Background to this inspection
Updated
13 January 2015
Our inspection team consisted of an 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 care service.
We visited the office of the agency on 28 July 2014 and talked to the registered manager and the regional assistant. We also spent time looking at a range of people’s and staff’s records. We also visited people who used the agency in their own homes and talked to two of them. Because some people who used the service could not verbally communicate with us we observed how the staff worked with them. An expert by experience telephoned the relatives of five people who used the agency to gain their views about the care and support that their family member had received. We also telephoned people who worked for the agency to gain their views about the service.
At the last inspection, undertaken in May 2013, there were no breaches in any of the six regulations examined.
Before the inspection the provider completed a Provider Information Return (PIR). The PIR is information that has been returned from the provider and is not a review of all the information we hold about the provider.
We also sent questionnaires about the service being provided to people who use the service, their relatives, staff and professionals that work with people who use the agency such as GPs and physiotherapists.
We also reviewed notifications we had received from the provider. A notification is information about important events which the provider is required by law to send us.
Updated
13 January 2015
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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
The inspection was announced. This meant that the provider was aware when we were inspecting and that staff were available to support our inspection.
The service currently provides care and support to 123 adults with a learning disability. The organisation manages services provided to people across four counties from the registered office location. The services provided vary from care and support provided for a few hours per day, or week, to individual people living in their own home to the provision of care and support on a 24 hours basis to people, or groups of people living together. The agency has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
All of the people that we talked with told us that they felt safe and that they would know what to do, and who to contact, if they thought they had been mistreated in any way. There were systems and processes in place to reduce the risk of people suffering any abuse. However people’s safety was being compromised in a number of areas this included how well medicines were administered, the staff understanding of how they should assess if people have the capacity to make certain decisions and ensuring there was always enough staff on duty with the right skills and knowledge to meet people’s needs.
The Mental Capacity Act 2005 sets out what must be done to make sure that the human rights of people who may lack capacity to make decisions are protected. Although the manager was aware of the requirements of the Mental Capacity Act 2005 and all staff had received training not all the staff that we talked with were able to tell us how it needed to be put into practice. The staff who are working directly with people must know what their responsibilities are regarding the MCA so that decisions are made in people’s best interests and people’s human rights are upheld. The manager was aware of the responsibilities and had taken appropriate action when he thought any restrictions had been placed on people.
Staff had been given training about how people should be treated as individuals and supported to make decisions and how to promote people’s dignity, respect and privacy. People who used the agency told us that staff were kind and treated them with dignity and respect and when they had raised any concerns they had been dealt with effectively.
People had been involved in the planning of their support and care. Important information about people’s history, preferences and goals for the future, which helped the staff get to know people and how they would like to be cared for and supported, was recorded in their support files.
The permanent staff had the support, skills and competencies they required to meet people’s needs. Care staff told us that they had attended all of the training they needed to do their job effectively and could request extra training if needed. We found that at times due to there being a shortage of permanent staff
There were effective systems in place to monitor and improve the quality of the service provided, which took into consideration the views of the people who used the agency. Staff felt that they could discuss any concerns with someone in the management team and that there was an open culture within the agency.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.