Archived: Care Choice North West Limited

Care Choice North West is a domiciliary care service located in Pemberton, near Wigan. The service provides care to people living in their own home, predominantly in and around the Wigan area. At the time of the inspection the service provided care and support to 31 people. The service registered with the Care Quality Commission in March 2015 and this was the first time we had undertaken an inspection.

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.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The people we spoke with told us they felt safe. Relatives also confirmed they felt their family member was safe with staff going into their home.

We found medication was generally handled safely and people received their medicines at the times they needed it. However, at one of the houses we visited, we found unexplained gaps in the staff signatures on the MAR (Medication Administration Records). We raised this concern with the manager who said they would implement an medication audit system to ensure these were completed by staff.

There was a system in place to record accidents and incidents, however we found there wasn’t always a record of what action had been taken, or information about how to prevent future re-occurrences following specific incidents. There was also no auditing of accidents and incidents, or systems to monitor any consistent trends which had, or could develop. The manager told us they would implement this immediately. This was a breach of 12(2)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 .

At the time of the inspection, the service did not have a system to check people had received a visit from staff at the times they needed them. Call monitoring systems allow managers to check care visits have been completed via an electronic system. The manager told us this was something they were in the process of implementing and following our inspection, on 01 February 2016, the manager contacted us to say staff would be starting to use this the next working day.

During the inspection we spoke with staff about their understanding of safeguarding vulnerable adults. Each member of staff was able to describe the process they would follow if they suspected abuse was taking place.

We looked at staff personnel files to ensure staff had been recruited safely, with appropriate checks undertaken. Each file we looked at contained application forms, CRB/DBS (Criminal Records Bureau/Disclosure Barring Service) checks and evidence of two references being sought from previous employers. These had been obtained before staff started working for the service.

The service used a matrix to monitor the training requirements of staff. This showed us staff were trained in core subjects such as; safeguarding, moving and handling, medication and health and safety. The manager told us not all staff had undertaken relevant training with regards to Mental Capacity Act/DoLS and Infection Control, although would look to book staff onto these courses when they became available.

At the time of the inspection staff assisted several people with meal preparation as part of their care package. which we saw was clearly recorded within peoples care plans.

We saw staff received regular supervision as part of their on-going development. This provided an opportunity to discuss their workload, concerns and training opportunities. We saw records were maintained to show these had taken place consistently.

The people we spoke with and their relatives told us they were happy with the care provided by the service. People told us staff treated them with dignity and respect and promoted their independence as much as possible.

Each person who used the service had a care plan in place and we saw a copy was kept in the person’s home and at the office. The manager undertook initial assessments, prior to people receiving care and care plans were implemented. The manager told us they aimed to capture as much personal information about people’s likes, dislikes and preferences during this process. This information would enable staff to provide person centred care and instigate conversation with people to develop relationships.

We identified two instances where care appropriate care plans hadn’t been implemented based on what was agreed during the initial assessment. One in relation to a person who was at risk of malnourishment and another person with mobility problems. We raised this with the manager who put these in place straight away during the inspection.

There was a complaint procedure in place. There had been no formal complaints at the time of our inspection. The statement of purpose clearly described the process people could follow if they were unhappy with the service they received. Many people had made compliments about the service they received.

People and staff told us they felt the service was well managed,. Staff told us they felt well supported and would feel comfortable raising and discussing concerns.

At the time of the inspection there was no formal system in place to seek feedback from people who used the service and drive improvements where necessary. The manager said they would send a survey to people following the inspection to collate people’s views and opinions about the service they received.

We found there were limited systems in place to monitor the quality of service provided to people to ensure good governance. At the time of the inspection there were no auditing systems in place (which would include care plans, medication or communication books), no regular spot checks of staff and no medication competency assessments being undertaken. The manager said they had not got round to implementing these systems yet. This was a breach of regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Good Governance.