31 January 2017
During a routine inspection
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.