Background to this inspection
Updated
1 September 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was announced and took place on 7 and 12 June 2017. Phone calls were completed on 13 June 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be at the office and able to assist us to arrange home visits.
The inspection was carried out by one 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 service.
Before the inspection we reviewed information that we held about the service. Providers are required to notify the Care Quality Commission about events and incidents that occur including injuries to people receiving care and safeguarding concerns. We reviewed the notifications that the service had sent to us and contacted the local quality assurance team to obtain their views about the service. The provider had completed a Provider Information Return (PIR). A PIR is a form that asks the provider to give some key information about the service, what the provider does well and what improvements they plan to make.
We spoke with three people in their homes. We also telephoned ten people, four relatives and a health professional to obtain their views about the service. We spoke with six members of staff, the nominated individual, and the director of the service. We looked at a range of records during the inspection. These included seven care records and four staff files. We also looked at information relating to the management of the service including quality assurance audits, policies and staff training.
Updated
1 September 2017
This inspection took place on 7 and 12 June 2017 and was unannounced.
Axe Valley Homecare is registered to provide personal care to people living in their own homes. At the time of our inspection the service was providing support to 52 people. The service was run from a location outside Dorchester.
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 inspected the service on 27 April 2016 we had concerns about how people’s risks were managed and there were issues about communication and accurate recording of medicines. Quality assurance measures were not comprehensive and did not provide an overview of themes or trends. There were breaches in two regulations and we asked the provider to take action about these concerns. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches and told us that they would be compliant with the regulations by July 2016. At this inspection we found that they were no longer in breach, but that there were still areas for improvement.
The service did not have capacity assessments in place for people in line with legislation and did not have systems in place to assess a person’s capacity or make a decision in a person’s best interest where this might be required. We have made a recommendation about completing assessments of people’s capacity.
The service had taken steps to try to improve communication where staff did not speak English as their first language. However people reported that they struggled to communicate with some staff and this had therefore not been effectively managed. We have made a recommendation about staff language skills.
Staff received training in some topics but felt that they needed additional training opportunities in conditions people faced to ensure that they had the correct knowledge and skills to support them. This had been identified at the last inspection but no changes had been made.
People had risk assessments which identified the risks they faced and gave general information about how to manage these. The service was in process of reviewing people’s care plans and ensuring that risk assessments were individualised.
People and their relatives told us they felt safe with the staff who provided their care and support. Staff were aware of their responsibilities in protecting people from harm and knew how to report any concerns about people's safety or wellbeing.
People were supported by staff who were recruited safely and were familiar to them. Staff received supervision using an online system and were able to request face to face time with a supervisor if needed.
Where people received support from staff to eat and drink sufficiently, we saw that staff offered choices and prepared foods in the way people liked.
People told us that staff who supported them were kind and helpful and we observed that staff supported people in the way they preferred and treated people with dignity and respect.
People told us that they received a rota each week letting them know what staff were due to visit at what times. Where changes were needed to visits, or where staff were running late, people told us that the office generally made contact to let them know.
Peoples care plans included details about what people liked and how they wanted to be supported.
People told us that they were involved in reviews about their care and we saw that reviews were completed annually, or more frequently if people’s needs changed.
Feedback was gathered from people through surveys and used to identify actions to improve the service. People told us that they would be confident to complain if they needed to and we saw that complaints were recorded and responded to appropriately.
Staff and people told us that the office was easy to contact and responsive. Team meetings were in place and regular newsletters and the PASS system were used to communicate effectively with staff.
Quality assurance measures were regular and used to monitor and identify areas for improvements.