24 January 2017
During a routine inspection
The service provides domiciliary care to approximately 30 people in the City of Bristol. There was no registered manager in place at the time of our inspection. However, arrangements were in place to manage the service whilst a new manager was recruited.
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.
We found that the service wasn’t safe in all aspects. Risk assessments were not always completed or detailed enough to guide staff in providing safe care and support for people. We also found that systems in relation to medicines administration were not robust. We found omissions in Medicine Administration Records (MAR) and there were also practices taking place that were not in line with published guidance on medicine administration.
People reported feeling safe with the staff who attended their calls; however we found that there were shortfalls in the recruitment process that meant the service did not fully comply with the requirements of legislation. For example, gaps in employment histories were not always discussed with the candidate and in one case, photo ID had not been obtained to verify the identity of the staff member.
Staff received training and supervision to support them in their development needs. There was a standard induction programme for all staff that included topics such as safeguarding, health and safety and infection control. The programme was based on the requirement of the Care Certificate; a nationally recognised set of standards that care staff are required to meet.
Overall, people were satisfied with the care they received although some did raise issues that they felt could be improved. For example, we heard that communication could be better when staff were running late for their scheduled care appointments. People also told us they would prefer to have a rota in advance so that they knew beforehand who would be coming. This was something that the service told us they were hoping to achieve for everyone.
There were systems in place to monitor calls and ensure they weren’t missed. This created an alert if staff hadn’t logged in to a call with their phone and enabled staff in the office to check the situation and phone ahead to people if necessary. People told us they hadn’t experienced ‘missed calls’ although one person did say that an evening visit running late (sometimes by 2 hours) had caused them some difficulty.
Care plans contained information about people’s individual needs and preferences. Where possible, regular staff attended to people’s calls so that they got to know people well. There were systems in place to monitor whether calls were taking place as scheduled.
There were systems in place to monitor the quality and safety of the service provided. This included gathering feedback from people and using this to develop a quality improvement plan.