Background to this inspection
Updated
7 February 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service provides care [and support] to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single
household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care [and support] service.
The service did not have a manager registered with the Care Quality Commission but there was an acting manager who had submitted an application to become registered as the manager with the CQC.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it was a domiciliary care service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.
During the inspection
We spoke with eleven people who used the service and five relatives about their experience of the care provided. We spoke with nine members of staff including senior managers, senior care workers and care workers.
Updated
7 February 2020
About the service
The service is a domiciliary care agency providing care and support to people living in an extra care housing complex. This consisted of 63 separate flats within the housing complex. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection, 31 people were receiving personal care and support.
People’s experience of using this service and what we found
People were not always safe because all risk was not identified or managed. Systems to protect people from abuse were not always effective because some concerns were not identified. Staff did not always have the time they required to spend with people so they could meet their needs and provide support in the way they preferred.
People and staff were not always supported because they did not always have confidence in the managers and found they were not accessible.
Systems in place to monitor the quality of the service were ineffective. They did not fully seek or listen to the views and feedback from people, relatives and staff.
Care and support did not always meet people’s needs or was not delivered in the way people preferred.
Staff were mostly caring and treated people with kindness and respect. However, there were some instances when this was not the case and there was some tension between staff and people because there were differences in understanding and expectations around care and support arrangements.
People had their medicines managed in a safe way and were supported to take their prescribed medicines. Infection control policies and procedures were in place and staff had access to the protective equipment they required.
Staff received induction and ongoing training. The support and supervision staff received had recently been increased.
People had access to healthcare services and staff knew how to recognise when people’s health was deteriorating.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
All care plans were being reviewed to make sure they met people’s needs and preferences. Some people and staff did not feel confident making a complaint and did not always feel listened to. Action had been taken to address this concern. Rotas had been changed so that care team leaders were available every weekend and additional training was being provided to staff.
Rating at last inspection
This service was registered with us on 29 October 2018 and this is the first inspection.
Why we inspected
This was a planned inspection as per our inspection programme.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified breaches in relation to assessing risk, safety monitoring and management and quality monitoring systems.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.