Archived: Quality Home Care

We inspected this service on 24 and 25 January 2017. The inspection was announced.

At the last inspection on 8 and 11 July 2016 there was a breach of the legal requirements found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

Improvements were needed to ensure that people were protected through the assessment and safe management of risks. People were not protected because staff had not followed the provider’s policy and procedures in relation to the management and recording of their prescribed medication.

During this inspection we found that the provider had made some improvements in relation to the previous breach.

There was an increased risk that people may not receive their prescribed medication. The provider’s policy on administration and recording of medication had not been followed by staff. Audits in relation to medication administration record (MAR) charts had been completed but were not robust, as they did not always identify all areas of improvement required.

There were some systems in place to monitor and audit the quality of the service provided. However, there were no audits on most areas of risk within the service. This meant that the provider’s quality monitoring system was not always robust or thorough enough to monitor and drive forward the necessary improvements needed.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 scheme is run.

People had their needs assessed and reviewed so that staff knew how to support them to maintain their independence. People’s care plans contained person centred information. The information was up to date and correct. People’s privacy and dignity was respected by staff and staff treated them with kindness.

People had risk assessments completed and staff had the necessary information they needed to reduce people’s risks.

There was a system in place to record complaints. This included the outcomes of complaints and how the information was used to reduce the risk of recurrence.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and could describe how people were supported to make decisions. Training had been provided by the service and staff were aware of current information and regulations regarding people’s care. This meant that there was a reduced risk that any decisions made on people's behalf by staff would not be in their best interest and as least restrictive as possible.

The risk of harm for people was reduced because staff knew how to recognise and report abuse. Staff had completed all training required by the provider. There was a system to ensure that staff received further training to update their skills.

The provider’s recruitment process was followed and this meant that people using the service received care from suitable staff. There was a sufficient number of staff to meet the needs of people receiving a service.

Staff meetings, supervision and individual staff appraisals were completed regularly. Staff were supported by team leaders, two care co-ordinators, deputy manager and the registered manager during the day. An out of hours on call system was in place to support staff, when required.

We found two 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.

This announced inspection took place on 8 and 11 July 2016.

The service had a registered manager in place. 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.

People were not always safe because risk assessments had not been completed to assess and minimise individual risks to people.

The provider’s policy on administration and recording of medicines had not been followed, which meant that people may not receive their prescribed medicines. There had been no audits that would have identified issues with medicines management.

Staff had not reported incidents that affected people’s health and welfare in line with the provider’s policy.

People had their needs assessed and reviewed so that staff knew how to support them to maintain their independence. People’s care plans contained person focussed information, but this information was not always sufficient, up to date or correct. This meant people could be at risk of inappropriate care.

There was a sufficient number of staff available to ensure people’s needs were met safely. The risk of harm for people was reduced because staff knew how to recognise and report abuse. Staff were aware of the procedures for reporting concerns and systems and policies were followed.

The recruitment process to complete comprehensive and satisfactory pre-employment checks had not always been followed to ensure that only suitable staff were employed to work with people in their own homes. Staff were well supported by the registered manager and area manager through supervisions and staff meetings.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. We found that staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and could describe how people were supported to make decisions.

People received care and support from staff who were kind, caring and respectful to them. Staff treated people with dignity and respected their privacy.

People knew how to make a complaint. The provider investigated any complaints and as a result made changes to improve the service for people.

The registered manager was supported by a staff team that included a regional manager, a care manager, two care co-ordinators and care workers. The service had an effective quality assurance system in place. People and relatives were encouraged to provide feedback on the service and their views were listened to and acted on.

We found one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was in relation to providing safe care and treatment as risk assessments were not always in place and medicines were not always managed in line with guidance. You can see what action we told the provider to take at the back of the full version of the report.

We saw that peoples' preferences were recorded in care plans regarding the way they wanted their care to be provided and planned. Care and support was appropriately assessed and each care visit was documented with guidelines for staff for the care and support the person required.

Records showed staff were trained and monitored regarding the administration of medication. Staff were aware of their responsibilities when recording medication that they had given or prompted people to take.

There were effective recruitment procedures in place which ensured that all appropriate checks had been made prior to staff starting work. There was an induction and mandatory training programme in place for new staff to ensure they were competent to deliver care.

The home had an effective system in place to deal with complaints. Complaints were responded to efficiently and people told us that they knew who to contact if they wished to raise any concerns about their care.

Staff had all received a thorough induction and further training relevant to their role so that they were equipped to do their job. They felt supported by the manager and provider. Staff were very pleased to be working for this agency, comparing it favourably with any agencies they had previously worked for. One staff member said, 'They've been great. They've supported me really well.'

People told us they felt safe, and that they knew how to raise concerns if they needed to.

One person told us, 'So far, so good. They're doing really well. I've nothing bad to say about them at all.' The provider had systems in place to make sure that the agency was providing a quality service.