Background to this inspection
Updated
7 February 2019
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.
This was an announced inspection and we gave the service two weeks’ notice of the inspection site visit. This was because some of the people using it could not consent to a receiving a telephone call or a home visit from an inspector, which meant that we had to arrange for a ‘best interests’ decision about this. This inspection was carried out by one inspector and two experts by experience. The experts by experience had knowledge of care services including domiciliary services.
The inspection site visit activity started on 14 November 2018 and ended on 19 November 2018. This included telephoning 23 people with their relative or friends and visiting seven people in their home with their consent. We spoke with seven staff and the registered manager, four domically care organisers and the office clerk. The inspection was also informed by feedback from questionnaires completed by 14 people using services, relatives and professionals. We visited the office location on 19 November 2017 to see the registered manager and office staff; and to review care records and policies and procedures.
The provider completed a provider information return as part of the Provider Information Collection. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and what improvements they plan to make. We took this into account when we made the judgements in this report.
We looked at seven people’s care records to see if their records were accurate and up to date. We also looked at records relating to the management of the service including quality checks. We reviewed statutory notifications the registered manager had sent us and information received from people that used the service. A statutory notification is information about important events which the provider is required to send to us by law.
Updated
7 February 2019
We inspected this service on 16 and 19 November 2018. This service is a domiciliary care agency. It provides personal care to older adults and younger disabled adults living in their own houses and flats and within an extra care facility. Not everyone using this service receives a 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. There were 134 people receiving a regulated service at the time of our inspection.
There was a registered manager in 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.
At our last inspection in July 2016 we rated the service Good. At this inspection we found improvements were now needed. The service is rated as requires improvement overall.
People did not always receive their care at the right time and people found that their care was not consistent as different staff, some who they did not know well, provided their care. People did not always receive their call and there was no evidence that any action had been taken to safeguard people when calls were missed. Staff were trained to recognise the various forms of abuse and encouraged to report any concerns. However, where people had calls missed, this had not been identified that this may mean they were at risk of harm or neglect. The quality monitoring systems did not identify where improvements were needed and missed calls, accidents and serious incidents were not monitored. We did not receive notifications of significant events to show how the provider had responded to events.
People did not always have care plans which recorded the care they were receiving and assessments of risks had not always been completed to ensure any risks were minimised. Care had not always been reviewed when this was needed which meant staff did not always have the information they needed to provide care safely.
Medicines were not managed safely where people received their medicines in boxes and checks were not made to ensure people had these as prescribed.
People felt able to complain but were not confident that their concerns were always actioned. The provider had not recognised that complaints were not recorded and responded to.
Improvements were needed to ensure that people were supported to have maximum choice and control of their lives and for staff to support them in the least restrictive way possible. People could make decisions about their care although improvements were needed to ensure where concerns about people’s capacity was identified, assessments were completed and decisions made in their best interests.
People retained their independence and staff respected this. Staff developed caring relationships with the people they supported which were respectful and staff were kind and patient and took an interest in them and their family. People’s privacy and dignity was maintained and people felt comfortable with staff they knew.
Recruitment systems were in place to ensure new staff were suitable to work with people. The provider had infection control procedures in place and personal protective equipment was available in people’s homes for staff to use. Personal emergency evacuation plans had been developed to guide staff how to support people to leave their homes in the event of an emergency situation.
People’s health needs were monitored and the staff worked with health care professionals and helped people to attend appointments where necessary. When people required assistance to eat and drink, the provider ensured that this was planned to meet their preferences and assessed need.
People were asked for their feedback on the quality of the service. The results of the survey were reviewed and people were informed of where the service needed to make improvements within a newsletter.
People felt the staff had the right skills to provide the care they wanted. Staff received training to understand how to support people and their competence was checked to ensure they had developed the skills they needed from the training. Staff received ongoing support and felt the management team was approachable and that they could talk to them at any time.
We found 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.