The comprehensive inspection took place on 8 and 9 October and was announced. This was so we could ensure someone would be available at the office when we visited.This service is a domiciliary care agency. It provides live-in support and personal care to people living in their own homes in the community. Staff live in the person’s home, generally for a four week period and then have two weeks off while a second staff member lives-in with the person. Staff have a mandatory break each day and family or another carer cover this period, if required. The service mostly provides a service to older adults but can also provide a service to adults and younger adults.
The provider had previously operated the service providing shorter visits to people in their own homes and operated from a different office location. This was the first inspection of the service at the new location providing live-in care.
The provider was also the registered manager. 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 provider was supported in the day to day management of the service by the regional care manager. They were both supported by office staff.
People were supported, if they required, to book and attend medical appointments and some people were supported by staff to take medicines. Staff had received training in medicines management but were not always following best practice when completing records about prescribed and administered medicines. People had risk assessments in place but some people had risks relating to their needs that had not been assessed.
Most people still had the capacity to make their own decisions and staff understood the Mental Capacity Act 2005 (MCA). However, one person no longer had the capacity to make their own decisions. Their care plan described the way they wanted their care delivering based on their previous routines and preferences; but an MCA assessment had not been completed to show why decisions were being made on their behalf.
People were supported by staff who had information about the accessible information standard (AIS). However, where people had sensory impairments, AIS assessments had not been completed to identify whether the person required information in a non-standard format.
The provider and regional care manager regularly sought feedback about the service from people and their relatives and acted on any concerns. They also had regular contact with staff and checked staff daily notes and medicines administration records on a weekly basis to identify any changes to people’s needs or areas for improvement in practice. The provider told us people’s records were regularly checked to ensure they were complete and up to date; however, these checks had not been recorded and had not identified the gaps identified during the inspection. The regional care manager and provider were responsive to feedback and learned from mistakes. Following the inspection, they told us the gaps identified during the inspection had been rectified and shared new records that were being implemented to help ensure they were not repeated in the future.
People and staff had developed strong relationships which were based on trust and genuine friendship. The provider and regional care manager took action to ensure they knew people and staff well enough to recommend which staff members would suit each individual who required support. This matching of shared interests and similar characters helped enable bonds to form between people and staff. People became partners in developing their care. This helped ensure it reflected their wishes and preferences.
The service placed an emphasis on seeking information about what affected people’s wellbeing. This was known by staff who used the information to help people plan their care. People’s care plans gave clear detail about the whole of their life including their likes, preferences and needs. This enabled staff to follow people’s routines, support their safety and help maintain their independence. People and staff clearly enjoyed spending time together and took enjoyment from sharing their interests with each other. Family members reported the happiness and wellbeing they saw in their family members as a result of the support and care they received. Staff members proudly talked about the changes they had effected in people’s health following the support they had provided.
Staff understood people’s diverse preferences and ensured that any associated needs were respected and met. People felt safe using the service and staff felt confident recognising and reporting abuse or any concerns they had.
People were supported by people who received an induction and regular updates to their training. The provider also ensured staff had access to information about best practice and any updates to legislation. These were discussed in regular supervisions and spot checks, along with any other training requests. Staff told us they felt supported in their role and people told us staff had sufficient knowledge to provide their care and support.
There was a positive culture within the service and people, relatives and staff gave positive feedback about the organisation. The provider had clear values about how they wished the service to be provided which were set out in their statement of purpose. The provider and regional care manager acted as role models for these values and the systems and processes they had designed to deliver the service, ensured these aims were embedded in it’s culture.
We found a breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.