We found improvements had been made and the provider had implemented effective recruitment and selection processes to ensure appropriate checks were undertaken before staff began work.
We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:
- Is the service safe?
- Is the service effective?
- Is the service caring?
- Is the service responsive?
- Is the service well led?
This is a summary of what we found-
Is the service safe?
People we spoke with, and their family members, told us they felt safe with the staff. They all said they would feel comfortable talking with the manager if they had any concerns.
We found effective recruitment and selection processes were not in place and appropriate checks had not been undertaken before staff began work.
People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. However, acts of omission in the form of missed calls were placing people at risk of harm.
Is the service effective?
Staff we spoke with demonstrated a good understanding of people's rights to make their own decisions. However, arrangements were not in place for ensuring only those lawfully able to give consent were asked to do so where the person receiving the care lacked capacity to consent. Where people did lack capacity to consent to their care, and there was no-one able to lawfully consent on their behalf, there were no arrangements in place for establishing and recording that care was in their best interests.
People we spoke with confirmed staff asked permission before providing any personal care and confirmed what they needed or wanted done at each visit. One person told us: "They always ask before doing anything." A family member commented that staff always asked their relative: "What would you like done today?"
Is the service caring?
People we spoke with told us they felt their needs were being met and their care was delivered in the way they preferred. One person told us: "They are all very good, they never refuse to do anything." A family member commented: "They are very good, if they see a problem or something my relative needs they always say."
Is the service responsive?
We saw care plans and risk assessments were routinely reviewed. The manager explained reviews were carried out every six months, or more often if any changes occurred. We saw any changes were documented on the review sheets. Changes or newly identified needs were added to care plans and any actions taken in response were clearly recorded.
People who use the service and their representatives were asked for their views about their care and treatment. People we spoke with confirmed they had recently been visited by a member of management and asked about the care they were receiving and to see if their needs remained the same. One family member told us their relative's needs had changed and the management had been out once to their home to discuss the new needs and then again to check the changes put in place were working. The family member told us: "I am very happy with things at the moment."
Is the service well-led
The provider had a system in place to regularly assess and monitor the quality of the services provided. However this was not always effective. The provider had a system to identify, assess and manage the risks relating to the health, welfare and safety of the people who use the service and others who may be at risk from the carrying on of the regulated activity. However this also, was not always effective.
Staff told us they regularly read people's care plans and discussed care with people to ensure they provided care as they wished. Care plans reflected the person's care needs.
The provider did not complete all relevant checks before staff began work. We did not see written explanations of gaps in employment history. Some of the files reviewed did not contain a medical questionnaire. Where staff had worked previously in a health and social care setting, their conduct or reason for leaving was not always checked.
People we spoke with told us they felt safe with staff and had no concerns. Staff attended regular safeguarding training. Staff were able to describe the possible signs of abuse and knew who to contact if they had concerns.
We saw measures to assess and monitor the service were in place. There were spot checks by management to monitor the quality and safety of services provided to people. There were processes in place for recording, investigating and resolving complaints from people who use the service and their relatives.