The summary is based on our observations during the inspection, speaking with nine people who used the service and two relatives. In addition, we spoke with the quality and compliance manager, the local manager and four staff. We looked at care records, the systems used to manage people's medication, staffing arrangements and quality assurance.We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:
Is the service caring?
We found that the service was caring. This was because people said that staff were respectful, kind and attentive. They considered staff to be kind and to be genuinely committed to helping them. Relatives were confident that staff were polite and courteous to people who used the service.
Is the service responsive?
We found that the service was responsive. This was because people's individual needs for care had been assessed and met. Staff knew about each person's care needs, choices and preferred routines. People said that their care needs were met in a flexible way with staff being happy to adjust the assistance they provided according to the person's changing needs and wishes.
However, we have said that the provider may find it useful to make an improvement to further develop the service. This involved responding to concerns raised by some people who found that staff were sometimes rushed because they had to complete too many visits in a short time.
Is the service safe?
We found that the service was not safe. Staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse including physical and financial abuse. This included having policies and procedures to guide staff in the correct application of the Mental Capacity Act 2005. This helped to ensure that people were supported to make decisions that were in their best interests.
However, the provider did not have a reliable and accurate system to record all medicines administered by staff. This increased the risk of errors occurring because there was no comprehensive account of what medicines people had been supported to take.
We have told the provider that it must make improvements. This is necessary so that people can reliably be assisted to safely take medicines that have been prescribed for them.
Is the service effective?
We found that the service was not effective. This was because there were inadequate arrangements to ensure that visits were always carried out, completed on time and lasted for the correct amount of time. These shortfalls significantly reduced the provider's ability to reliably and consistently support people at home.
We have told the provider that it must make improvements. This is necessary so that people can effectively receive the care they need at home.
Is the service well led?
We found that the service was not well led. This was because the manager had been in post for approximately four months but the provider had not submitted an application for her to be registered with us. The law says that the provider is required to have a registered manager. This is because we need to establish that there is someone in charge who has the knowledge and skills necessary to ensure that the service is caring and meets people's support needs.
In addition, there was not a robust system to receive feedback from people about their experience of using the service. We also found that quality checks had not been completed in a comprehensive and rigorous way. This had resulted in significant problems with the reliability of the service people received not being quickly identified and resolved.
We have told the provider that it must make improvements. This is necessary so that people can reliably receive the care they need at home.