Background to this inspection
Updated
23 September 2020
The inspection
This was a targeted inspection to check whether the provider had met the requirements of the warning notices in relation to Regulations 17, (Good governance) and 19, (Fit and proper persons employed), of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means 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. This was because it is a small service and we needed to be sure the provider or registered manager would be in the office to support the inspection. Inspection activity started on 29 July 2020 and ended on 7 August 2020. We visited the office location on 29 July 2020.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and healthcare professionals who work with the service. We used all of this information to plan our inspection.
During the inspection-
We reviewed a range of records, including all four people’s care records and we looked at all the care staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We spoke with two people who used the service and two relatives about their experience of the care provided. We spoke with all five members of care staff, the nominated individual and the registered manager. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
23 September 2020
About the service
Northstar Home Care is a domiciliary care service providing care and support to people living in their own homes. The agency provides help and support to adults with a variety of needs. The service provides a range of care services including; assistance with personal care, preparation of meals, medication administration and companionship. At the time of our inspection two people were using the service.
People’s experience of using this service and what we found
We found systems were not in place to demonstrate clear management and oversight of the service. A thorough system of auditing and checks were not completed, and records were not always accurately completed and maintained. The registered manager and nominated individual acknowledged that improvements were needed to demonstrate compliance with the regulations.
Safe recruitment processes were not in place to ensure the suitability of those applying to work for the service. A structured programme of induction, training and support needed to be implemented to make sure staff had the knowledge and skills needed to support people safely. The registered manager had relied on personal knowledge of staff rather than evidencing a thorough recruitment and training process had been followed.
Medication plans did not accurately reflect the level of support provided by staff. Appropriate medication training and assessment of staff competency had not been completed to check practice was safe. A review of administration records showed information was not always accurate and complete.
Initial assessments had not been completed by the provider prior to commencing support to ensure the service was able to meet the needs of people.
The Statement of Purpose and policies and procedures needed to be revised and updated. Information should reflect the service provision, so people knew what to expect from the service and staff were guided in how this was to be delivered. We have made a recommendation about the implementation of the Accessible Information Standard (AIS).
Staff rotas were not in place to show how work was co-ordinated in line with people’s contractual agreement.
Care plans provide relevant information about the support people wanted and needed. Areas of risk had been assessed and planned for. Records showed that people had been involved and consulted with about their care and support. 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.
People’s relatives spoke positively about their experiences. They said they had been consulted with and were kept informed. We were told that staff treated their family members in a respectful and dignified manner. Staff were described as “Very mindful and go the extra mile.”
We were told there were no current complaints or safeguarding concerns about people who used the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection - This service was registered with us on 11/02/2019 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about the registered manager. A decision was made for us to inspect and examine those risks.
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.
Enforcement
At this inspection we have identified breaches in relation to initial assessments, staff recruitment, training and development, incomplete and inaccurate records, policies and procedures and quality monitoring systems. A further breach was found in the Care Quality Commission (Registration) Regulations 2009 with regards to the service’s Statement of Purpose.
Please see the action we have told the provider to take at the end of this report. 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
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.