This inspection of Quality Support Solutions took place on 04,05 and 07 December 2018 and was announced. The service was last inspected in February 2016 and the rating at the last inspection was Good.Quality Support Solutions is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people, younger adults, people living with a physical disability, people living with a sensory impairment and people living with learning disabilities or autistic spectrum disorder. People using the service were all being supported with the regulated activity which the service was registered to provide.
There were 19 people using the service when we completed the inspection. There was a registered manager employed at the service. 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.
The service was last inspected in February 2016 and the rating at the last inspection was Good. At this inspection the rating has deteriorated to Requires Improvement.
We found that the service was not always safe. Risk assessments for some people were not detailed and did not explain how to reduce risks. Known risks were not always documented in people's care plans.
The current rota system meant that there was no way of effectively monitoring whether staff were arriving for calls at the correct time or staying for the entire call duration. People told us about calls that had been missed or late however these had not been picked up by the current rota system.
Staff members had necessary checks completed before starting employment including a disclosure and barring services (DBS) check.
People were not always supported safely to take medicines. Some people were prescribed as and when required (PRN) medicines however the protocols for these were often not clear as to when or how medicines should be administered. Staff members did not receive regular competency checks to ensure that they were able to support people with medicines safely. Monitoring of medication stock and administration records were not effective.
There were systems and processes in place to protect people from harm or abuse.
The service was effective although some improvements were needed. Some staff members had not received regular training in some areas of their job roles. Staff members did not receive regular supervisions or observations of practice to ensure that they were performing their job roles.
People were supported to maintain their health and well-being. The service worked with and referred people to other health and social care professionals to support people’s wellbeing. People were supported with their dietary needs where needed.
Consent to care and treatment was obtained from people and people were supported in line with the principles of the Mental Capacity Act (2005).
People were positive about the care and support that they received from staff members. There were systems in place to ensure that people’s privacy and dignity were respected and that people had the opportunity to remain as independent as possible and make choices about their care and support.
People were supported with kindness and respect and staff members. People and those important to them had been involved in making decisions about their support as much as possible.
People received care that was responsive to their needs. However, the service was not always responsive as changes to people’s care was not always documented thoroughly. People’s care plans were task-orientated and there was little information about people’s preferences, likes and dislikes in their care plans.
Assessments completed for people before they started using the service were task orientated and did not go in to detail about people’s preferences with regards to the support they received.
People's complaints and comments about the service were not always documented or responded to appropriately. People's concerns had not been picked up in quality audits and late calls had not been monitored or noted within the current rota monitoring systems.
Quality monitoring and the recording of records were not operating effectively which meant that the provider is in breach of Regulation 17 of the Health and Social Care Act 2018 (Regulated activities) Regulations 2014. Good governance.
Rota monitoring systems were not effective at monitoring whether peoples care calls were happening on time or whether people were staying at care calls for the full duration of the time.
Quality monitoring and assurance systems were not completed regularly. Where audits were completed they did not identify issues in the service and actions were not taken to continually improve the service. Feedback collected from people who use the service was not always used to improve the quality of the service.
The provider worked with other organisations such as the local authority and we saw that action plans were produced following these visits. However we saw that these were not monitored and actions were not completed in the timeframes that the provider had set themselves.
Feedback about the registered manager from people and staff members was positive. The registered manager had a passion for supporting people in a caring manner and wanted to improve the service going forward.