About the service: Home Instead Preston is a domiciliary care service, which provides support for adults in the community, who require assistance with personal care, including those living with dementia, physical and learning disabilities, mental health needs and sensory impairments. The agency office is on the outskirts of the city of Preston, adjacent to the railway station and accessible by the local bus services. People live in their own houses within the local community. At the time of our inspection there were 53 people who used the service, 22 caregivers, 2 administrators, a training officer and a care-co-ordinator, as well as the registered manager.
People’s experience of using this service:
Everyone we spoke with provided us with positive comments about the quality of service provided and the ability of the staff team. The provider had systems to act on allegations of abuse. Environmental risk assessments contained good detail. However, health and social care risk assessments were basic and lacked important information. The provider had a system for the reporting and recording of accidents and incidents. Staff had received training in medicines awareness and guidance for staff was available. We have made a recommendation about the process for auditing medicines. Staff were recruited safely, although on one occasion the provider could have further explored the employment history of one staff member. We have made a recommendation about this.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's needs and choices were assessed before a package of care was arranged and before a client returned from hospital. These assessments were sometimes very brief and would have benefitted from more detailed information being obtained. We have made a recommendation about assessing people’s needs. However, positive feedback was provided by people we spoke with, who told us they received effective outcomes from their caregivers, who were kind and caring.
New staff received an induction programme and a broad range of training had been completed by all staff, who were regularly supervised and observed at work. However, training for staff in relation to end of life care had not been provided. We have made a recommendation about this. Appraisal systems were not up to date and therefore, staff members were not formally offered the opportunity to discuss their work performance at regular intervals. We have made a recommendation about this.
Support plans did not contain detailed and person-centred information and therefore these did not always accurately reflect the needs of those who used the service. The needs assessment, risk assessment and support plan for one person failed to refer to a medical condition which impacted on their specific dietary requirements. This could have had a detrimental effect on their daily life should inappropriate foods be served. A mental capacity assessment had not been conducted for one person, who had a mental health diagnosis. We have made a recommendation about mental capacity assessments. Community health and social care professionals were involved in the care and treatment of those who used the service.
The provider had systems for the management of complaints. However, none had been recorded since the last inspection, but people told us they would know how to make a complain, should the need arise. Everyone we spoke with provided us with very positive comments about the quality of service provided and the staff team.
There was little oversight of the management of the service and effective audits were not taking place. Therefore, a robust system for assessing and monitoring the quality of service provided had not been established. However, feedback was periodically obtained from those who used the service, their relatives and the staff team. Regular team meetings had been conducted and staff members felt able to approach the managers with any concerns, should they need to do so.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection:
The service was rated good at the last inspection (Published 10 December 2016).
Why we inspected:
This was a scheduled inspection based on the previous ratings.
Enforcement:
At this inspection we rated the service as requires improvement. We identified two breaches of regulations, in relation to person-centred care and good governance. Please refer to the end of the report for action we have told the provider to take.
Follow up:
The service will be re-inspected as per our inspection programme. We will continue to monitor any information we receive about the service. We may bring the next inspection forward if we receive any concerning information.