Signet Healthcare Limited

Signet Healthcare Limited is a domiciliary care agency providing personal care and support to people living their own homes. At the time of our inspection there were 53 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

During the inspection we found risk assessments were not always robust enough and medicines were not always managed safely. Safe recruitment practices were not always followed.

The provider had procedures for managing incidents, accidents, safeguarding alerts and complaints, and quality monitoring processes in place, to help monitor and improve service delivery. However, these were not always effective, as they had not identified the areas where improvements were required that we found during the inspection.

People were not always supported to have maximum choice and control of their lives and the provider could not demonstrate people were always supported in their best interests. While the provider had policies and systems, these were not always robustly implemented.

We have made a recommendation for the provider to consider current guidance around recording in a person centred way.

Notwithstanding the above, people were satisfied with the care provided and felt safe. Staff received appropriate training to meet people’s care needs. People were supported by the same staff which provided consistency.

People using the service, their relatives and staff told us the management team were approachable and had responded to complaints.

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 good (published 16 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Signet Healthcare Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, consent to care, good governance and staffing at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service had a registered manager. 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.

When we last visited the service on 7 and 12 September 2016 the service was rated as ‘Requires Improvement’, and we identified four breaches related to staffing, safe care and treatment, recruitment and good governance respectively.

Therefore, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions 'Safe', ‘Effective’ and 'Well-Led' to at least good. At this inspection we found action had been taken to make improvements.

The service had made improvements to ensure people were safe. There were systems and processes in place to support care workers to understand their role and responsibilities to protect people from avoidable harm. Where safeguarding concerns had been identified there were records to confirm the service had taken appropriate action.

Risks to people were minimised because there were effective systems and processes in place. The risk assessment contained detailed information for supporting care workers on how to protect people.

Staffing had improved since the last inspection. The service had filled many of the staff vacancies and there was an ongoing recruitment drive. Pre-employment checks had been carried out to make sure new care workers were of good character. As a result, there were sufficient numbers of suitable care workers to support people to stay safe.

There was a process in place to monitor any accidents and incidents. Guidelines were in place for care workers on how to report accidents and incidents. Learning derived from incidents was documented and discussed with staff.

People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination.

There were systems in place to ensure proper and safe use of medicines. Care workers had been trained and assessed as competent to support people to take their medicines.

Care workers understood the Mental Capacity Act 2005 (MCA) and we found that people's consent was sought before the service provided care to them. Care workers were aware of the need to assess people's capacity to make specific decisions.

People’s health needs were met. They had their needs assessed across a wide range of areas. Care plans included details about how needs in these areas were met.

There was a comprehensive training system in place. Care workers received an induction before they could provide care to people. They also underwent a 12-month probationary period, which was followed by regular training and support.

Care workers had regular supervisions with their line managers. They also received spot checks to monitor their performance when caring for people. Those who had been at the service for longer than 12 months had also received an appraisal.

People were supported to have sufficient amounts to eat and drink. Their care plans contained detailed information about food and drink. Care workers monitored people's weight and sought professional guidance when required.

Care workers respected people’s privacy. There were arrangements for gaining access to people’s homes, whilst maintaining privacy and ensuring people’s safety.

Care workers had built good relationships with people. The service matched care workers to meet people's preferences, which meant, care workers were able to build meaningful relationships with people.

Care workers supported people to maintain their independence. They knew each person's ability to undertake tasks related to their daily living. Care plans encouraged care workers to take time to support people to participate as fully as they could.

Individual communication needs were assessed and met. People's communication methods were clearly recorded in their care plans.

People were involved in their care. Care plans reflected people’s needs, likes and dislikes and had been reviewed on a regular basis to ensure they remained up to date.

There was a complaints procedure which people and their relatives knew about. People were provided with a service user guide that gave details of the process for reporting a complaint. People told us they were aware they could call the office or speak with care workers if they had any concerns.

There was an overall improvement in the governance arrangements. There were systems to assess, monitor and improve the quality of the service provided.

During our last inspection on 2 July 2015 the provider was not meeting the legal requirements in relation to ensuring people safely received their medicines, following the Mental Capacity Act, making sure that people’s nutritional needs were being met and having an effective quality assurance system in place.

At this inspection we found some improvements had been made but improvements still needed to be made to the quality assurance systems in place to ensure areas requiring attention were identified and addressed.

Signet Healthcare Limited provides a range of services to people in their own home including personal care. People using the service had a range of needs such as learning and/or physical disabilities and dementia. At the time of our inspection 47 people were receiving personal care in their home. The care had either been funded by their local authority, the Clinical Commissioning Group (CCG) or people were paying for their own care.

There was a registered manager 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.

Although care workers confirmed they received an induction and training, the records did not always evidence that this had taken place.

Most risks to people's safety had been assessed and the provider had taken action to minimise the risks of harm. However, some areas of risk had not been identified and assessed and this placed people at risk because they did not follow good practice guidance and did not always ensure people were being cared for in a safe way.

The recruitment checks carried out on care workers did not always ensure that they were suitable to work with people using the service.

Not all records were accurately maintained or complete.

The provider had a complaints process in place and people knew what to do if they wished to raise any concerns. However, records needed to show how some complaints had been investigated.

There was some mixed feedback about the care workers and missed calls occasionally occurring but overall people and their relatives were complimentary about the service.

There were appropriate procedures to safeguard people and the staff were aware of reporting any concerns to the registered manager.

There were systems and training in place for care workers so that people safely received their medicines.

Assessments of the person’s needs were carried out before the person started to receive care in their own home. Each person had a care plan in place which described their support needs.

People had consented to their care and treatment and were involved in decisions about their care.

You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we saw that where possible the manager had made attempts to obtain recruitment information that was missing at the last visit. We viewed seven staff employment files and saw that relevant information was held on file, such as completed application forms and identification of the staff member. Criminal record checks were completed for staff before they worked with people in their own homes and the manager said staff would only start working once all the recruitment information had been received and checked.

We also saw evidence that since the last inspection visit the manager and deputy manager had carried out monitoring spot checks on the care staff. These checks involved observing staff carrying out their tasks in people's homes. It also provided the person using the service an opportunity to give their views about the support and care they received. We saw that staff had also received one to one supervision and had an annual appraisal. This provided them with the chance to discuss their performance and for the manager to raise any concerns or issues that had been identified.

We viewed the care records of three people using the service and found that the majority of their care needs were assessed and recorded in their care plans. However, we found that information about their needs in relation to medicines was unclear and did not always reflect what staff were doing. The deputy manager said she would review this to ensure that care plans accurately reflected people's needs.

Risk assessments had been completed to make sure that people were cared for safely. People's needs were reviewed and relatives confirmed they had seen a member of staff from the office who had asked them for their views.

Recruitment procedures did not fully protect people using the service. There was a lack of systems in place to check that all the necessary information about a new member of staff was in place before they started working for the service.

Staff were provided with training relevant to their roles and responsibilities; however they did not receive regular one to one supervision or an annual appraisal.

The manager of the service had not implemented any formal quality assurance processes. However she had developed an annual audit of the service and we saw the report relating to this. It included looking at where the service had made improvements and adjustments to how it operated.

The service had a complaints policy in place and the relatives we spoke with told us they would feel confident to raise any concerns with the manager. We saw from the records that complaints were listened to and acted on.