23 November 2015
During a routine inspection
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.