Archived: Guardian Homecare (Southport)

Updated 9 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

This inspection took place on 16 and 17 November 2017 and was announced.

We gave the service 48 hours’ notice of the inspection visit because the service provides domiciliary care and we wanted to make sure one of the managers would be available.

Inspection site visit activity started on 16 November 2017 and ended on 17 November 2017. It included a day to conduct telephone interviews with people who used the service. We visited the office location on 16 November 2017 to see the registered manager and office staff; and to review care records and policies and procedures.

The inspection team consisted of two adult social care inspectors and an expert by experience. An expert by experience is a person who has expertise in a particular area, in this case, care of older people at home.

Before our inspection visit, we reviewed the information we held about Guardian. This included notifications we had received from the provider about incidents that affect the health, safety and welfare of people who used the service. We accessed the Provider Information Record (PIR) we received prior to our inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The provider had not received the PIR due to the email address not being correct.

We spoke to 12 people who used the service via telephone and two family members who cared for their relative. We spoke with nine staff, the regional manager, and the registered manager. We looked at the care plans for four people and other related records. We checked the recruitment files for four staff. We also looked at other documentation associated with the running of the service.

Updated 9 January 2018

This inspection took place on 16 & 17 November 2017. The inspection was announced, which means the provider was given 48 hours’ notice as we wanted to make sure someone would be available. This inspection was conducted by two adult social care inspectors and an expert by experience who conducted a series of phone calls to people in their homes on the second day of our inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in their community. It provides a service to older adults and younger disabled adults. The service was re-registered by CQC last November due to a change of legal entity. This was the services first inspection under the new provider’s registration.

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 some concerns with the quality assurance processes the provider had in place. Some of these were effective and clearly highlighted areas for improvements which were needed, and in some cases, like the need for the rostering system to improve, this was being action. However, in other areas, we saw no follow up action was documented to check whether issues in other areas, like the record keeping, had improved. Some of the information recorded in incident forms was poor and remedial action was often not documented. This meant we could not say for sure that lessons had been learnt from shortfalls in service provision.

People we spoke with said they received their medications on time. Records we viewed clearly showed there were issues with regards to care staff accurately completing medication records. The providers own audits had identified this, and some improvement had been made, however, a recent audit showed there were still concern and additional action was not always documented. The regional and registered manager explained they were taking more robust action to follow up on these concerns and had introduced more auditing and stock checks in attempt to address this concern.

you can see what action we have told the provider to take at the back of this report.

Some people told us that they did not always know who was coming to support them. There was mixed feedback regarding this and some people felt this was a real concern for them. They also told us this had improved lately.

Before our inspection, we had received some information of concern regarding the rotas and numbers of staff. This included staff being expected to rush from place to place. Before our inspection, we analysed a sample of rotas which the regional manager had emailed to us at our request. We checked to see if there was adequate traveling time for staff and routes were realistic and well planned. We did see some occasions when call times were one after the other and the distance between the two addresses was in excess of 12 minutes. However, we saw during our inspection that the provider had completed their own audit, were addressing these concerns and had already made some improvements. We have made a recommendation regarding this.

People told us they felt mostly felt safe being supported by Guardian and the feedback regarding the care staff was mainly positive.

Risks were well recorded and reviewed. We did find some of the scoring mechanisms confusing, however we raised this at the time and the registered manager explained and addressed this. Other risk assessments were clear and described how risk should be mitigated and what the staff would need to do to ensure they were managing this.

Staff were able to describe the process they would follow to report actual or potential abuse, this mostly consisted of reporting the abuse to the line manager. The service had a safeguarding policy in place, which we viewed and staff we spoke with told us they were aware of the policy. Safeguarding training took place as part of the induction for new staff, and was refreshed every year. Staff also discussed safeguarding as part of ‘themed’ supervisions, and we saw safeguarding was discussed as an agenda item in team meeting minutes.

Staff recruitment records showed that staff were recruited safely after a series of checks were undertaken on their character and work history. We saw some inconsistencies with regards to one staff member’s previous employment and references which we highlighted at the time with the registered manager.

Staff were supplied with personal protective equipment (PPE). This included gloves, aprons and hand sanitizer. Staff we spoke with told us they were always able to ask for more PPE when needed. Staff had completed infection control and prevention training and understood the important of reporting outbreaks of flu and vomiting to the registered manager, so they could cover their work so as not to spread the infection.

People’s needs were assessed when they started to receive care and support from Guardian. When this was not possible due to the care package being required to be in place urgently, the care plan from the local authority was requested and used as a temporary measure. Everyone confirmed they had a care plan in their homes which had been discussed with them.

Staff undertook training in accordance with the providers training policy, we observed some training take place at the time of our inspection. Staff told us they enjoyed the training, and they received alerts and emails when their training was due to be refreshed.

Induction training took place over the course of five days, and this training was accompanied by assessment booklets for various subjects which staff were required to complete.

Staff were aware of their roles in relation to the Mental Capacity Act (MCA) and we saw that where people lacked capacity to make specific decisions, this was determined by an two stage mental capacity assessment with the rational clearly documented.

People were supported as part of their assessed care needs with eating and drinking and staff documented what people ate and drank to ensure they were getting access to adequate nutrition and hydration.

Staff supported people to access other healthcare professionals such as GP’s and District Nurses if they felt unwell. We saw in most cases family members would do this for their relative, however, staff were able to describe some occurrences when they had to call other medical professionals, such as 111 for advice on someone’s behalf.

We received positive feedback regarding the caring nature of the staff.

People said they were supported to make decisions regarding their care and treatment and they were able to chat with the staff when they came to their homes.

People and their relatives told us their independence was promoted as much as possible in the way that staff gave them choice and control over how they wanted their care delivered.

Care plans contained detailed information about people, what their preferences were, and how they liked their ‘call’ to be conducted. Information in care plans was regularly reviewed and updated in line with people’s changing needs, which showed that the provider was responsive to people’s needs and preferences.

Complaints were investigated in line with the provider’s policies and procedures. We saw that complaints had been acknowledged and information was available for people to enable them to escalate their complaint to independent investigators if they were not happy with the outcome.

Staff and people who used the service spoke positively about the management. Staff felt the service was person centred, and they were encouraged to get to know the people they supported.

The service worked well with the local authorities and took care packages at short notice to enable people to return to their own homes after a stay in hospital.