Practical Care

Practical Care is a domiciliary care agency providing support with personal care to people in their own homes. Seventy-one people were using the service at the time of the inspection.

People’s experience of using this service and what we found

Systems were in place to safeguard people from the risk of abuse. There were enough staff to support people and checks had been carried out on prospective staff to ensure they were suitable to work in a care setting. Risk assessments had been carried out so that people were supported safely. Medicines were well managed, and procedures were established to reduce the risk of the spread of infection.

Assessments were carried out of people’s needs to check the service was able to meet those needs. Staff received support through training and supervision to help them in their role. Where people were supported with meal preparation they were able to choose what they ate and drank. The service worked with other agencies to promote people’s health, safety and wellbeing. 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. People were able to consent to the care provided.

Staff understood how to support people in a way that promoted their dignity, independence and choice. People told us staff were caring in the way they interacted with them. People’s confidentiality and privacy was respected.

Care plans were in place which were personalised around the needs of individuals. Care plans included information about how to support people with their communication needs. Systems were established for dealing with complaints and people told us complaints raised by them had been dealt with appropriately. The service worked with other agencies to support people with end of life care.

People and staff spoke positively about the senior staff and told us they were accessible and helpful. Systems were in place for monitoring and improving the quality of support provided. Some of these included seeking the views of people who used the service.

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 12 July 2018) and there was one breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of the inspection Practical Care provided domiciliary care and support for 89 people in their own home. The service worked primarily with older people living with dementia and people with physical and mental health needs. People received varying levels of support depending upon their care needs from 24-hour care to one visit per day.

The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At our last inspection on 29 September 2015 we completed a focused inspection that looked at the key question of ‘effective’ only. This was to ensure that a breach of regulation found at the previous comprehensive inspection on 22 December 2014 regarding documenting people’s ability to consent to their care had been addressed. We found that the service had addressed the breach of regulation and the key question of effective was rated as ‘good’. This meant that the service was rated ‘good’ in all key questions and therefore ‘good’ overall.

At this inspection we found a breach in regulation around adequate risk assessments. The service is now rated ‘requires improvement’. This is the first time the service has been rated as ‘requires improvement’.

There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider. The registered manager was present throughout the inspection.

Risk assessments were inconsistent and did not always detail known risks. There was insufficient guidance for staff on how to minimise known risks to people receiving care.

Medicines were overall well managed but we have made a recommendation about medicines management.

People’s care plans detailed tasks to be completed at each care visit. However, care plans were not always person centred. The provider was in the process of updating the care plan format.

Staff understood what safeguarding was and were aware of how to report any concerns if they had them. Staff understood what whistleblowing was and who to contact if necessary.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff had received training in infection control and were aware of how to control and prevent infection.

Staff received regular, effective supervision, appraisal and training.

People and relatives were positive about staff and felt that they were kind and caring. People received a continuity of care and often had the same staff.

The service worked well with people at the end of their lives and provided end of life care. Staff were compassionate regarding caring for people at the end of their lives.

Audits were carried out across the service on a regular basis that assessed areas such as medicines management, health and safety and the quality of care. Telephone surveys were completed with people who use the service and their relatives. Where issues or concerns were identified, the manager used this as an opportunity for change to improve care for people.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. There were effective recruitment and selection processes in place, and staff had been through induction and shadowing before starting work. This ensured that the staff were of good character and were competent to meet the care and welfare needs of people.

Is the service effective?

People's health and care needs were assessed, specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in the care planning process and that they were happy with the care that was provided.

Is the service caring?

People were supported by kind and attentive staff. People told us that care workers showed patience and gave encouragement when supporting people. One person told us, 'staff are very flexible and help me to do what I want.' People using the service, and their relatives, were contacted regularly to check if they were satisfied with their care. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. The provider had a robust complaints procedure that was accessible to people who use the service.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff told us that the manager was 'always rooting' for people who used the service and 'responded very quickly.'

Staff told us they were very happy with the manager, 'she is good at providing support when you need it.'

Staff were clear about their roles and responsibilities, and had a good understanding of the ethos of the agency.

People who used the service had been assessed and their choices and preferences were recorded. Risk assessments had been prepared for people. Care plans were in place and the care provided was closely monitored by the manager. The manager and two care staff we spoke with were aware of the needs of people and the care to be provided. The agency had a policy and procedure for the administration of medication. Staff responsible for assisting with medication had been provided with medication training.

People who used the service indicated that their care staff were competent and reliable. Staff had been carefully recruited. The recruitment records contained the required documentation. Staff we spoke with were knowledgeable regarding their roles and responsibilities.

The agency had a complaints procedure. People and relatives knew who to talk to if they were unhappy with the services provided. There was a record of compliments received.

People praised the staff supplied by the agency. 'The staff are very good,' said one person. 'They're very helpful,' another person told us. People told us they had regular contact with the manager about their experience of the service. 'The manager asks if we are happy all the time,' one person said. This meant the agency provided an individualised service that aimed to meet people's needs.

We found, however, that a staff member started providing personal care to someone in their home a number of months before the provider had acquired recruitment checks including references and a Criminal Records Bureau disclosure. This meant the provider's recruitment systems put people at risk receiving care from someone who may not be of good character.