Background to this inspection
Updated
14 September 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 prompted in part by information of concern raised about the safety of care. The service had sent an action plan to CQC in May 2018 to address shortfalls identified by the provider. The action plan set out the main shortfalls related to recruitment processes, care plans, medicines administration records (MARs), risk assessments, quality assurance, training and spot checks.
Inspection site visit activity started on 25 July 2018 and ended on 6 August 2018 and was unannounced. It included telephone interviews with six people and three relatives. We visited the office location on 25 July 2018 to see the manager and office staff; and to review care records and policies and procedures. Two inspectors visited the office, one inspector carried out telephone interviews.
Before the inspection we reviewed records held by CQC which included notifications, complaints and any safeguarding concerns. A notification is information about important events which the registered person is required to send us by law. This enabled us to ensure we were addressing potential areas of concern at the inspection. Before the inspection the provider completed a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the PIR prior to our inspection.
We visited two people at home and spoke with five people by telephone about the care they received. We also spoke to seven staff and the registered provider. We looked at four care plans and seven staff files. We checked the complaints log, accident/incident records and surveys completed by people who used the service. We also checked quality monitoring audits and records of spot checks on staff.
This was the first inspection undertaken at this service.
Updated
14 September 2018
This service is a domiciliary care agency which provides personal care and support to people in their own homes. It provides a service to older adults. Not everyone using the service receives 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 visit the service supported 11 people in the Surrey area.
The inspection took place between 25 July and 6 August 2018 and was unannounced.
This service had not been inspected before. The service is in the process of registering a new manager with CQC who has applied for registration. 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.
CQC was contacted by the provider in April 2018 to discuss an action plan that had been created to address various issues that had been identified in relation to the quality of care. This was still in the process of being implemented by management and the provider at the time of the inspection.
Recruitment policies and procedures were not being adhered to, to ensure that staff were suitable to work with people. The provider was not ensuring safe and proper recording of medicine administration. There was no overview or analysis of accidents and incidents to enable staff to see patterns or trends to reduce the risk of an incident or accident re-occurring. Care plans were not always person centred or detailed.
Staff had not completed the mandatory training set out by management and had not been signed off to work independently which was contrary to the providers own policy. Staff supervisions and appraisals had not been completed. The action plan created to improve, develop and sustain the service had not been completed by management. There were no audits or quality assurance processes being completed by management except for spot checks on visits.
Staff managed risks to people’s safely. Where incidents had occurred, the staff took appropriate action to keep people safe. Staff understood how to identify and respond to suspected abuse. Staff took appropriate measures to stop the spread of infection when care was being provided. There was a business continuity plan in place for people in case of an emergency or disaster.
People were supported to prepare and eat food that they liked in line with their dietary requirements. People's needs and choices were assessed and people were involved in important decisions. Staff worked alongside healthcare professionals and other organisations to meet people's needs.
Staff treated people in a caring, considerate and respectful way. People told us that they felt staff were kind towards them. People's choices were considered in the delivery of care.
People's histories and care needs were included in their care plans which helped staff provide responsive care. People received personalised care that reflected their needs, interests and preferences. People had access to activities that reflected what was important to them. Regular reviews were undertaken and any changes to people's needs were actioned by staff. Staff communicated any changes in care with each other. The provider had a clear and accessible complaints procedure although some responses had not been recorded.
No one was receiving end of life care at the time of our inspection. Surveys and newsletters had been completed to involve people and staff in the running of the service.
During our inspection we found six breaches 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.