We carried out this inspection over three days on the 7, 31 October 2016 and 16 November 2016. The inspection was announced. This was because the location provides a domiciliary care service. We wanted to make sure the registered manager, or someone who could act on their behalf would be available to support our inspection. At the last comprehensive inspection on 16, 22 September and 15 October 2015, we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s consent was not always gained before undertaking certain tasks, the agency’s ethos of person centred care was not consistently applied in practice and there was some concern about the registered manager’s practice. Following the inspection, the provider sent us an action plan, which detailed how improvements would be made. At this inspection, improvements had been made but further work was required to ensure a good service.
Blue Sky Enabling is a domiciliary care agency, which provides care and support to people in their own homes on a short and long term basis. The agency provides people with support on a sessional basis or staff can ‘live in’ the person’s home, to provide 24 hour care. At the time of the inspection, the agency was supporting eight people.
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. The registered manager is responsible for the day to day management of the agency and was available throughout the inspection.
There remained some concerns about the registered manager’s manner and the way in which they interacted with those around them. The registered manager told us they had reflected on their practice and undertaken some additional training. However, they said it was very difficult to change something that was “built in”. In response to the concerns previously raised, the registered manager had made changes to the structure of the agency. This meant they only worked with the younger adults who required a service. This had minimised further concerns about the registered manager but not necessarily addressed their practice.
The registered manager told us they had expanded the management team. This had enabled greater expertise and more individuals to share ideas with. Decisions were being made more collectively and there had been greater liaison with other health/social care professionals and the local safeguarding team. However, there remained some techniques which staff used with people, which had not been formally agreed.
There were sufficient numbers of staff available to support people effectively. Additional staff were being recruited for any new care packages. Whilst a recruitment agency was sometimes used to find the right calibre of staff and check their suitability, records did not always demonstrate a robust recruitment process.
Staff felt well supported and received formal meetings with their manager to discuss their work. There had not been any incidents which required the agency’s disciplinary processes to be initiated. Those incidents which had occurred were appropriately reported to the local safeguarding team. Relatives told us they had no concerns about their family member’s safety. They said they had confidence in the staff who provided the support. Staff were confident when discussing how they kept people safe. They were aware of local safeguarding procedures and would immediately inform the registered manager if they had any concerns.
The registered manager and care manager had undertaken training so they could train staff in their area of expertise. A range of ‘person specific’ training and topics deemed as mandatory by the provider had been undertaken. This included safeguarding, Autism awareness and the safe administration of medicines. However, staff had not received training in positive behaviour management. This did not equip staff with the skills or confidence to keep them or the person safe during an incident which occurred. Following reflection, the registered manager confirmed this training had been arranged.
People were supported by a consistent member of staff or small team. This consistency enabled established relationships to be built. Staff knew people well and were aware of their needs. There was a strong emphasis on enabling people to be as independent as possible and achieve their goals. People’s rights to privacy and dignity were maintained.
There were no concerns about people’s safety. People had comprehensive support plans which they helped devise. The information was well written and contained a range of risk assessments, management plans and protocols. These documents gave staff added guidance to enable them to effectively meet people’s needs. Medicines were safely managed and people had access to a range of services to meet their health care needs. People were supported to prepare their meals and to make choices about what they wanted to eat and drink.
People and their relatives knew how to make a complaint and were encouraged to give their views about the service. The use of surveys and checks on staff’s practice were used to assess the quality of the service. Consideration was being given to how this evidence could be used to give a greater overview of the management systems in place.