IMPACT

Updated 14 September 2019

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

This inspection was carried out by an 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 homes.

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 started on 29 July 2019 and ended on 01 August 2019. We visited the office location on 30 July 2019.

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. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We looked at people’s feedback available via Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service and eight relatives about their experience of the care provided. We spoke with two members of staff including carers, and the registered manager. We also met and spoke with the nominated individual during and after the inspection. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included five people’s care records including medication records. We looked at one staff file in relation to recruitment, and a variety of records related to the quality, safety and oversight of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and recruitment records including files related to an additional three staff members. We also spoke with another staff member. Evidence we requested from the registered manager was not always available and/or provided on time.

Updated 14 September 2019

About the service

IMPACT is a domiciliary care service providing personal care to older people aged 65 and over in their own homes. The service was supporting 13 people at the time of the inspection including some people with learning disabilities.

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

This inspection identified three breaches of the regulations. We identified one breach of the regulations due to concerns around risk management including with people’s medicines support and the quality of some people’s risk assessments.

Learning had not been taken from one reportable incident, to promote people’s safety as far as possible and we had not been notified of this incident as required. This is in breach of the regulations.

We identified a third breach of the regulations because the provider’s auditing systems and processes did not effectively assess, monitor and improve the quality and safety of the service. Although people and relatives spoke positively about the service, we found improvements were required to processes related to recruitment, medicines management and how people’s care records were maintained.

People and relatives told us they felt the support people received was safe. Staff showed an understanding of most people’s risks and knew how to identify and report any suspicions of abuse. People and relatives told us they generally received their calls on time. Systems were being developed further to reduce the likelihood of late calls.

The provider’s systems did not demonstrate people always received safe support with their medicines, although people and relatives raised no concerns about this aspect of people’s care.

The provider was not able to demonstrate they had always carried out robust recruitment checks to promote people’s safety as far as possible.

People and relatives all spoke positively about the care provided and told us they had regular carers who knew people’s care needs and preferences, and who were equipped for their roles. Staff felt they had enough guidance and training to provide support in the way people preferred. People and relatives spoke positively about support provided from staff to access healthcare services and to prepare meals.

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; however the policies and systems in the service did not always support this practice and ensure this was a consistent experience for all people using the service.

Our discussions with people, relatives and staff reflected a caring service that respected and promoted people’s privacy, dignity and independence. All people and relatives told us staff were kind and caring. People and/or relatives as appropriate were involved in discussions about the care provided to help gather and meet people’s individual needs and preferences.

People’s communication needs were known to and met by staff however care planning processes did not meet the Accessible Information Standard (AIS). Nobody using the service required end of life care and support at the time of our inspection. People’s cultural needs and preferences were known to the service and the nominated individual told us they would further develop care plans to reflect people’s end of life care plans as appropriate. The service had received no complaints. Relatives told us feedback they had previously raised had been dealt with appropriately.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 04 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report. We prompted the provider to take action to mitigate risks these concerns posed to people using the service and informed the local authority of our findings.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.