Background to this inspection
Updated
12 March 2020
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 an inspector, an assistant 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.
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 took place between 27 January 2020 and 11 February 2020. We visited the office location on 27 January 2020.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service, including Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. 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 six people who used the service and six relatives about their experience of the care provided. We spoke with six members of staff including the provider, registered manager, office manager and care workers.
We reviewed a range of records. This included four people’s care records and medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We reviewed training certificates.
Updated
12 March 2020
About the service
Quality Homecare (Barnsley) Ltd is a domiciliary care agency providing personal care to 38 people at the time of the inspection. 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
Although a governance framework was in place records were not consistent and did not always support quality processes. People were supported by suitably trained staff, however records were not always clear or consistent, and in some instances, it was not clear which member of staff was being identified, for example, in supervision records. Medicines were administered safely, however, records were not always clear about changes to medicines or when reminders for medicines or topical creams were applied. Systems for analysing information were not in evidence to fully support learning lessons from when things went wrong.
Due to poor record keeping there is a risk people using the service may be placed in harm. This is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff did not have access to regular meetings and these were not always recorded consistently.
We have made a recommendation about staff meetings.
A business continuity plan and business development was in place to support the management of the service. A quality survey for people and relatives had taken place and results were analysed. The service had considered and implement changes to some care records to support improvement.
People told us they felt safe and were very happy with the care and support they received. Systems were in place to safeguard people from abuse: information about this was included in people’s care plans. Risks to people were assessed and reviewed to ensure people were supported safely. Infection control measures were considered and detailed in people’s care plans.
People’s needs and choices were assessed to achieve clear outcomes. Staff were supported through competency and spot checks, from information seen these were not always regular.
We have made a recommendation about recording staff support.
People were supported to eat and drink, and care plans provided detailed information for staff about how to do this. Care plans contained evidence of how staff worked with health professionals and other organisations to support people’s support and wellbeing. People were supported to access health professionals. Consent to care and treatment was sought and recorded from people, where they were able to do so. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Care plans detailed how to support people whilst protecting their privacy and dignity. Daily records showed where people had their choices asked and respected.
Care plans recorded how people received personalised care that is responsive to their needs and wishes. There have been no complaints since the last inspection, however information about how to complain is contained in the service user guide. There was no one receiving end of life care, however there was no evidence in care plans viewed that people were asked about their end of life wishes.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 31 January 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last four consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to record keeping at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.