Archived: Grade A Care

Grade A is a domiciliary care agency in Hindley, Wigan. It provides personal care to people living in their own houses and flats in the community. Not everyone using Grade A receives a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care'; 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, there were seven people receiving a regulated activity from the service.

The service was last inspected in June 2017, when we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regard to regulation 17; good governance. We also made three recommendations in relation to risk assessment documentation, training and reviewing people's care needs within specified time frames.

Following this inspection, the service was rated as requires improvement overall and in the key lines of enquiry (KLOE's); responsive and well-led. The service was rated as good in safe, effective and caring.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; responsive and well-led to at least good. However, the provider failed to submit the requested action plan.

We reviewed the progress the provider had made as part of this inspection and found the provider remained in breach of regulation 17; good governance (two parts). We also identified an additional breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regard to regulation 18; staffing. We also made a further recommendation to review risk assessment documentation. You can see what action we told the provider to take at the end of the full version of this report.

This was our third inspection of Grade A where the rating has not improved from requires improvement. All previous inspection reports can be viewed by clicking the ‘all reports’ button on our website at www.cqc.org.uk. We are currently considering our options in response to this third requires improvement rating in line with our methodology.

At the time of the inspection 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.

People we spoke with told us they felt comfortable with the staff and had no safety concerns.

At our last inspection we recommended the service sought advice and guidance from a reputable source regarding individual risk assessment documentation. This was because the risk assessments in place did not identify sufficient control measures to mitigate all risks and were not kept under review. At this inspection we found this had not been actioned and the risk assessment documentation was unchanged.

There was a recruitment process in place, but records to demonstrate this had been followed were not sufficiently maintained.

People continued to be supported by staff who understood their responsibilities if they suspected people receiving support from the agency had been abused or mistreated.. Staff were also knowledgeable about how to report accidents and incidents.

Medicines were managed in a safe way with records being completed accurately and all medicines given as prescribed.

There were sufficient staff employed to meet current care commitments and missed visits were not a concern within the service.

There was a basic induction and training in place at the service and one staff member had completed the care certificate. However, staff did not consistently receive supervision at regular intervals or complete an appraisal of their work.

People's rights under the Mental Capacity Act 2005 (MCA) continued to be protected. Care staff supported people to have maximum choice and control of their lives.

The agency is a small family run service so people were supported by a small familiar staff team which promoted continuity of care and people and staff spoke positively of the care provided and the relationships that had developed.

Staff were caring and respected people's privacy and dignity. Staff were provided with enough time on care calls to be able to provide compassionate care. People told us staff visited at the scheduled time and were flexible about staying longer when required.

Staff demonstrated they knew people’s preferences and care needs. We saw there were basic support plans in place to provide initial guidance to staff which had been reviewed.

There was a complaints process in place which had been followed and we saw the service had received compliments from people receiving support.

We found basic quality assurance systems had been implemented but these had not been devised or fully operated to monitor all aspects of service delivery. In addition, it could not be determined when formal feedback had been sought to obtain people's views through reviews or questionnaires. Team meetings had not been maintained but staff confirmed their views were sought and they had regular communication with the registered manager and provider.

At our inspection in December 2015, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in regards to the following regulations; safe care and treatment, good governance (two-parts) and staffing.

The service was rated as good in caring and requires improvement in all the other key lines of enquiry (KLOE’s) which meant the service was rated as requires improvement overall.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to regulation 17; good governance. You can see what we told the provider to do about it at the end of this report.

We also made three recommendations in relation to risk assessment documentation, training and reviewing people’s care needs within specified time frames.

Grade A is a small family run domiciliary care agency in Hindley, Wigan. The agency provides care and support to people who live in their own home who have a variety of care needs. At the time of our inspection there were 14 people using the service.

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.

All the people and relatives of people receiving support told us they had no concerns regarding people’s safety as a result of the care provided.

We saw the service had suitable safeguarding policies and procedures in place. Staff had received training in safeguarding vulnerable adults and demonstrated a good understanding of how to report both safeguarding and whistleblowing concerns

Recruitment checks were carried out to ensure staff were of suitable character to work with vulnerable people. We saw there were sufficient numbers of staff employed by the service to meet people's needs and the registered manager told us staffing levels were sufficient to meet the current care packages.

We recommended the service sought advice and guidance from a reputable source regarding individual risk assessment documentation. This was because the risk assessments in place did not identify sufficient control measures to mitigate all the risks.

People and their relatives confirmed there were not frequent missed visits and when staff were running late due to unforeseen circumstances, people were contacted by phone and given an explanation.

Medicines continued to be managed safely and administration procedures were followed correctly by staff.

A robust induction programme such as the 'care certificate' had not been implemented at the service but all current staff had enrolled on NVQ’s and had previous care experience and relevant qualifications.

People's rights under the Mental Capacity Act 2005 (MCA) were protected. Care staff supported people to have maximum choice and control of their lives in the least restrictive way possible; company policies and procedures supported this practice. Care records showed people were involved in their care and support.

People were supported by a small staff team which promoted continuity of care and people and their relatives spoke positively of the care provided and the relationships that had developed.

Care plans were in place to guide staff about how best to support people, but were not personalised to take in to account people's equality and diversity needs. However, we found staff demonstrated that they knew people's likes, dislikes, preferences, routines and arrangements were in place for people’s social and emotional support needs to be met.

Reviews of people's needs required further development and we have made a recommendation about this.

We found quality assurance systems had not been devised or fully operated to monitor all aspects of service delivery. In addition, feedback was not consistently sought by the provider to obtain people's views and seek staff opinions to drive continued improvements.

The last inspection report rating was displayed at the agency office so people could make an informed decision about using the service.

All staff were positive about working for the agency, which they described as a small, 'family run' service that put the needs of people first. Staff told us they felt valued and enjoyed their roles.

The registered manager had enrolled on the NVQ 5 in management and leadership to support them in their role. The provider and registered manager were receptive to feedback and demonstrated a commitment to further service improvement.

From the staff records we looked at we were able to see that the staff who currently worked for the agency had been appointed correctly. That is, all of the appropriate checks and references, including obtaining Criminal Record Bureau disclosures [CRB's] had been carried out. This showed that the provider had taken appropriate steps to ensure that there were safe recruitment procedures in place and that people who were not suitable to work with vulnerable adults were not employed within the service.

People said they felt safe and well supported by the agency.

Staff said they received adequate training to enable them to provide care appropriate to need.

The agency is in the process of recruiting more staff to enable the service to expand. They are also updating the care plans to ensure they are person centred and identify all aspects of how the care and support will be carried out.