Background to this inspection
Updated
27 March 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 checked 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 took place on 20 February 2018 and was announced. We gave the registered manager two working days’ notice as the location provided a service to people in their own homes and we needed to confirm the registered manager would be available when we inspected. They were not available until a week after the original planned inspection, and therefore had seven working days’ notice. The inspection was carried out by one inspector.
Prior to the inspection we looked at the information we held on the service including notifications of significant events and safeguarding. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about. We also contacted the local authority’s safeguarding team and commissioning team to gather information about their views of the service.
During the inspection we spoke with the registered manager and the only care worker working in the service. We viewed the care records of both people using the service and the care worker’s file that included recruitment, supervision, appraisal records and records. We also looked at records relating to the management of the service including service checks and audits.
After the inspection visit we spoke with two people using the service and contacted two social care professionals to get their views on the service.
Updated
27 March 2018
This comprehensive inspection took place on 20 February 2018 and was announced. We gave the registered manager seven days’ notice of the inspection. This was because when we contacted them to give two working days’ notice of the inspection to make sure they would be available during the inspection, as per our processes when we inspect domiciliary care agencies, they were not available.
The last comprehensive inspection took place in November 2016. The service was rated ‘Requires Improvement’ in the key question ‘Is the service Well Led?’ but ‘Good’ overall. We found a breach of Regulations relating to good governance. Following the inspection, we asked the provider to complete an action plan to tell us what they would do, and by when they would make the necessary improvements to meet the regulations. We then undertook an announced focused inspection in March 2017 to check that improvements to meet legal requirements planned by the provider after our November 2016 inspection had been made, and found that some improvements had been made but not enough to meet all the regulations.
This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older people, people with learning disabilities, physical disabilities and mental health needs including dementia. At the time of the inspection, two people were receiving a service for the regulated activity of personal care.
The owner of the business was the Nominated Individual and registered manager, and ran the service with a relative, who was the service’s only care worker. 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 the inspection on 20 February 2018, we found safe recruitment procedures were not always followed as the provider could not evidence they had a second reference for the care worker to ensure they were suitable to work with people using the service.
Risk assessments and risk management plans were not robust enough to minimise risks to people using the service. For example one person at a high risk of falls did not have a falls risk assessment.
People were not always protected against the risks associated with the management of medicines. The medicines risk assessments were not up to date. Nor was the medicines training for the care worker or their competency assessment to manage medicines.
The registered manager and care worker, told us the care worker had up to date supervisions, appraisals, training and spot checks but they were unable to provide any written evidence of this happening. Therefore we could not be sure the care worker had the skills and knowledge to deliver effective care and support.
There was no information in people’s files indicating if they had consented to their care. However the care worker understood and supported people’s right to choose how they would like their care delivered and people using the service confirmed this. We recommended the provider follow guidance from reputable sources to better demonstrate how they comply with the principles of the Mental Capacity Act 2005.
The people we spoke with indicated that the care delivered was personalised and responsive to their needs but care plans were not always up to date and reviews did not have outcomes to reflect people’s current needs or how issues had been addressed. Therefore the care worker did not have guidelines to effectively care for people in a way that met their needs.
The provider had data management and audit systems in place to monitor the quality of the care provided. However records were not monitored effectively to ensure there were no gaps in the required information and there was an overall issue with administrative tasks and records not being organised or accessible when needed.
The provider had policies and procedures in place to safeguard people from abuse and the care worker knew how to respond to safeguarding concerns to help ensure people received care safely. There had not been any incidents or accidents with the service, but there were procedures in place to manage any incidents or accidents.
The provider had an infection control policy in place and the care worker understood how to protect people against the risks of the spread of infection.
People’s dietary requirements were met and the care worker knew how to support people to maintain good health.
The people using the service said the care worker was kind and caring and spoke well of them. People were involved in their care planning.
The provider had not had any complaints, but had a complaints procedure to record, investigate and follow up complaints in a timely manner.
The registered manager was available to people using the service and the care worker, and listened to their concerns.
We found five breaches of regulations during the inspection. These were in respect of safe care and treatment, staffing, person centred care, fit and proper persons employed and good governance. You can see what action we told the provider to take at the back of the full version of the report.