Our inspection of Wagtail Close took place between 22 February 2018 and 2 March 2018 and was unannounced. At our last inspection in December 2016, we found breaches of legal requirements relating to safe medicines management and good governance. At this inspection we found improvements had been made to medicines management and the service was no longer in breach of this Regulation. However, we found insufficient improvements had been made in relation to good governance and the service remains in breach of this Regulation. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe management of medicines and good governance to at least good. We found medicines administration sheet (MARs) were well completed and people were receiving the correct medicines. However, robust quality systems should have identified and actioned some of the concerns we found at inspection such as accuracy of care records, financial management of some people's monies, listening to people's views about the running of the service, taking actions as a result to improve the service.
This service provides a domiciliary care agency and a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The domiciliary care agency provides personal care to people living in their own houses and flats in the community, some of which are based in 'extra care' facilities. It provides a service to older adults and younger disabled adults. Wagtail Close provides a respite care unit and accommodates three people in one adapted building. The domiciliary care service was providing personal care for 122 people at the time of our inspection;some people receiving personal care from the domiciliary care live in the extra care services of Dove Court, Mary Seacole Court and Eden Gardens. Some people receive night care support but this is provided currently by another agency.
A registered manager was 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 was supported by locality managers based at each of the 'extra care' facilities.
Most people or their relatives told us they felt safe with the service provided. We saw staff had been trained to recognise signs of abuse and appropriate referrals had been made to the local authority. However, we found more robust systems were required to protect people from the risk of financial abuse. Following our inspection the registered manager put extra safeguarding measures in place to mitigate this risk. However, this should have been identified and actioned prior to our inspection.
Medicines were mostly managed safely and the service was no longer in breach of Regulations regarding the safe management of medicines.
Accidents and incidents were recorded and the registered manager was taking steps to ensure outcomes of these were fully documented, including lessons learned. Risks to people's safety were assessed and care plans put in place to mitigate these risks.
Sufficient staff were deployed to keep people safe. Some concerns were expressed by staff cover during night time and agency staff, with concerns raised about some staff not being fully aware of people's care and support needs. The registered manager was aware of this and told us this was being reviewed. Staff were recruited safely and were subject to annual appraisal and regular supervision. We saw the separate areas of the service had their own training matrixes and most staff training was up to date or booked. We have made a recommendation about the service maintaining accurate and clear systems to ensure staff training is kept up to date.
Most people and/or relatives told us the service met their health care needs and took action if they were concerned about people's health. Our review of people's care records confirmed this.
The service was meeting the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberties Safeguards. We saw evidence of consent being sought during our inspection although more evidence of people's consent to care and support needed to be present in care records.
People were satisfied with the food on offer at Wagtail Court and said a good selection of meals were available to choose from. People who received support with their meals within the domiciliary care service told us they were satisfied with the food prepared by staff.
People and their relatives told us some staff were caring and treated them with compassion and kindness whereas they felt other staff had a less compassionate and caring approach. Staff respected people's privacy and dignity.
Although people had individualised care records in place, these did not always reflect up to date and accurate information. For example, clearer and more accurate guidance was required for staff who supported people with their nutritional intake. Care records needed to show more evidence of people being involved in the planning and review of their care and support. This lack of evidence reflected what some people and/or their relatives told us about not having taken part in care planning or reviews.
Although there had been no formal complaints we saw a complaints policy was in place and displayed at Wagtail Close. People told us they knew how to make a complaint if necessary.
Activities were offered at Wagtail Close according to people's preferences and they were made welcome at social events at the provider's extra care service next door.
People and staff spoke positively about the management team and said they could approach them with any concerns. We found the registered manager open and keen to make improvements within the service.
Some people and/or their relatives told us their views about the service quality had not been sought and some people told us they did not feel listened to. Some people told us when their views had been sought they had not been told of any actions taken as a result.
Although a system of audit and quality assurance was in place, this had failed to recognise some of the concerns we found at inspection. This meant the provider was not meeting the requirements of the law and was in breach of Regulations.
You can see what action we told the provider to take at the back of the full version of the report.