The inspection took place over two dates and was unannounced. On the 19 December 2016 we visited the registered office, met with some of the staff and viewed the paperwork, including care plans, staff files and other records relating to the management and running of the business. On the 23 December we accompanied a carer to visit some people who used the service. We also contacted a number of people, their relatives and staff to ask them about their experience of the care provided by the service. The service provided domiciliary care and at the time of our visit was supporting approximately 87 people with a range of different support packages including domestic support, help with personal care and overnight sits.
The service had two registered managers 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.
The service was well managed with two registered managers both overseeing different areas. Together they formed an established team who knew their business well. They had worked within the care profession for many years and had extensive knowledge of the resources in the area and professional contacts. There were enough staff to deliver the care at the time they it was needed.
The feedback we received about the service was good. People using the service understood the role of the service and were positive about the care that they received and the management team. People knew how to contact the office and told us that they were kept informed if for any reason there was a change in the staff member providing their care or if staff were running late. People told us they had not had any missed calls and the agency provided a reliable service. People benefited from being supported by regular staff with whom they had established a strong bond and who were familiar with their needs.
Care plans were implemented quickly following an assessment of a person’s needs. Staff were familiar with people’s needs and referred to care plans to help inform their care practices. People told us care plans were not reviewed regularly and there was some discrepancy in how often they should be reviewed.
The agency had robust staff selection and recruitment procedures in place to help ensure only suitable staff were employed. Staff received excellent training and a thorough initial induction to help ensure they had the right competencies and skills to fulfil their role. The service also provided on going opportunities for staff to further develop their knowledge and skills. However, staff were not provided with regular formal supervision sessions and we were not assured that there were adequate systems in place to monitor staff competencies and practice
Some people required staff to administer their medication, whilst other people were able to take their own medication with staff prompting them when required. Training was given to staff and staff were observed by senior staff to ensure they were competent to undertake this task. However, we found that the auditing of medication records could be improved upon. We also had concerns about the processes that were in place to support a person who took their own medicines but were not consistently able to so reliably.
Staff knew how to safeguard people and protect them from abuse. Systems were in place to assess and manage potential risks to people. However, risk assessments needed to be more robust and the service were not adequately protecting people’s personal information. There were also systems in place to ensure risks were adequately managed. Risk assessments could be more robust. The service was not adequately protecting people’s personal information.
People gave their consent before care and treatment was provided. Staff had been provided with training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). People were supported in line with the legislation of the MCA and no unnecessarily restrictive practices were in place. The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process.
People were encouraged to eat and drink and staff kept detailed records showing how people’s needs were being met. These provided evidence that staff were acting upon concerns and changes to people’s health and ensured that people received timely medical intervention as needed.
The service took into account feedback from people to shape and improve the service. The service was responsive to people’s needs and communication was described as excellent by staff and people using the service.
Staff were caring and helped facilitate people’s independence and promote their well-being. Care was provided in a respectful, consultative way.
The service was well- managed which enabled it to provide effective care that was flexible and reliable. Staff felt well supported however, the systems in place to support staff needed further review.
The service had systems in place to monitor the service it provided and respond to feedback about the service.