Archived: Direct Carers - York

Updated 23 March 2017

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 registered 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 site visit to the agency office took place on 31 January 2017 and was announced. The registered provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be at the agency office to assist us with the inspection. The inspection was carried out by two adult social care inspectors.

Before this inspection we reviewed the information we held about the agency, such as information we had received from the local authority who commissioned a service from the registered provider and feedback from people who used the service.

The registered provider was asked to submit a provider information return (PIR) before this inspection. This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR was submitted within the required timescale.

On the day of the inspection we spoke with a care coordinator, the registered manager and the registered provider and other staff in the office. We also spent time looking at records, which included the care records for five people who used the service, the recruitment records for six care workers and other records relating to the management of the service, including quality assurance, staff training, health and safety and medication. We visited one person receiving a service in their own home and following the inspection we spoke with one relative, two people who used the service and three members of staff.

Updated 23 March 2017

We completed an announced comprehensive inspection on 31 January 2017. We gave the provider 48 hours' notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service and we needed to be sure that someone would be at the agency office that could assist us with the inspection. The registered provider first registered this service with the Care Quality Commission on 29 April 2015. During a previous inspection in March 2016 the registered provider was rated as Good in all domains.

This domiciliary care agency is registered to provide personal care for people with a range of varying needs including dementia, learning disabilities or autistic spectrum disorder, mental health, older people, people who misuse drugs and alcohol, people with an eating disorder, physical disability, sensory impairment and younger people who live in their own homes. At the time of our inspection nineteen people received a personal care service.

The registered provider is required to have a registered manager in post and on the day of this inspection there was a registered manager registered with the Care Quality Commission (CQC). A registered manager is someone who has registered with the CQC 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 agency had not followed their own policies and procedures when recruiting new staff and that this could have resulted in people receiving care from staff who were not suitable to work with vulnerable people.

This was a breach of Regulation 19 (1)(a)(b) (2) of the Health and Social Care Act (Regulated Activities) Regulations 2014: Fit and proper persons employed.

Staff had received training in medicines management and the registered provider had an associated policy and procedure in place. However, the registered provider had not maintained accurate and up to date records when people received support with their medicines.

Systems and processes in place that ensured staff received up to date training were not always effective in their purpose as some staff training and most supervisions were overdue.

The registered provider had implemented an electronic call monitoring system. However, we found that care workers did not always stay for the full call duration which brought into question the effectiveness of the electronic call monitoring system.

The above concerns were a breach of Regulation 17 (1) (2)(a)(c) of the Health and Social Care Act (Regulated Activities) Regulations 2014: Good governance.

Staff and management understood the requirements of legislation under the Mental Capacity Act 2005 (MCA). Staff told us they always assumed people had capacity unless assessments identified otherwise.

Staff encouraged people to make their own decisions. People were involved in their care planning and we saw where people had capacity to do so they had signed their consent to the care and support.

Care workers we spoke with understood the types of abuse they might see and knew how to respond to protect people from avoidable harm and abuse. People’s needs were assessed and risk assessments put in place to protect people from avoidable harm.

Staff confirmed they received induction training when they were new in post and told us that the training provided for them ensured they had the necessary skills required to commence their role. The training records showed that staff had completed induction training and the training that was considered to be essential by the agency, although we found some refresher training was overdue.

The feedback we received confirmed that people had positive relationships with care workers and it was apparent that care workers genuinely cared about the people they supported. People received their care and support from regular staff which meant that care workers knew how best to support the individual person. This consistency helped people to develop meaningful caring relationships.

People told us that care workers treated them with dignity and respect and staff told us they understood how to maintain their confidentiality.

There was a complaints policy and procedure and this had been made available to people who received a service and their relatives. People and their relatives we spoke with told us they were confident of raising any concerns and that these would be acted upon.

There were systems in place to seek feedback from people who received a service and we saw that most of this feedback was positive. There were minimal systems in place to request feedback from staff.

We found the registered provider was in breach of two regulations under 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 the report.