Background to this inspection
Updated
14 April 2022
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 and an Expert by Experience, who conducted telephone calls with people using the service and their relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses, flats and specialist housing.
The service had a manager registered with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 36 hours’ notice of the inspection. This was to ensure the registered manager was available to support the inspection and to ensure we had prior information to promote safety due to the COVID-19 pandemic. The notice period also allowed the provider time to start asking people using the service and their relatives, if they would be prepared to speak to us about their experiences. Inspection activity started on 14 February 2022 and ended on 11 March 2022, by which time we had sought the views of people, relatives and staff and reviewed all additional information sent following the visit. We conducted the office visit on 16 February 2022.
What we did before the inspection
We reviewed information we had received about the service since it was registered. This included notifications sent to us by the home. Notifications are changes, events or incidents that the provider is legally obliged to send to us without delay. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.
During the inspection
We spoke with four people who used the service and four relatives about their experience of the care provided. We spoke with registered manager in person and captured the views of four staff members via emailed questionnaires.
We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at four staff files in relation to recruitment, training and support. A variety of records relating to the management of the service were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at audit and governance information, staff rotas, surveys, medicine records, training and supervision information.
Updated
14 April 2022
About the service
Paula Integrated Care is a domiciliary care service registered to support children and adults, including older people, people with a physical disability and people living with dementia. 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, the service supported 29 people with personal care.
People’s experience of using this service and what we found
We found improvements were required with training documentation, supervision completion, topical medicines process, review process for accidents and incidents, care planning and the audit and governance process.
Staff supervision had not been provided in line with guidance, as not all staff had completed supervision sessions over the last 12 months. Staff told us they received enough training to carry out their roles, however, the documenting of training completion was disjointed. 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.
The majority of people, relatives and staff spoke positively about the management of the service and support provided. Although some audits had been used to monitor the quality and effectiveness of the service, there was not a clear schedule in place. Actions plans had been used to help drive improvement, however issues had either not been addressed timely or improvements sustained.
Care files contained mainly task based information about each person and how they wished to be supported, with limited information about people’s likes, dislikes and interests. Most of the people and relatives we spoke with had been involved in discussions around care planning. The complaints process was provided to people at the beginning of their care package. Each person or relative we spoke with knew how to formally raise concerns but had not needed to. Communication care plans explained people’s communication needs; however, we saw no evidence information was available in different formats.
We have made a recommendation around how information is provided to people.
People who received assistance to take their medicines, had no concerns with the support provided. From records viewed we could not be certain whether people required support with topical medicines and if so, if these had been applied. People confirmed staff wore PPE and staff told us specific COVID-19 training had been provided. However, recent guidance changes to the staff testing process had not been fully implemented.
We have made a recommendation about adhering to testing guidance.
People and relatives told us the service provided safe care and they felt comfortable in staff’s presence. Staff had received training in safeguarding and knew how to report any concerns. Overall, care visits were completed timely. However, travel time was not always included on the call planning system, which could have led to late visits.
We have made a recommendation about the call scheduling process.
People and relatives spoke positively of the care provided, which they said was delivered by staff who were kind, friendly and helpful. We were also told staff respected people’s privacy and dignity and offered them choice. People’s views were sought through care reviews and annual surveys, to ensure the service continued to meet their needs.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 19 November 2020 and this is the first inspection.
Why we inspected
This was a planned inspection based on the date of registration in order to provide an initial rating for the service.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, 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.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.