registered manager and there was a registered manager in post at the time of our inspection. 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.

During our inspection, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff did not have access to regular formal supervision and appraisal and the provider did not maintain adequate records of staff induction. The provider’s processes for assessing the risks to people’s safety and wellbeing were not sufficiently robust. Staff had not been provided with clear guidance on the expected use of people’s ‘as required’ medicines. People’s rights under the Mental Capacity Act were not fully promoted. People’s care plans had not been kept under regular review and were not always individual to them. Staff expressed mixed views about the overall management and leadership of the service. The provider's quality assurance systems and procedures were not sufficiently comprehensive.

Staff had training in, and understood, their role in protecting people from abuse and discrimination. People’s received a consistent and reliable service from Key Staff, provided by familiar staff. The provider undertook checks to confirm prospective staff were suitable to care for people in their own homes. Staff received training and had access to appropriate personal protective equipment to protect people from the risk of infection.

Staff received a range of training to help them provide people with care and support safely and effectively. People’s individual needs and requirements were assessed prior to their care from Key Staff commencing. People had the support they needed to prepare food and drinks, and any associated risks were managed. Staff helped people seek professional medical advice and treatment if they were unwell.

Staff supported their family members in a kind and caring manner. People’s relatives felt able to freely express their views about the service provided to their family members. People’s communication needs had been assessed and staff had been provided with guidance on promoting effective communication with individuals. People were treated with dignity and respect at all times.

Staff understood the need to follow people’s care plans, which covered key aspects of their care and support needs. People’s relatives were clear about how to raise any complaints about the service and had confidence they would be listened to.

Staff found the management team accessible and approachable. The registered manager had a clear vision of the culture aimed to promote within the service and staff felt valued in their work. People’s relatives had a positive relationship with the care staff and management team.

You can see what action we told the provider to take at the back of the full version of the report.