24 February 2018
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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This comprehensive inspection visit was announced and was carried out by one inspector. The provider who was also the registered manager was given short notice of the inspection visit because it is small and the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.
The inspection site visit activity started on 25 January 2018 and ended on 26 January 2018. It included visiting the office location on 25 January 2018 to see the registered manager and staff; and to review care records and policies and procedures. We continued to speak with people using the service, their relatives and staff up until the 26 January 2018.
Prior to the inspection, we looked at previous inspection reports and notifications about important events that had taken place at the service. We used information the provider sent us in the Provider Information Return (PIR). 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 improvements they plan to make. We used these information to plan our inspection.
During this inspection, we spoke with two people using the service and three relatives to gain their views about the service. We spoke with four members of staff. They included the registered manager and three support workers. We also received feedback from one external health and social care professional.
We reviewed the care records of five people that used the service, which included their care plans, health and medication records, risk assessments and daily care records. We also looked at the recruitment records for four members of staff to see how the provider operated their recruitment procedures.
Other records we examined related to the management of the service and included staff rotas, training and supervision records, meeting minutes, quality audits and service user feedback, in order to ensure that robust quality monitoring systems were in place.
We also viewed the safeguarding, recruitment, equality and diversity, infection control, medicines and complaints policies.
24 February 2018
This comprehensive inspection took place on the 25 and 26 January 2018 and was announced.
188 Upper Luton Road is a small domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older and younger adults, including people with dementia and physical disabilities.
Not everyone using the service receives 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. At the time of the inspection, there were five people receiving the regulated activity of personal care from the service.
At our last inspection, the service was rated Good. At this inspection we found the service remained Good.
There continued to be a registered manager in post. 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.
People continued to receive care that was safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risks to people were assessed and monitored regularly.
There continued to be enough suitably qualified staff available to meet people's needs. The service was flexible and responded to people's changing needs. People told us they were able to request their visits at agreed times. People and relatives we spoke with told us they had never experienced a missed care visit.
People continued to receive care from staff that were caring, kind and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained.
People were encouraged to make decisions about how their care was provided. Staff had a good understanding of people's needs and preferences.
People’s needs continued to be assessed, their care provided in line with up to date guidance and best practice. People’s cultural and religious needs were taken into consideration at the time of assessment.
People received care from staff that had received training and support to carry out their roles.
Risks continued to be assessed and recorded by staff to protect people. There continued to be systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.
Staff continued to support people to attend appointments with healthcare professionals, and supported them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.
Staff told us that they seek guidance from healthcare professionals as required. They told us they would speak with people’s families and inform the manager if they had any concerns about people’s health.
Staff understood the Mental Capacity Act 2005 and how to support people's best interest if they lacked capacity. People continued to be 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 support this practice.
Staff continued to have good levels of support and supervision to enable them to carry out their roles. There was a programme of planned training which was relevant to the work staff carried out and the needs of the people using the service.
Staff continued to be recruited safely through a robust recruitment and selection process. This enabled the provider to select staff that were suitable to work with vulnerable people. Staff received an induction which included mandatory training and shadowing experienced staff.
The provider had a system in place to ensure people received their medicines as prescribed. Staff continued to receive training to administer medicines safely and staff spoke confidently about their skills and abilities to do this well.
There continued to be policies in place which ensured people would be listened to and treated fairly if they complained. The provider had a robust process in place to enable them to respond to people and their concerns, investigate them and had taken action to address their concerns.
The service had an open culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.
Procedures for reporting safeguarding concerns continued to be in place. The provider knew how and when they should escalate concerns following the local authorities safeguarding protocols.
The provider continued to have processes in place to monitor the delivery of the service. People’s views were obtained through surveys, one-to-one meetings, meetings with people’s families and meetings with social workers.
Quality assurance audits continued to be carried out to identify any shortfalls within the service and how the service could improve.
Staff continued to have access to an ‘out of hours’ support that they could contact during evenings and weekends if they had concerns about people. The service could continue to run in the event of emergencies arising so that people’s care would continue.
The provider and staff were committed to the values and vision of the company and they took these into account when delivering care and support.
Further information is in the detailed findings below.