The inspection took place on 28 and 29 April 2015, and was an announced inspection. The provider was given 48 hours’ notice of the inspection. The previous inspection on 4 November 2013 was a follow up inspection, to look at previous breaches in the areas of care and welfare of people who use services, management of medicines, requirements relating to workers and assessing and monitoring the quality of service provision. The provider had taken action and there were no breaches in the legal requirements.
One 2 One Private Care Services provides care and support to adults in their own homes. It provides a service mainly to older people and some younger adults and people who have a learning disability. At the time of the inspection it provided a personal care service to 7 people. It provided short visits to people as well as visits up to six and a half hours. It would provide 24 hour care to support people if required.
The service does not require a registered manager as the provider manages the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
People managed their own medicines. Staff were applying creams as part of personal care routines, but there were no proper records maintained.
People were involved in their initial assessment and the planning of their care and support and some had chosen to involve their relatives as well. Care plans did not always included people’s preferred routines, their wishes and preferences and skills and abilities. People said the provider visited periodically to discuss the care plan review, but there were not always records of these discussions. Risks were assessed and practices were in place to keep people safe, but the details of how people were to be kept safe were not always fully recorded in risk assessments.
New staff underwent an induction programme, but not all of this induction was evident in records. Induction included relevant training courses and shadowing the provider, until staff were competent to work on their own. Not all staff had received training appropriate to their role and some refresher training had been delayed. Not all staff had received spot checks on their practice, or appraisals to enable them to carry out their duties effectively.
People felt safe whilst staff were in their homes and whilst using the service. The service had safeguarding procedures in place, although most staff had not received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns.
People had their needs met by sufficient numbers of staff. People received a service from a very small team of care workers. People’s visits were allocated permanently to staff rotas and these were only changed when staff were on leave. Staffing numbers were kept under constant review.
People were protected by robust recruitment procedures. Staff files contained the required information.
People were happy with the service they received. They felt staff had the right skills and experience to meet their needs. People said their independence was encouraged wherever possible.
People told us their consent was gained at each visit. People were supported to make their own decisions and choices. One person was subject to an order of the Court of Protection and other people had Lasting Power of Attorney in place. Sometimes people chose to be supported by family members to make decisions. The provider understood their responsibility under the Mental Capacity Act (MC) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.
People were supported to maintain good health. People told us staff were quick in spotting any concerns with their health and reported these appropriately.
People felt staff were caring. People were relaxed in staff’s company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. People said staff were kind in their approach and knew them and their support needs well.
People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Staff had built up relationships with people and were familiar with their personal histories and preferences.
People told us that communication with the office was good or excellent and if there were any queries they called the provider and they always responded immediately.
People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided both informally and formally. Feedback received had all been positive.
People felt the service was well-led. The provider adopted an open door policy and took swift action to address any concerns or issues straightaway to help ensure the service ran smoothly.
The provider had a philosophy and principles. Staff were not directly aware of these, but felt the service listened, was very caring and promoted dignity and respect. Staff said they treated people how they would want to be treated.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.