Archived: Staff Line Home Care Limited

Our previous comprehensive inspection to the service was undertaken between 4 and 17 May 2017. The overall rating of the service at that time was judged to be ‘Requires Improvement’. Five breaches of regulation were highlighted.

This inspection was completed between 14 June 2018 and 21 August 2018 and was announced. At the time of the inspection there were 108 people receiving support from the domiciliary care service.

A registered manager was in post. 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.

Quality assurance checks were not routinely being undertaken to enable the registered provider and registered manager to assess and monitor the service in line with regulatory requirements or to improve the quality of the service. The registered provider and registered manager had not taken appropriate steps to ensure they had sufficient oversight of the service to ensure that people using the service received personalised and responsive care. The lack of managerial oversight had impacted on people and the quality of care provided. The registered provider and registered manager were unable to demonstrate where improvements to the service were needed, how these had been addressed.

People’s comments about staffing remained variable. The service sought people’s views about the quality of the service provided and from this a review form was completed. These demonstrated people did not always receive a consistent service that was caring and our findings in terms of how staff supported people did not concur with people’s comments about a caring service. People did not always know if they were to have a regular member of staff attend to their care and support needs. People told us this impacted on the level of care they received as they would have to tell the member of staff what they needed to do and how they wished their care and support to be provided. People were concerned that the times of visits by staff were inconsistent especially in the evenings and at weekends. Furthermore, people and those acting on their behalf were concerned and unhappy that some members of care staff did not stay very long or for the full allocated time that they should. This also meant we could be assured people using the service always received their medication at the times they needed them and received appropriate nutrition and hydration according to their needs.

The Care Quality Commission had not been notified of safeguarding incidents, despite the service working in collaboration with the Local Authority on several safeguarding concerns since our last inspection in 2017. This was not in accordance with regulatory requirements pertaining to notifications. Where the service had been asked by the Local Authority to undertake an internal investigation and complete a subsequent written report, these were poorly completed. This showed that the management team did not fully understand their role and the relevant safeguarding processes to follow.

People’s comments about the care and support they received was variable. Our findings as discussed with people using the service, their relatives and detailed within review forms, showed people did not always receive a consistent service that was caring or respectful.

Responses to complainants did not always consider all elements of the complaint and responses to professionals and complainants were not always appropriate.

Appropriate arrangements were now in place to recruit staff safely. Risks to people were now assessed, managed and reviewed to ensure their safety.

People’s healthcare needs were managed well. Medication practices and procedures had improved since our previous inspection and although there were still some recurrent errors, these were mainly in relation to records.

Staff received opportunities for training and this ensured staff employed at the service had the right skills and competencies to meet people’s needs. Newly employed staff received a robust induction. Staff felt supported and received supervision at regular intervals and an appraisal of their overall performance. However, where concerns about a staff member’s performance had been raised, there was insufficient information available to show how this was monitored and suitable actions taken to address this with the staff member.

Staff demonstrated a good knowledge and understanding of the people they cared for and supported. People told us their personal care and support was provided in a way which maintained their privacy and dignity. We found that people’s support plans reflected information to guide staff on the care people required to meet their needs.

You can see what actions we told the provider to take at the back of the full version of the report.

The inspection was completed on 4, 5, 9, 10, 15 and 17 May 2017 and was announced. At the time of the inspection there were 140 people receiving support from the domiciliary care service.

A registered manager was in post. 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.

Quality assurance checks were not routinely being undertaken to enable the provider and registered manager to assess and monitor the service in line with regulatory requirements or to improve the quality and safety of the service. The provider’s arrangements were not as robust as they should be as they had not recognised the issues we identified during our inspection or made sufficient progress to address shortfalls already identified by the Local Authority in November 2016.

Proper recruitment checks had not been completed on all staff before they commenced working at the service and processes had not been operated in line with the provider’s own policy and procedures. Although staff were provided with a range of mandatory training as determined by the provider when first employed by the service, training records showed that not all staff had received refresher or up-dated training in key areas and improvements were required so as to ensure the training provided was embedded in staff’s practice. Some members of staff spoken with confirmed they relied on others for advice and support, particularly when supporting people with their safe moving and handling needs.

Ambiguity between the provider’s and staff’s understanding of the terms to ‘assist’ and ‘administer’ medication were evident. Our findings showed that we could not be assured that the administration of medication and staff’s practice was always appropriate and safe or in line with national guidance; and this placed people at potential risk of harm.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. Risk assessments had not been developed for all areas of identified risk.

Although an induction workbook was evident to support the induction process, none of these had been assessed or marked to provide sufficient evidence as to whether or not staff had or had not met the induction standards and were competent to undertake their role. Though suitable arrangements were in place for staff to be supervised and monitored at regular intervals through ‘spot visits’, improvements were required to ensure where issues were highlighted, actions were taken to address these.

Information held by us confirmed there had been no safeguarding concerns raised since January 2016. However, prior to this inspection the Local Authority made us aware that there had been seven safeguarding incidents within a 12 month period, however we had not been notified of the safeguarding incidents in accordance with regulatory requirements pertaining to notifications.

People’s comments about staffing were variable. Whilst some people’s comments were positive others were not. People and those acting on their behalf told us that although there was a consistent team of staff supporting them or their relative Monday to Friday this was not consistently applied at the weekend. Though people using the service and those acting on their behalf were generally complimentary about the care and support provided, ‘Service Review and Quality Monitoring’ forms showed that people did not always receive a consistent service that was caring and our findings in terms of how staff supported people did not concur with people’s comments about a caring service. People did not always know if they were to have a regular member of staff attend to their care and support needs. People told us this impacted on the level of care they received as they would have to tell the member of staff what they needed to do and how they wished their care and support to be provided. People were concerned that the times of visits by staff were inconsistent especially in the evenings and at weekends. Furthermore, people and those acting on their behalf were concerned and unhappy that some members of care staff did not stay very long or for the full allocated time that they should.

Where concerns or complaints had been raised as part of the provider’s own quality assurance processes; although information relating to the issues raised had been identified, no further action had been taken to formally log these as a concern or complaint or to address the issues raised. Where people were unhappy with some aspects of the service, none of the issues raised had been logged as a complaint and there was no evidence to show that this had been brought to the provider or registered manager’s attention in a timely manner.

People told us they were kept safe. People told us there had been no missed calls. People’s healthcare needs were managed well and they received appropriate nutrition and hydration each day according to their needs.

Staff demonstrated a good knowledge and understanding of the people they cared for and supported. People told us that their personal care and support was provided in a way which maintained their privacy and dignity. We found that people’s support plans reflected information to guide staff on the care people required to meet their needs.

You can see what actions we told the provider to take at the back of the full version of the report.

There was a registered manager in post. 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.

Staff Line Home Care Limited provides support with personal care to adults living in their own homes. At the time of our visit they were providing personal care to 180 people and had around 80 staff working for them.

People were safeguarded from the risk of abuse as the service had systems to identify the possibility of abuse and stop it occurring. Staff had attended safeguarding training and were able to explain the different types of abuse and what action they would take if they were concerned that abuse or neglect was taking place.

Before newly recruited staff started employment the provider undertook all necessary employment checks. There were enough staff to ensure people received care and support as they needed it.

Each person had a care plan outlining how they needed support and how they liked to be helped. We saw referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were supported to take their medicines safely as part of their care package. We have made a recommendation about the recording of administration of medicines.

People knew who to speak with if they had any concerns they wished to raise and felt this would be taken seriously.

People were treated with respect and their privacy and dignity was promoted. Staff were caring and responsive to the needs of the people they supported. Where included in their care package, people were supported to eat and drink enough.

Staff had good understanding of the requirements of the Mental Capacity Act (2005) and what they should do should a person lack the capacity to make a decision.

Staff sought people's consent before working with them and promoted their independence. People were supported to make choices and involved in the care and support they received. They were encouraged to be part of the local community.

The provider had quality assurance and audit systems in place. From discussions with the registered manager, it was clear that they routinely reviewed practice to improve the care and support provided to people who used the service.