White River Homecare is a community service that provides care and support to adults of all ages, in their own homes, in the St Austell and surrounding area. This includes people with physical disabilities and dementia care needs. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and give support with meals, shopping and housework.
At the time of our inspection 38 people were receiving a personal care service. These services were funded either privately, through Cornwall Council or NHS funding.
There was a registered manager in post who was responsible for the day-to-day running of 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.
The service’s last comprehensive inspection was 10 May 2016 when there was a breach of the regulations relating to medicines administration. We then carried out a focused inspection on the 17 January 2017 to check on the action taken by the provider to meet the requirements of the regulations. At this focused inspection we found that improvements had been made in the training of staff in medicines management and the medicines policy had been improved and the service was found to be compliant with the regulations.
We carried out this announced comprehensive inspection on 2 January 2019. We told the provider two days before that we would be coming. This is in line with our methodology for inspecting domiciliary care providers and was to ensure that someone would be available in the office at the time of our visit.
People and their relatives told us they felt safe using the service. Staff had received training in how to recognise and report abuse. Staff were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. The service was flexible and responded to people’s changing needs.
People told us, “I like our daily conversations regarding family & friends, the weather,” “Carers will ask me is there anything they can do for me or what do I need doing today. I do tell them when I want a drink and what to eat on each visit” and “My carers are well trained and seem to know their job. They are helpful and useful.”
People received care from staff who knew them well, and had the knowledge and skills to meet their needs. People and their relatives spoke well of staff, comments included, “We mostly have the same staff, they are a good bunch.”
Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were kind and compassionate and treated people with dignity and respect.
The management had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.
Staff told us there was good communication with the management of the service. Staff told us, “I think this company does listen to your suggestions even if they are not always followed through for whatever reason” and “I do discuss things with the office if I think there is a problem.”
There were some quality assurance systems in place which were not always effective and therefore opportunities for improvement were not always identified and addressed. Where the provider had identified areas that required improvement, actions had been promptly taken to improve the quality of the service provided.
Care records were regularly reviewed to ensure staff met their needs. However, the care plans were not always updated to provide accurate up to date direction and guidance for staff. This meant some care plans provided out of date information. Staff recorded when they supported people with their medicines in the daily notes. However, there was not a robust process for staff to record, on specific medicine documentation, when they had given medicines that are required occasionally, such as Paracetamol.
The service had a process for recruiting new staff. Some checks were done before they commenced working alone, such as a DBS check. However, some staff had been allowed to start working alone with people in their own homes before the service had received any references from their previous employers. This meant staff were not always recruited safely, and people were not always protected from staff who may not be suitable to work alone with them.
We found breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.