Background to this inspection
Updated
11 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 9 and 11 August 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.
The inspection was conducted by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed information we hold about the service, including previous inspection reports and notifications sent to us by the provider. Notifications are information about specific important events the service is legally required to send to us.
We contacted people by phone and used questionnaires to gain feedback from people about their experiences of the agency. We gained feedback from staff from questionnaires and we also spoke to two staff, the deputy and registered manager. We looked at records about the management of the service
Updated
11 November 2016
This inspection took place on the 8 and 11 August and the provider was given short notice of the inspection. We gave notice to make sure the staff and or registered manager was at the office. The previous inspection took place in November 2013 where all standards inspected were met.
Spire Homecare Limited provides personal care and support to people in their own home.
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.’
Risk management systems were not fully effective. Staff knew the potential risks for people they delivered personal care for and the actions needed to reduce the risks. Some risk assessment had been reviewed and updated. For example moving and handling and environmental risk assessments. However, risk assessments were not developed for all risks and were not reviewed as people’s needs changed. For example for people at risk of pressure ulceration, choking and malnutrition.
People told us their personal care was delivered by consistent staff. They told us there were times when staff arrived late. Staff told us the staffing levels were appropriate during the week but at weekends the agency struggled to cover shifts. The registered manager told us recruitment was in progress to employ staff prepared to work more flexible hours.
Recruitment procedures did not ensure that the staff employed were suitable to work with vulnerable adults. Character references were accepted instead of obtaining professional references from the previous employer on the staff’s conduct. The Disclosure and Barring Service (DBS) check had not been fully completed which meant the person was working without DBS clearance. The DBS helps employers to make safer recruitment decisions by providing information about a person’s criminal record and whether they are barred from working with vulnerable adults.
Systems were not in place to gain consent from people for staff to deliver personal care. People told us the staff gained their consent verbally to deliver personal care. However, Mental Capacity Act (MCA) assessments were not completed to establish people’s capacity to make specific decisions such as administration of medicines. Staff told us for people who resisted personal care, time was given to allow the person to change their decision. MCA assessments were not undertaken to determine the person awareness of the consequences of not having personal care and best interest decisions reached on how to manage these behaviours.
Care plans were not person centred and lacked detail on the aspects of care people were able to manage for themselves or how people liked their care to be delivered. Information gathered about the person was not drawn together to develop detailed care plans and were mainly based on the tasks the staff had to complete.
Quality monitoring of the service was in place; however a plan on how all improvements to the service were going to be made was not in place. For example, care planning. The registered manager was addressing continuity of care by recruiting staff to work flexible hours.
People told us they felt safe with the staff. Relatives were confident their family members received safe care from the staff. The staff we consulted were knowledgeable on the procedures for safeguarding adults from abuse.
New staff received an induction to prepare them for the role they were to perform. Training and regular one to one meetings ensured staff had the skills needed to meet people’s needs. One to one meetings with their line manager ensured staff were supported to meet the responsibilities of the role.
There were good working partnerships with external agencies and healthcare professionals. Where appropriate visits were organised when staff were available to support people. Staff documented the visits and the outcome.
People told us the staff were kind and caring. They told us the staff that delivered their personal care were good. Questionnaires were used by the agency to gain their views on specific topics. The staff told us how relationships were built with people.
People were aware of the complaints procedure and who to approach with their complaints. Members of staff were knowledgeable on how to respond when concerns were raised. We saw the manager investigated complaints and resolved them to an acceptable level.
We recommend that the service finds out more about training for staff, based on current best practice, in relation to assessing people’s capacity to make specific decisions.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.