The inspection of the service took place 6 March 2018. A follow up desktop review of evidence was completed 22 March 2018. This was completed following a meeting with the registered manager of the service. The delay was due to the registered manager and the inspectors conflicting schedules. The service was given 24 hours' notice prior to the inspection this was done as the service is small and we wanted to be sure there would be someone available to speak with us.
KTG Recruitment Ltd is managed from well-equipped offices located in central Preston. Services are provided to support people to live independently in the community. During this inspection there were 12 people who used the service.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing.
Not everyone using KTG Recruitment Ltd receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
There was a registered manager at the service. 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.
At the last inspection we made a recommendation that the agency reviews it practices regarding the signing of consent forms and ensure that any discussions with people who do not wish to sign elements of their care plan, but have the capacity to do so, are documented appropriately.
During this inspection we found the principles of the MCA were not consistently embedded in practice. We found people’s capacity to consent to care had not always been assessed and information was at times conflicting. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice
This amounted to a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Need for consent). You can see what action we told the provider to take at the back of the full version of the report.
We found inconsistencies in individualised risk assessments and the plans in place to mitigate these. The documentation did not always contain information to adequately mitigate the risks to individuals.
This amounted to a breach of Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
At the last inspection of the service we made a recommendation that care plans and risk assessments fully reflect people's current needs.
During this inspection we found care plans did not always contain up to date current needs for people. For example we saw that one person had developed a scab and redness on their bottom area and was using a pressure cushion. This change in need was not reflected in their risk assessments or care plan.
This amounted to a breach of Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
We looked at the procedures the provider had for the administration of medicines and creams. We found that people did not always have medicine support plans in place. We found that protocols for “as and when” medicines were not always in place as per the medicines policy. Medicines audits we checked had not picked up on issues we found such as missed signatures.
This amounted to a breach of Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
We saw evidence that quarterly quality monitoring was being undertaken, however the audits were not always effective. We found little information surrounding the details of issues found and how these had been rectified and lessons learned. We also noted the audit system had not identified the breaches of regulation and areas of improvement we had noted during this inspection.
These shortfalls in quality assurance amounted to a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance). You can see what action we told the provider to take at the back of the full version of the report.
The service is currently supporting people who are considered on an end of life pathway however we found limited documentation around people’s preferences or wishes. We have made a recommendation about this.
We looked at what arrangements the service had taken to identify record and meet communication and support needs of people with a disability, impairment or sensory loss. We could not see that individual needs had been assessed or planned for. We have made a recommendation about this.
There was a complaints policy to enable people’s complaints to be addressed. However we found not all complaints relating to regulated activity had been recorded. We have made a recommendation about this.
At the last inspection of the service we made a recommendation that the provider ensures that formal records are in place following accidents and incidents.
During this inspection we found there was a central record for accident and incidents to monitor for trends and patterns and the management had oversight of these.
We found recruitment to be safe. We reviewed staffing at the service and did not find any concerns.
We were able to see staff supervision was taking place. Staff we spoke with confirmed they felt supported in their role. Staff training was ongoing and evidence has been seen of staff completing training.
People were supported by staff with activities to minimise the risk of becoming socially isolated. An example was seen in one person's care file where the person enjoyed gardening and painting and staff supported them with this.
We received consistently positive feedback about the staff and about the care people received. Staff received training to help ensure they understood how to respect people’s privacy, dignity and rights. Staff were highly motivated and described their work with a clear sense of pride and enthusiasm.
The provider and registered manager had clear visions around the registered activities and plans for improvement moving forward. The management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.