Archived: The Wood Street Day Care Centre

Wood Street Day Care Centre is a domiciliary care agency which provides a bathing service for people in their own homes. The care is provided for a range of people including older people and people with dementia. The service operates in the Tunbridge Wells area. Not everyone using Wood Street Day Care Centre receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene. Where they do we also take into account any wider social care provided. At the time of the inspection there were 30 people using the service.

The service had 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.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

There were suitable processes in place to safeguard people from different forms of abuse. Where risks to people or the environment were identified, staff took action to minimise them. There were enough staff to meet people's needs. Staff were recruited safely. People were not supported with their medicines. People were protected by the prevention and control of infection. Lessons were learned when things went wrong.

People's needs were assessed before they started to receive a service. These needs were met by staff who had the knowledge and skills to deliver effective support. People were supported to lead healthier lives by having timely access to healthcare services. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were treated with dignity and respect by staff who were compassionate and caring. People were able to make decisions about how their care was provided, and were involved in reviews of their care along with people who were important to them. Staff treated people's private information confidentially.

People received care that was personalised to their individual preferences. Staff knew people's needs and personal histories well. People knew how to complain and felt confident to do so if needed.

The service was led by a committed registered manager who had the necessary skills and experience to carry out their role. There were appropriate audits in place to check the quality of service being provided. People and their families were encouraged to be involved and engaged with the service. The registered manager had developed links with the local community.

Further information is in the detailed findings below.

There was 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were safe while bathing. Accidents and incidents were recorded and monitored to identify how risks of recurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs. The provider followed safe recruitment practices.

Each person’s needs and personal preferences had been assessed before support was provided and were regularly reviewed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

Staff knew each person well and understood how to meet their support needs. People told us, “They [care workers] got to know me pretty well over the years” and, “They know exactly what I like and what I don’t like.”

All members of care staff received regular one to one supervision sessions and appraisal to ensure they were supporting people based on their needs.

Staff sought and obtained people’s consent before they provided support. People told us that staff communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. People were very satisfied with how their support was delivered.

Clear information about the service and how to complain was provided to people. Information was available in a format that met people’s needs.

People’s privacy was respected and people were supported while bathing or showering in a way that respected their dignity and independence.

People were referred to other services when necessary. Personal records included people’s individual support plans and preferences. The staff promoted people’s independence and encouraged them to do as much as possible for themselves.

People’s individual assessments and support plans were reviewed regularly with their participation. People’s support plans were updated when their needs changed to make sure they received the support they needed.

The provider sought and obtained their feedback on the quality of the service. The provider took account of people’s comments and suggestions. People’s views were sought and acted upon. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued under the manager’s leadership. The manager notified the Care Quality Commission of any significant events that affected people or the service. Quality assurance checks were carried out to identify how the service could improve and remedial action was taken when necessary.

We considered all the evidence we had gathered under the outcome we inspected which included areas of non-compliance. We used the information to answer the following questions; is the service safe? Is the service effective? Is the service responsive? Is the service well led?

Below is a summary of what we found.

Is the service safe?

The majority of care plans had been reviewed.

Daily care records reflected whether people's care plans had been followed in the majority of cases.

Is the service effective?

People were asked for their agreement as part of the care planning and risk assessment process.

Care records stated the days and times that support was to be provided. People had signed to confirm that they agreed with the time slot.

The provider was due to undertake a survey to gain feedback from people using the service in order to demonstrate that the service was effective.

Is the service responsive?

Care plans specifically stated which areas people could wash for themselves. One care plan contained specific guidance for staff to follow.

People's individual preferences were recorded in their care plans.

Is the service well-led?

Senior members of staff were able to access records on the computer system promptly.

Staff had received a weekly one to one supervision, but we found that the relevant supervision documentation had not been completed since August 2014 due to time constraints.

Below is a summary of what we found

Is the service caring?

People or their relatives we spoke with were positive about the care they received from the service. People we spoke with and their relatives told us that the staff who provided support to them were caring. Comments included 'I have been impressed with what they do and their caring attitude', 'I cannot fault the service. It has been fantastic', '[Their relative] chuckles non-stop', 'You couldn't wish for better people to bathe you', they are 'Very kind'.

Is the service responsive?

People's needs were assessed before they received care from the service. We saw examples of assessments on people's care records.

The service was responsive to people's changing needs. We saw three recorded examples where a health concern had been identified by staff members and reported to the relevant health care professionals for them to address. One person we spoke with told us about the action a staff member had taken, in response to a health matter, to ensure an area of their body was kept dry during their wash. Another person's records showed that the frequency of their bathing support was increased in order to meet their needs. Records showed that most people's care had been reviewed to ensure their needs were being met. This meant that people received the support they needed.

Is the service safe?

We saw that effective systems were in place to safeguard people who used the service from abuse. We saw that the service had two policies in place on safeguarding vulnerable adults, a local authority one and a service specific one. There was also a policy on whistle blowing for staff to be able to report concerns about the service.

Records showed that staff had completed training in safeguarding vulnerable adults.

People we spoke with and their relatives all told us that they felt safe around the staff when they visited them in their own homes.

There were arrangements in place to deal with foreseeable emergencies.

Is the service effective?

People who used the service were given appropriate information and support regarding their care. People were given information about the service when they began to receive support from them.

People were involved in making choices about their care. One staff member gave an example of asking one person where they preferred to get undressed.

People were supported in promoting their independence. People we spoke with or their relatives told us that they completed tasks themselves where possible. One person told us that during their visit they washed areas they could themselves.

People were treated with respect and their privacy and dignity was upheld. People told us that they were happy with the level of privacy staff provided to them when supporting them to bathe.

Care was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw examples of risk assessments that identified when a person was at risk of falls. We saw that people's care records showed when staff were to use a specific piece of equipment to support people to bathe.

Is the service well led?

There were systems in place to monitor the quality of service delivery. People who used the service and their relatives were asked for their views about their care. For example, a survey was provided twice a year to gather people's views and inform service delivery.

There were systems in place to provide staff with the opportunity to share their views about the service. Staff meetings were held for staff to attend to feedback about the service.

We saw that there was a complaints process in place. There were systems in place to monitor staff training and to monitor any accidents.

There was a system in place to ensure staff received regular support on a one to one basis. We saw records of recent supervision meetings. However, there was no record of supervision for one staff member to demonstrate the effective management of all staff.

Staff told us they were supported in their role. For example, one staff member told us that '[The person in day to day charge of the service] is always there'.

However, not all care records contained information to show that people or their relatives had agreed to the care being provided. Written information was not always available to show the times when the support was to be provided to people. Records were not always kept to show people or their relatives were in agreement with their initial assessments, risk assessments, care plans and reviews undertaken by the service.

Written guidance was not available for staff to reference about how to meet one people's individual needs to ensure a consistent approach.

Daily records of the support provided were not always completed to reflect the care provided.