Background to this inspection
Updated
25 May 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’
The inspection took place on 12 and 13 April 2016 and was announced. We gave the provider 48 hours’ notice that we would be coming. We gave the provider notice of our inspection as the location provides a domiciliary care service within a supported living scheme and we needed to make sure that someone was at the office in order for us to carry out the inspection. The service was registered in December 2013 and had not been previously inspected.
The inspection team comprised of one inspector.
Before we visited the service we checked information that we held about the service and the provider. This included looking at notifications and incidents affecting the safety and wellbeing of people as well as information that the provider had sent to us as part of the Provider Information Return (PIR) process. The PIR is a form that asks the provider to give us some key information about the service, what it does well and improvements they plan to make.
As part of the information gathering process we also contact local authority commissioning teams for their views and experience of the service.
As part of the inspection process we spoke with two relatives, the registered manager, one senior carer and one carer. At the time of the inspection there was only one person who used the service who was engaged in their own activity but also had limited communication and were unable to share their views about the care and support that they received. We observe people being supported and interactions between them and care staff. We looked at the care records of the two people who used the service as well as four staff files. Other documents we looked at relating to peoples care included risk assessments, medicine records, policies and procedures and training records.
Updated
25 May 2016
This inspection took place on the 12 and 13 April 2016 and was announced. We gave the provider 48 hours’ notice that we would be coming. We gave the provider notice of our inspection as we needed to make sure that someone was at the office in order for us to carry out the inspection. The service was registered in December 2013 and had not been previously inspected.
The service provides personal care for people living in a supported living scheme in North London. At the time of our inspection, the service was providing care and support to one person who was living at the scheme and a second person whom they supported as part of a respite programme, once a month.
There was a registered manager in post who was registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The inspection took place over two days. On the first day of the inspection we visited the service’s main office. On the second day of the inspection we visited the supported living scheme in which the service provides care and support. On visiting the supported living scheme we observed that it was clean. On entry we were introduced to one person living at the scheme. They were able to welcome us into the scheme and gave us permission to look around. The scheme had a relaxed and homely feel.
The registered manager and staff were aware of the basic requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were able to demonstrate a basic understanding of mental capacity and how this may impact on people living at the service. However, staff needed to be provided with more in-depth knowledge in this area especially as the service had not completed mental capacity assessments for the people that they support, even though they identified that these people may lack capacity to make decisions in particular areas. In addition, the person living at the supported living scheme was unable to leave the home without being accompanied by a staff member and therefore may require a DoLS authorisation. This had not been addressed by the service.
People and relatives were positive about the care that they received and about the staff who supported them. Staff knew the people they supported very well and were able to tell us about their individual needs and requirements and how they supported them with these.
Positive caring relationships had been developed between people who used the service and staff. People were treated with kindness and compassion, dignity and respect. Staff provided prompt assistance to people but also encouraged and promoted people to build and retain their independent living skills.
Policies and procedures were in place to help ensure people were protected from abuse or risk of abuse. A detailed safeguarding policy was in place which gave staff information and direction on how to recognise signs of abuse and how to report abuse to the appropriate authorities. Risk assessments were in place that considered the individual potential risk for each person using the service.
People received personalised care that was responsive to their needs. Care plans were detailed and specific to each person and their needs. Care plans included a specific document about the person’s personal support and care needs which was drawn up with input and contribution from the person themselves. These documents were pictorial with a statement written by the person about how they wished to be supported. However, the service had not completed a health action plan which would provide vital information to assist other health providers to support people effectively through their journey when accessing health care services.
We saw suitable arrangements were in place in relation to the recording and administration of medicines.
The service had appropriate procedures in place to ensure safe recruitment processes were followed. Staff had the appropriate skills and knowledge to carry out their role effectively. Regular training and refresher sessions were offered to the staff team where required. All staff received regular supervision where they could discuss their work and any related issues or concerns. Supervision also addressed any training or development needs. However, the service had not carried out any annual appraisals with any of the staff members. We spoke with the registered manager about this who told us that they would ensure that all staff members received an appraisal over forthcoming weeks. Care staff we spoke with felt supported by the registered manager and were positive about their experience of working at the service.
Relatives of people using the service knew the registered manager and senior carers and felt able to raise any issues or concerns they may have had. Relatives and staff were encouraged to complete regular quality assurance feedback forms in order to learn and improve services. The provider also had systems in place to monitor and improve the quality of the service.
There was one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.