Archived: Peatons Healthcare

Updated 9 June 2015

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 the 23 March 2015, it was announced. Forty eight hours’ notice of the inspection was given to ensure that the people we needed to speak to were available.

The inspection team consisted of two adult social care inspectors.

We spent time speaking with a relative of a person who was not able to verbally express their experiences of receiving care and support from Peatons Healthcare. We telephoned two staff to interview them and we spoke with the registered manager.

We looked at records held by the provider and care records held in one person’s home. These included two people’s care records, risk assessments, 27 weeks of staff rotas, seven staff recruitment records, meeting minutes, policies and procedures.

We asked the registered manager to send additional information after the inspection visit, including support plans, quality audits, business plan and contact details for health professionals. We contacted health and social care professionals to obtain feedback about their experience of the service. The information we requested was not sent to us in a timely manner. The quality audit and business plan was not sent to us.

This was the first inspection of the service since it was registered with the Commission.

Updated 9 June 2015

The inspection was carried out on 23 March 2015. Our inspection was announced. Forty eight hours notice of the inspection was given to ensure that the people we needed to speak to were available. Peatons Healthcare provides care to people who live in the community in their own homes. People receive support from visiting staff. At the time of our inspection two people received care and support from the service. People receiving care and support were older adults who had physical disabilities.

Peatons Healthcare had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the home is run.

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 came into force on 1 April 2015. They replaced the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found a number of breaches 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 this report.

People were unable to verbally tell us about their experiences. One relative told us that staff kept their family members safe. They also said that staff wore their identification badge and uniform when they arrived at their family member’s home.

The provider had a safeguarding policy in place. The policy did not give staff accurate contact names, addresses or telephone numbers to enable staff to raise safeguarding concerns. The registered manager and staff were not aware of their roles and responsibilities in regards to safeguarding people from abuse.

Risks to people’s safety had not been properly managed. Risk assessments were not in place to manage the risks associated with storage and use of oxygen. There was no guidance for staff relating to safe storage and practice regarding oxygen. Suitable risk assessments had not been carried out to identify safe ways of working with people. We have made a recommendation about this in the report.

Accidents had been recorded, however the accident form did not evidence action that the registered provider had taken to minimise the risk of repeated accidents and relevant health professionals had not been involved where necessary.

Safe recruitment procedures were not always followed. The registered manager had failed to always check references, full employment histories or obtain DBS enhanced disclosure checks to make sure the staff employed were suitable to work with people.

The provider did not have appropriate arrangements for the recording, using and safe administration of medicines. Medicine records did not accurately reflect whether people had taken their medicines or not.

Staff had not received effective training, support and supervision. However, there was a policy in place which was not being followed. Not all staff employed had completed training.

Staff were unable to describe their responsibilities related to the Mental Capacity Act 2005 (MCA) or how people’s capacity to make different decisions affected how they should be cared for and supported. No MCA assessments had been carried out.

There were no support plans in place to support people with food preparation. An assessment of their dislikes had been undertaken, however, this had not informed their support plan.

People were not offered a choice of whether they wanted a male or female staff member to support them with their care needs. However, a relative said that they were grateful for the help and support they received.

Daily records showed that people were supported to make choices. Records showed that staff listened to people’s preferences and choices. Staff were able to describe people’s needs, which evidenced that they knew them. However, people’s preferences and personal histories had not been detailed within people’s care files.

People did not always get their full allocated time for care and support. Staff arrived on time for the care visits, however, they did not always stay for the full length of their visit in the evening.

Each care file contained an assessment of each person’s needs. The assessment recorded who was involved in the assessment. However, there were no support plans in either person’s care file. The registered manager was unable to locate a support plan in the office for people. We checked at one person’s home and they did not have a copy of their support plan either. The care files for both people did not evidence that their care needs had been reviewed. Care files did not contain all of the information required.

The provider had a whistleblowing policy in place. The policy did not detail how staff should report concerns and there was no telephone number for staff to ring. We have made a recommendation about the policies and procedures.

Before the inspection the provider was difficult to contact. The telephone number was unobtainable. The numbers listed within the service user guides and marketing information relied on staff remembering to divert telephones. People and relatives may experience difficulties getting in contact when they needed to. We have made a recommendation about this in the report.

There was no quality monitoring in place. Care records had not been audited or reviewed.

Record keeping was not consistent. Some records had been misfiled and some records were missing. One of the computer servers had broken down which meant that staff and the registered manager could not access information relating to people and staff.

Staff described how they monitored people’s health. If they became concerned about a person they would seek medical help when it was needed and contact the person’s GP for advice. Staff worked with healthcare professionals such as district nurses and recorded and responded to peoples changing health and care needs.

People received care and support from a consistent team of staff. The service was small with a small staff team. The registered manager worked seven days a week to carry out care and support visits where two staff members were needed to provide one person their support. People were supported by staff who knew them well.

Staff had access to and used suitable personal protective equipment (PPE). This included gloves, aprons and antibacterial hand gel. A small stock of this equipment was kept in the office. The staff knew how they should use this equipment to prevent the risk of people acquiring infections.

People were involved in assessing their own care needs where appropriate to do so. Relatives confirmed they had been involved in peoples care and had signed the care contract.

Staff were careful to protect people’s privacy and dignity, they made sure that doors and curtains were closed when personal care was given.

Records relating to people’s personal details and their care were stored securely and safely. Records held in the office were locked in secure cabinets. People could be assured that information about them was treated confidentially.

Relatives felt the service was responsive to their family member’s needs. Daily records evidenced that staff passed on information and concerns so that medical assistance could be arranged. Language used within the daily records was respectful and compassionate.

People and their relatives had been asked for feedback about the service they received. We viewed completed questionnaires on both people’s files. The feedback about the service and staff was positive.

Complaints had not been effectively dealt with. People and their relatives were not aware of the provider’s complaints procedure and had not been given a copy of the procedure. We have made a recommendation about this in the report.

Feedback from staff and relatives demonstrated that people were supported to be as independent as possible in their home.

The registered manager was aware of the day to day culture of the service, including staff attitudes and behaviour because they had been assisting staff to provide care and support to people. Staff stated the registered manager was passionate about providing a quality service.

The registered manager had an understanding of their role and responsibility to provide quality care and support to people. The registered manager demonstrated that they kept themselves up to date with local and national news and information.