Archived: Real Care Ribble Valley Limited

Updated 5 January 2016

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 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.

We told the provider 72 hours before our visit that we would be coming. This was to ensure the registered manager and staff would be available to answer our questions during the inspection. On 23 November we spoke on the telephone to two relatives of people who used the service and a member of care staff. We also visited the registered office for the service to meet with the registered manager and the staff member designated as supervisor. On 25 November 2015 we visited three people who used the service and spoke with a further member of care staff and a relative.

The inspection team consisted of one adult social care inspector. Before our inspection we reviewed the information we held about the service including notifications the provider had sent to us. We also contacted the local commissioning team and Healthwatch to obtain their views about the service. We did not receive any feedback from the agencies we contacted.

During the inspection we looked at the care records for the five people who were using the service. We also looked at a range of records relating to how the service was managed; these included staff personnel files, training records and policies and procedures.

Updated 5 January 2016

This was an announced inspection which took place on 23 and 25 November 2015. We had previously carried out an inspection in February 2015 when we found the service was in breach of six of the regulations we reviewed. We made requirement actions in relation to staff recruitment procedures, safeguarding people from abuse, record keeping, management of medicines, support and training for staff and quality assurance systems in the service. Following the inspection in February 2015 the provider sent us an action plan telling us what steps they were going to take to ensure all the regulations were met. They told us they would take action to ensure all the legal requirements were met by 31 May 2015.This inspection was undertaken to check that the required actions had been completed.

Real Care Ribble Valley is registered to provide personal care to people living in their own homes. At the time of our inspection there were five older people using the service.

The provider had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). A registered manager is a person 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. The registered manager told us they had delegated all responsibility for the running of the service to a care staff member who they had nominated as supervisor. However there is not provision within the Act for such delegation. The registered manager also acknowledged they had not ensured this staff member was provided with training and support to be able to effectively carry out their supervisory role.

Our finding during this inspection showed the registered manager and provider had made no effort to comply with the requirements of the last inspection. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to staff recruitment procedures, systems to ensure people received safe care including the management of medicines, support and training for staff and quality assurance systems in the service

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

People who used the service told us they felt safe when staff from Real Care Ribble Valley Limited provided them with any care or support. They told us there were always sufficient staff available to meet their needs and that staff always arrived promptly and stayed for the correct amount of time. However, we found required improvements had not been made to the recruitment processes in the service. This meant people who used the service were not fully protected from the risk of staff who were unsuitable to work with vulnerable people.

Although the registered manager had arranged for staff to undertake e-learning training in a number of courses in April 2015 we were told that none of the staff had completed any of this training. We were told that this was because staff had been waiting for passwords to access the e-learning system. We found that the registered manager had not taken any action to ensure staff had completed the training in a timely manner.

Although staff were able to tell us about the action they should take if they had concerns about a person who used the service, this knowledge was based on training undertaken with other employers and was not necessarily up to date. Staff had not had the opportunity to read the service’s policy relating to safeguarding adults.

Although risk assessments had been completed in relation to the individual needs of people these lacked detail. There were also no plans in place to guide staff about the action to take to manage the identified risks.

The systems in place to manage the way medicines were administered to people who used the service were not sufficiently robust to protect people from the risks associated with the unsafe handling of medicines.

Although staff told us they enjoyed their role, they did not have confidence in the leadership of the service. There were no systems in place to allow the registered manager to regularly monitor the quality of the service provided.

People who used the service told us they were able to make choices about the way their care was provided. Although staff had not received training in the Mental Capacity Act (MCA) 2005, they were able to tell us how they supported people to make their own decisions and remain as independent as possible in line with the principles of this legislation.

All the people we spoke with were highly complimentary about the staff from Real Care Ribble Valley Limited. Comments people made to us included, “The staff are excellent. I feel like its personal when they are here for me”, “I can’t fault them [staff]. They are very caring and respectful of me when they are helping me to get dressed.” A relative also told us, “[My family member] absolutely loves the staff. She thinks they are wonderful.”

During our discussions with staff they demonstrated their understanding of person-centred care. Staff told us they would always listen to people to ensure they provided the care people wanted in a way which promoted people’s independence and choice. All the people we spoke with told us the care provided by the service was responsive to their needs and staff always respected their dignity and privacy.

Staff provided people with the necessary support to help ensure their nutritional needs were met. People who used the service told us staff would always check if they had enough to eat and drink.

Systems were in place to respond to any complaints people might make about the service. The registered manager told us no complaints had been received since our last inspection.