Background to this inspection
Updated
8 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
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 that 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 that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 4 May 2021 and ended on 21 May 2021. We visited the office location on 6 May 2021 and 14 May 2021.
What we did before the inspection
We reviewed information we had received about the service since the registration date. We also contacted the local authority and professionals who work with the service to gather their feedback.
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 used all of this information to plan our inspection.
During the inspection-
We spoke with four people who used the service and one relative about their experience of the care
provided. We spoke with eight staff including the registered manager, coordinator and the operations manager.
We reviewed a range of records. This included seven people's care records and multiple medication records.
We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to
the management of the service were also reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at staff rotas and policies and procedures.
Updated
8 July 2021
About the service
Westwood Homecare (North West) Limited provides personal care to people in their own homes. At the time of our inspection the service was supporting 24 people with personal care.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
Risks to people were not always recorded effectively. Risk assessments did not include enough detail to guide staff to support people safely. However, staff understood where people required support to reduce the risk of avoidable harm.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The registered manager was not complying with the principles of the MCA (Mental Capacity Act). Where there were concerns over a person's ability to consent to specific decisions in respect of their care, no assessment of their capacity to consent had been undertaken.
Staff knew people well including their likes and dislikes, and people were supported in line with their preferences. However, people's care plans did not consistently reflect the personalised care being given.
Systems in place to monitor the quality and safety of the service were not always effective.
Staff were safely recruited. People and relatives told us they felt care was delivered safely by a consistent staff team who knew them. Comments included, “[staff] always arrive on time.” Staff had a good understanding of what to do to make sure people were protected from harm or abuse. People received their medicines as prescribed and staff followed good infection control practices.
The provider understood their responsibility to make information accessible and inclusive. The culture of the staff team was positive. All staff demonstrated they put the people they supported first and did their best to ensure they received care in the way they preferred. People and relatives told us they felt staff knew what they were doing. One person told us, “[staff] is well trained, experienced and knows what they are doing.”
People were encouraged to maintain their independence as much as possible. When people’s health needs changed, the registered manager made referrals to the relevant healthcare professionals in a timely manner.
People were treated with kindness and respect. People we spoke with told us, “They [staff] are great, they are very kind and they make me happy.” The registered manager held regular care reviews with people and where appropriate their relatives. The service had a complaints policy which was made available to people and their relatives. Staff told us that the manager was supportive and listened to their views and opinions.
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 7 April 2020 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about staff training and infection control. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led sections of this full report.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to the need for consent and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.