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One Day At A Time Home Care Ltd Requires improvement

Reports


Inspection carried out on 19 February 2020

During a routine inspection

About the service

One Day at a Time Ltd is a domiciliary care agency. It provides personal care and support to people living in their own homes or assisted living houses and flats. At the time of the inspection 21 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People told us they felt happy with how their medicines were managed, however, guidance was not in place for 'as required' medicines and therefore staff did not have all the information necessary when

administering these medicines. Staff responsible for people's medicines had not always had their knowledge and competency of medicines management checked in line with national guidance and best practice. Daily records confirmed people were supported with the administration of their medicines in a safe way.

People had care assessments that identified their needs. Risks associated with people's health and wellbeing needs were identified and managed to mitigate risks found. People told us the service was safe. Staff knew how to recognise and report any concerns about people's safety and welfare.

There were systems in place to monitor the quality of the service and make improvements when needed. However, the registered provider did not always use these effectively. Medicine audits had not been undertaken consistently or did not identify concerns found during inspection and systems in place to record actions taken to improve the quality and safety of the service were not always effective.

Staff received training, supervision and appraisal which supported them to have the knowledge and skills to do their job well and effectively meet people's needs. Staff supported people to have enough to eat and drink and to access healthcare services when they needed. Assessments of people likes, dislikes and preferences were undertaken prior to the service supporting each person. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by staff who were kind and caring. Staff were dedicated to ensuring people experienced the best possible care and support. People's equality and diversity needs, and preferences were respected. People and their relatives were happy with the support offered and felt very comfortable with all staff who were flexible, understanding and sensitive to people's needs. Staff clearly knew people well. Privacy and dignity were promoted and respected.

People and their relatives told us they were satisfied with the management of the service. People understood how to make a complaint about the service if they were unhappy with aspects of their care.

People who use the service, relatives and staff could express their views about the service which were acted upon. The management team provided leadership that gained the respect of staff and motivated them as a team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (report published 20 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 9 (Person-centred care) and regulation 18 (Staffing). However, further improvements were needed to ensure all regulation were met.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on act

Inspection carried out on 17 September 2019

During an inspection looking at part of the service

About the service

One Day At a Time Home Care Limited is a domiciliary care service providing care and support to people in their own homes to promote their independence and well-being. At the time of the inspection personal care was provided to 14 people.

People’s experience of using this service and what we found

The provider and the registered manager had taken steps to improve the service and ensured people received safer care. An action plan to address the warning notice carried out by CQC had been implemented. Not all the requirements of the warning notice had been met.

The registered manager had ensured that peoples care files contained comprehensive risk assessments that were highly detailed and gave step by step guidance to staff. However, some waterlow did not detail specific actions staff would need to take.

The registered manager had applied for all staff to have the required staff recruitment checks with the Disclosure and Barring Service. People were protected from having staff work with them who were not suitable. However, 2 out of 4 staff files looked at did not show a full employment history. There were still gaps in staff’s employment history that needed to be obtained.

The registered manager had gained feedback, via questionnaire, from people and staff following on from the previous inspection where this had not previously been received.

The registered manager had introduced a staffing structure into the service that gave staff clear defined job roles and job descriptions, that improved the way people and staff were supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 June 2019) when there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Following our last inspection, we served a warning notice on the provider and the registered manager. We required them to be compliant with Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 9 September 2019.

Why we inspected

This was a targeted inspection based on the warning notice we served on the provider and the registered manager following our last inspection. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service.

We undertook this targeted inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the governance of the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 11 June 2019

During a routine inspection

About the service

This inspection took place on 11 June 2019 and was announced. One day at a time home care limited is a domiciliary care service providing care and support to people in their own homes to promote their independence and well-being. At the time of the inspection personal care was provided to 18 people. This was their first inspection since registering with the Care Quality Commission.

People’s experience of using this service and what we found

Risks to people were not always managed safely. The level of detail in people’s care plans to ensure any risk was managed effectively was limited. The registered manager did not have any clear processes in place to manage risks appropriately. There was no evidence that people were involved in decision making about their care. Recruitment of staff was not managed safely. However, people told us that they felt safe.

The provider did not have an effective system to ensure that staff received appropriate training. Not all staff had undergone an induction process. People could not be assured that they would be supported by sufficiently skilled staff, who were well supported by management. The registered manager stated they undertook spot checks on staff to check their competency but stated they did not have any written evidence of this.

The registered manager had formed some links with the local authority.

The registered manager had not gained any feedback from people or relatives regarding service improvements.

People’s care plans were not always person-centred and did not contain details of people’s individual choices and preferences. The service did not evidence how it was meeting the Accessible Information Standard. All complaints and concerns were managed appropriately by the service but common themes had not been identified so that it could feed into learning and service improvements.

People were not supported to have maximum choice and control of their lives, there was limited information in people’s care plans regarding social support needs and personal information.

We have made a recommendation about Accessible Information Standards.

People spoken to who used the service stated the staff were very kind and caring.

People were supported by sufficient numbers of staff and most visits were completed on time.

Medicines were mostly managed safely however there were a lack of medicine risk assessments in place. The service used a computerised system to support staff to administer medicines safely and no medicine errors had been identified.

People were treated with dignity and respect and told us that staff treated them well.

Rating at last inspection

This was the first inspection of the service.

Why we inspected

This was a planned inspection based on our published timescales.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider was sent a letter from the commission asking them to provide an urgent action plan following the inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified five breaches in relation to the below regulations at this inspection.

Please see the action we have told the provider to take at the end of this report.

Where we are taking or proposing to take enforcement action but cannot yet publish the actions due to representation and appeals process the text below must be added under this heading.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

Due to the number of concerns found, immediately after the inspection we requested information, in the form of an action plan, from the provider about how they w