Archived: S & M Healthcare

Updated 14 March 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection team consisted of one inspector.

Service and service type:

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults in the Watton, Thetford and Haverhill areas. At the time of our inspection 28 people were using the service.

The service had a manager registered with the Care Quality Commission. This means that they, and the provider, are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 48 hours’ notice of the inspection visit because it is small and the dregistered manager is sometimes out of the office supporting staff or providing care. We needed to be sure that someone would be in.

Inspection site visit activity started on 30 November 2018 and ended on 11 December 2018. It included visits and telephone calls to people who used the service, their relatives and to staff. We visited the office location on 30 November 2018 to see the manager and office staff and to review records, policies and procedures. We also carried out a final visit to the office on 11 December 2018 to provide and discuss our feedback with the registered manager.

What we did:

We used the information the provider sent us in the Provider Information Return (PIR). This is information providers send to us to give some key information about the service, what the service does well and improvements they plan to make. We also looked at other information we held about the service including notifications which relate to significant events the service is required to tell us about. We also requested feedback from the local authority quality monitoring team. This information helped us to target our inspection activity and highlight where to focus our attention.

During the inspection we spoke with five people who used the service, four relatives, the director, the registered manager, six members of the care staff and an administrator. We reviewed six care plans, five medication administration records and looked at three staff files which documented recruitment procedures and ongoing support for staff. We also reviewed rotas, staff training records and other documents relating to the safety and quality of the service.

Updated 14 March 2019

About the service:

S & M Healthcare is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our inspection the service was providing personal care to 28 people.

People’s experience of using this service:

At our last inspection we identified a breach of regulation relating to recruitment practices which were not robust and placed people at risk. At this inspection we found improvements in recruitment practices but identified other areas of the service which required some improvement.

Systems did not alert the registered manager quickly when calls were missed. This meant some people had gone without their care visits. Although people told us that there had been missed calls, it was acknowledged that things had improved in recent weeks. People's experience was mixed. One person who used the service commented, "They get somebody in an emergency. Not always the best somebody, but somebody...I think if I were to rate them I don't think they'd be outstanding but they're pretty good."

The registered manager carried out person centred assessments of people’s needs and preferences. However, sometimes the information from these assessments was not placed promptly in people’s homes so that staff could refer to it. Some aspects of the care plans for people with complex health conditions needed more detail to help staff provide safe care. The registered manager regularly reviewed care plans but did not always update care plans with people’s changing needs promptly. Staff were not always clear about people’s needs as a result.

Staff were trained to give people their medicines but we found some errors with the medication administration records. Staff received a structured induction and other training to help them carry out their roles. Some important training had not been given to staff which could have placed people at risk.

Informal support from the manager was very good, although structured, regular support was not in place for all staff. The registered manager was addressing this by developing the role of one member of staff to help carry out spot checks and supervisions to monitor the quality of the service.

People were very positive about the kindness and caring nature of the staff, with some being singled out for particular praise.

The provider regularly asked for feedback from the people who used the service and addressed people’s informal concerns well. Formal complaints were responded to in a timely manner and to people’s satisfaction.

Staff understood their responsibilities with regard to keeping people safe from abuse and knew how to raise concerns if they needed to.

People, or their relatives consented to their care and were able to express their preferences with regard to how their care was delivered. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

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

Rating at last inspection:

At the last comprehensive inspection the service was rated Good (report published 21 April 2016). This inspection was followed by a focused inspection which rated the key question of Safe as Requires Improvement and the key question of Well-Led as Good. This report was published on 5 October 2017 but did not change the overall rating of Good. At this inspection we found the overall rating to change to Requires Improvement overall and now the four key questions of Safe, Effective, Responsive and Well-Led have all been individually rated as Requires Improvement.

Why we inspected:

This inspection was carried out as part of our regulatory schedule. The inspection was brought forward due to an increase in the number of concerns about missed calls and staffing levels.

Please see the action we have told the provider to take section towards the end of the report.

Follow up:

We have issued a requirement notice for the breach of regulation. We will require the provider to send us an action plan detailing how they will make the necessary changes and in what timeframe they intend to do this. We will carry out another inspection in the future to check if the improvements have been made and sustained.