Archived: Acacia Homecare Limited

At this visit we met with the registered manager and care manager. The manager confirmed 29 care workers were currently working for the service. At this inspection we viewed four care workers employment files. Since the last inspection an audit on all the care workers employment files had taken place. This included checking for gaps in employment history, verifying, where necessary, references and ensuring criminal record checks had been requested and /or obtained.

We viewed four care workers employment files. Two employment files contained all the required information needed to ensure the provider had taken the necessary steps in obtaining as much information about the care workers before they worked with vulnerable people in the community. A third file, although had an audit completed on it, the application form had an unexplained gap in the care worker's employment history, which later on the same day of the inspection was obtained by the manager. A fourth file only had one reference from their previous employer and the audit had noted that a second reference was still to be sought. This care worker had started working in August 2014 for the service. Later on the same day of the inspection the manager informed us that the second reference was obtained. The manager was aware that the audits needed to be used effectively to ensure any missing information was obtained prior to a care worker starting to work alone and unsupervised.

We also found that in two of the three staff employment recruitment files viewed their criminal checks were not available to view. The manager informed us that this would be addressed by 22 May 2014.

Furthermore we found that incidents which should have been reported to the Care Quality Commission (CQC) were not. This meant CQC were not aware of any concerns or incidents and were not able to see how the service responded to a concern or incident. The manager informed us that this would be addressed by 31 May 2014.

Finally we found that some records were not being adequately maintained, kept for the appropriate period of time or were available on the day of the inspection. The manager informed us that this would be addressed by 30 April 2014.

At this visit we met with the registered manager, viewed three people's care records and three care staff's recruitment files.

We found that care records had improved as they were clearer and provided care staff with current information about the person's needs. The manager also informed us that people using the service now had copies of the service user's guide along with a copy of their care plan and risk assessments.

We saw that the three care staff recruitment files contained criminal record checks. However we found other shortfalls in the staff employment files, such as gaps in employment and lack of detail regarding dates of employment and their education and qualification details.

The manager was aware of reporting incidents and events to the CQC and she confirmed there had been none to report since the April 2014 inspection.

Overall there had been improvements made to record keeping and the organisation of records.

During the inspection we spoke with three people using the service, four relatives and six staff. The staff included the provider, the registered manager and four care staff.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

We found that the service was not safe.

Risk assessments for individuals had been carried out but were not available in people's homes, so staff providing care did not have access to these. As a result they would not be able to find the necessary information to minimise risks to people. Care plans were not always updated to reflect changes and copies were not always available in people's homes. This meant staff did not always have the information they required to meet people's current needs.

Staff recruitment checks were not always being carried out fully, which could place people at risk. The agency had not always completed criminal records checks on the staff when they were recruited. This meant they could not demonstrate these staff were suitable to work with people using the service.

Records were not being maintained appropriately, were not up to date and information was not always being recorded. Therefore people were not protected against risks that can arise if records are not kept appropriately and accurately.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staff recruitment and record keeping.

Is the service effective?

People said their needs had been assessed by staff at the service to ask them about and identify their needs and wishes in respect of the care they required.

Is the service caring?

People told us staff were caring and polite. They said they had good communication with the service and the staff understood their needs. One relative said 'there is a family feel to the service and they are very good at responding to needs' and another said 'everything is perfect, they are doing a good job.' One person using the service described it as 'very good, on the whole.'

Is the service responsive?

People and relatives said where they had raised concerns these were listened to and action was taken to address them. They also told us that the service responded to changes in people's needs. However, when changes in people's needs had been identified, the care records had not always been updated to reflect this, so people could be at risk of not receiving the care they required.

Is the service well-led?

The manager said she carried out reviews of people to ensure changes in their needs were identified, and people we spoke with confirmed this. Staff were monitored regularly to ensure they were providing care appropriate to meet the needs of people. This was done with spot checks at people's homes and also through supervision sessions with staff.

The service had a registered manager and people we spoke with and staff said she was approachable and managed any issues brought to her attention.

Systems were in place to monitor and review the service being provided to people. Action was taken to address any issues identified so people received the care they wanted.

We looked at safeguarding records for all staff and saw evidence that all staff had received safeguarding training. Staff were trained to identify and escalate signs of potential abuse and neglect. Staff we spoke to understood what safeguarding was and their role in protecting people who used the service.

We looked at how the service was staffed and found that suitably trained and experienced staff were used. We also found that the staff were allocated in sufficient number to meet the needs of people using the service. Staff records also showed that appraisals and supervision had taken place.

We looked at how the registered manager monitored the quality of care provided. We found that there were systems in place to ensure quality was maintained and when it wasn't of a high standard, the provider acted quickly to rectify this.We saw evidence of a complaints log and that the provider reviewed and assessed the complaints received. Staff we spoke to demonstrated that they knew how to escalate complaints. Relatives and clients told us that they to felt able to contact senior staff if they had concerns.

People said the care delivered by the agency was very good and met their needs. One person told us that staff and managers had changed their life.' I feel well cared for and in control of my life', they told us. They confirmed that they were involved with their care planning and their care was continuously reviewed with their involvement. Both people told us that they felt respected by staff and staff were normally on time and they had a regular staff member who provided their care.

We found that people's needs were assessed regularly and they were given all the necessary information they needed including out of hours contact numbers and information outlining the terms and conditions of the agency.

People told us that they knew how to make a complaint and said that they felt able to raise any concerns that they had. There were no complaints recorded for the service during our inspection and the agency provided information on how to make a compliant to people when they first signed up for services.

We found that there were appropriate systems in place to protect people from harm. Staff were able to explain the different types of abuse and their roles in safeguarding people.

There were good systems in place to deal with the recruitment and training of staff and staff were provided with appropriate training to enable them to carry out their job.