Background to this inspection
Updated
22 January 2015
We inspected on 14 and 15 August 2014, our inspection team was made up of three inspectors and three experts by experience who carried out phone interviews of people who used the service. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our experts by experience had home visits experience, and experience of supporting family and friends with healthcare needs.
We spoke with ten care staff and the registered manager. We also contacted health and social care professionals who provided health and social care services to people. These included community nurses, speech and language therapist, local authority care managers and commissioners of services.
As part of our inspection, we spoke with thirty eight people, seven relatives, one supervisor/trainer. We also contacted six health and social care professionals to obtain feedback about their experience of the service but received no response.
During our inspection, we looked at forty people’s care records. These included care plans, health action plans, risk assessments and four people’s daily visits notes. We looked at eighteen staff files, a sample of the provider’s audits, satisfaction surveys, staff rotas, and the service’s policies and procedures.
Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. we reviewed the information included in the PIR along with information we held about the home. We reviewed our records including correspondence, notifications and safeguarding alerts received by CQC.
At our last inspection on 22 January 2013, no concerns were noted.
Updated
22 January 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
The inspection was announced. We gave the agency forty eight hours’ notice ahead of our inspection visit because the service is a domiciliary care agency and staff are out in the community supporting people. The manager is also often out of the office supporting staff or attending meetings. We needed to be sure that both staff and the manager would be in.
All Seasons and Lauriem Associates LLP is an agency that offers personal care to two hundred adults with many varied needs, supporting them to remain in their own homes. They provide dementia care, respite at home, live in service, medication administration, and focuses on supporting people to use their local community, take part in social activities and develop independent living skills.
There was a registered manager in post at the time we visited. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
Out of thirty eight people we spoke with, thirty four told us they felt safe, four people told us that they do not feel safe. They told us that a few staff were very inconsiderate in the way they treated them and this makes them feel unsafe with the staff. Some staff also told us that although they were aware of the agency’s safeguarding policy, they were not familiar with it in order to guide them on what to do if they had concerns.
A few people and relatives felt at risk because they were not supported by skilled staff. They felt they were not safe. For example, one person’s complaint was not passed to the manager for investigation, which we found to be a safeguarding issue and we raised this as a safeguarding alert to the local authority to make sure the person was protected.
Medicines were not administered safely. Medicines were being administered by staff to people when staff were only expected to prompt people to take their medicines. Records showed that some people had not received their prescribed medicines according to the prescriber’s instructions.
Staff underwent induction training, and on-going training in order for them to carry out their role and responsibilities. There were enough qualified, skilled and experienced staff to meet people's needs. The permanent staff team comprised of staff, supervisors and a registered manager. The staff training schedule showed staff were trained in essential areas and staff we spoke with told us they received opportunities to meet with their line manager to discuss their work and performance. Staff said, “I had induction training, full day of Safeguarding Vulnerable adult, Dementia and then yearly updates” and “Yes we have supervision and appraisals. The supervisor carries out spot checks, like checking that I was doing things in the right way and to see if I needed to do things differently”.
Staff understood how to meet people’s nutritional needs. Care plans showed that people were supported to be able to eat and drink sufficient amounts to meet their needs and people were provided with a choice of food and drink according to their preference of food in their own homes.
We found that staff were caring. People said, “The girls look after me if I’m unwell, they help me in every way they can and I enjoy their company”. People's care needs were assessed before they received a service. The supervisor visited people in their home before they received a service. Staff were knowledgeable about how to support each person in ways that were right for them and people told us that they were involved in their care plan. One person told us “I was involved in drawing my care plan up, which was good.”
Staff had not always responded appropriately to people’s needs. For example, we found in some cases that the assessed need of people were not met. We found that one person’s medical needs were not responded to appropriately.
People were not always aware of how to make a complaint people had not always had their comments and complaints listened to. We found that not all people and staff were aware of it.
The agency had a quality audit system in place to make sure that the service assessed and monitored its delivery of care. However, the audit system had not been effective in some areas. Namely the areas which were identified as part of this inspection were referrals not being made to health professionals when needed; a complaint had not been passed on to the manager for investigation, people not knowing how to make a complaint and people not understanding that they have a care plan which they could be involved in if possible.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.