Archived: Julie Blackburn Homecare

Julie Blackburn is a care at home service. The service provides personal care to people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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 inspection, nine people were receiving personal care.

People’s experience of using this service and what we found

Risk assessments were not always in place or completed comprehensively to minimise risks to people. People told us staff mostly turned up on time, however there was a lack of monitoring of call attendance and call times.

There was a lack of governance systems in place to monitor and improve the quality of the service. Required records were not always readily available.

People told us they were supported by staff who were knowledgeable. However, staff had not completed all training. Records of staff induction were not kept.

We have made a recommendation about induction and training.

People told us they felt safe with the staff who supported them. People were supported by a consistent staff team.

People received good support to maintain a healthy balanced diet and, where appropriate, the provider worked closely with other health professionals to support people with their health and wellbeing.

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.

People were supported by kind and caring staff who knew them well.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update. The last rating for this service was requires improvement (published 24 July 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection, enough improvement had not been made/sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continued breach in relation to governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

The provider was also the registered manager for the service. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection we rated the service as ‘Good’ and there were no breaches of relevant regulations. However, on this inspection we found three breaches of regulation. There was a lack of record keeping in relation to quality audits and the driving forward of continuous improvements. The staff team felt supported through supervisions and team meetings but these were not formally recorded or minutes taken. We also found that a failure to have protocols in place for ‘as and when required medication’ and details within people’s care plans about the medicines that they needed to receive. This is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Good Governance due to a lack of records.

We identified two events that should have been notified to CQC but had not been. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Despite the breaches of regulation, we found there was a positive culture within the service; people were treated with dignity and respect and were supported to make their own decisions. Care plans demonstrated the basic principles of the Mental Capacity Act (MCA) 2005 and we observed this being applied in practice.

Care plans demonstrated a commitment to person centred care and risks to people were assessed and managed. Care and risk plans were reviewed and the service worked in partnership with external agencies to meet people’s needs. Staff had a good understanding of people's needs and were kind and caring. They understood the importance of respecting people's dignity and upholding their right to privacy.

Staff had access to training and plans for future training were in place. The registered manager carried out spot checks to ensure staff were competent in their roles. The manager also worked side by side with the staff on a daily basis which enabled them to be at the forefront of the care provided to the people who used the service. Staff felt supported in their role. We made a recommendation about formal supervision and appraisals.

Recruitment processes were in place and were robust and there was sufficient staff to meet people’s needs. People confirmed they received care and support from regular staff who they knew. Staff understood what action to take to safeguard people from abuse and training about this was provided.

People’s nutritional needs were catered for and the level of support provided was dependant on people’s abilities. Staff told us how they worked alongside people to prepare their own meals where they were capable.

The registered manager recorded incidents and accidents on specific concerns forms to enable monitoring and reflection on events. There had been very few since the last inspection but all instances were reflected upon and provided examples of lessons learnt.

People were protected from the risks of cross infection because staff used personal protective equipment followed appropriate infection prevention and control best practice.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. There were no active complaints at the time of the inspection. We saw historic complaints had been dealt with promptly and appropriately.

The service didn’t record people’s end of life preferences however staff attended end of life training and the provider told us they will consider recording people’s preferences moving forward.

We saw evidence in documentation that people only received care and support after they had given their consent and people confirmed this was the case when we spoke with them.

We found that people were very satisfied with the care and support they or their relative received. We saw that care was provided in line with care and support plans. People said, 'The girls are very good, they treat me well' and relatives said, 'Staff are very good to X' and 'We have confidence in the service, the provider and the staff'.

We found that good standards of infection control were adhered to and staff were trained in infection control and food hygiene. People told us they had confidence in staff's ability.

We saw evidence in staff files that recruitment procedures were followed and that staff received opportunities to train and develop their skills. People told us they thought the staff were appropriately trained and skilled, as they were knowledgeable about conditions, health care and care needs.

We also saw documentary evidence that quality monitoring systems were used to effectively assess the quality of the service performance so that people received improved services whenever possible.