8 June 2022
During a routine inspection
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.
People’s experience of using this service
We identified issues with the management of the service. We found there were insufficient risk assessments in place to provide safe guidance to staff when providing care. Care plans lacked personalised information, and we found gaps in records to show that complaints were dealt with in line with best practice.
The service had grown significantly since the last inspection and we were concerned that there was insufficient management oversight and input to ensure quality care was provided. We found contradictory information on some care plans in relation to mental capacity assessments, and mobility issues. We found some complaints documentation had not been completed to evidence actions taken, although people told us complaints were dealt with.
The management team knew people’s needs and we found staff to be well-informed, so this mitigated against some of the concerns identified.
The service had some systems in place to monitor and improve the quality and safety of the service provided. These included spot checks and reviews, although review documentation was not always fully completed.
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; but the completed documentation did not always evidence this practice.
People and their relatives found the care staff kind and caring, and skilled to do their job. People were treated with dignity and respect.
People and their relatives told us they felt safe. Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.
Staff recruitment was safe, and people told us they usually had a consistent team of care staff.
Staff told us they enjoyed working for the service and received support and training to carry out their role. Records evidenced that supervision and training took place.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
The inspection was prompted in part due to concerns received about the consistency and quality of the service. A decision was made for us to inspect and examine those risks.
Rating at last inspection
At the last inspection we rated this service good (18 December 2020).
Enforcement and Recommendations
We have identified breaches in relation to insufficient risk assessments and the governance of the service.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.