Archived: All Seasons

Updated 10 November 2016

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 inspection took place on 26 August 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in.

The inspection team consisted of one adult social care inspector who visited the provider’s premises and spoke by telephone with people who used the service and their relatives.

At the time of our inspection there were 13 people who used the service. We spoke on the telephone with four people who used the service and six relatives of people who used the service. We spoke with five members of staff, the manager and the registered provider. We spent some time looking at documents and records that related to people’s care and the management of the service. We looked at three people’s care and support plans.

Before our inspection, we reviewed all the information we held about the home, including previous inspection reports. We contacted the local authority and Healthwatch. Healthwatch feedback stated they had no comments or concerns. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

Updated 10 November 2016

This was an announced inspection carried out on 26 August 2016. At the last inspection in July 2014 we found the provider met the regulations we looked at.

All Seasons is based in the Garforth area of Leeds. The agency provides personal care and support to people living in their own homes.

At the time of our inspection the service had a registered provider, although they did not have a registered manager. 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 and associated Regulations about how the service is run.

The inspection concluded the administration of medicines was not always safe as staff competency checks had not been carried out. Protocols for ‘as and when required’ (PRN) medicines were not in place and we found some gaps in the recording on medication administration records, although a sample of daily notes showed some of these visits had been cancelled.

Staff had an understanding of the Mental Capacity Act 2005 (MCA) and the responsibilities this placed on them. The registered provider had made referrals to the local authority regarding MCA assessments. We recommended the registered provider formalise these records in people’s care and support plans.

Staff did not receive supervisions and appraisals in line with the registered provider’s policy, although staff felt they were adequately supported by the manager who was approachable and familiar with people who received this service.

Recruitment practices were not always safe as one member of staff had been allowed to commence work with a DBS dated May 2012 and no last employer reference.

People felt safe receiving this service and we saw risks had been appropriately assessed. People were confident they received care and support from a staff team who had been adequately trained and were familiar with their needs. People and relatives were satisfied that staff worked at their pace and ensured they were able to maintain their privacy and dignity.

People and their relatives had been involved in creating their care plans which were detailed and person-centred. Staff were satisfied they accurately represented people’s care and support needs, although we saw some updates were required. Reviews of care plans were taking place on a regular basis.

There were no outstanding complaints at the time of our inspection. People had been given information which enabled them to complain in the event they were unhappy with the service they received. A recent satisfaction survey contained positive feedback from people who received this service. The manager had formally contacted people who raised any concerns.

Staff were allocated sufficient travel times between their calls and the registered provider and manager covered for any emergencies or staff absences. Visits were usually on time and no one reported experiencing a missed visit.

People were supported by staff to access the local community and appropriate referrals to healthcare professionals had been made. People were supported by staff who ensured they had enough to eat and drink and could identify the risks of not receiving adequate nutrition.

The registered provider carried out medication audits, although we found these were not always fully completed. Daily notes were also checked to ensure visits had taken place and times recorded match staff time sheets. Some of the policies we checked were not up-to-date.

Notifications were not submitted to the CQC as required under the terms of the registered provider’s registration. We dealt with this outside the inspection process.