Background to this inspection
Updated
3 September 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.
This inspection took place on 20 June 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to ensure the provider had care records available for review had we required them. The inspection team consisted of one inspector.
We checked if the provider had sent us any notifications since our last visit. These contain details of events and incidents the provider is required to notify us about by law, including unexpected deaths and injuries occurring to people receiving care. We reviewed any additional information we held or had received about the service. We also spoke with a person who commissions packages of care from the service. We used this information to plan what areas we were going to focus on during our inspection.
During our inspection we spoke to the nominated individual for the service who was also the registered manager. We spoke with three care co-ordinators, three care staff and the service administrator. We looked at records including the care plans of six people and medication records of six people who used the service. We looked at five staff files and staff training and recruitment records to identify if staff had the necessary skills and knowledge to meet people’s care needs. We looked at the provider’s records for monitoring the quality of the service to see how they responded to issues raised. We also discussed how the service was responding to concerns raised by other agencies.
After our inspection we spoke to thirteen people who used the service and three people’s relatives. We also reviewed additional information received from the provider.
Updated
3 September 2016
The inspection took place on 20 June 2016 and was announced. At our last inspection in January 2015 we were concerned that people were not being supported in line with the Mental Capacity Act 2005 and we asked the provider to make improvements to ensure that staff worked in accordance with the Mental Capacity Act and receive relevant training. We saw that this action had been completed.
The service provided domiciliary care to 90 people in their own homes. There was a registered manager at this location. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run.
Staff we spoke with were knowledgeable about how to meet the care needs of the people they supported although records did not identify all the training staff had undertaken or when further training would be required. Recruitment processes ensured people were supported by staff who were suitable to meet their care needs.
The registered manager was aware of their legal responsibilities to notify the commission of specific events however they had not ensured their latest ratings were clearly displayed on their website. They had not established adequate quality monitor processes to identify if the service was meeting people’s needs or how it could be improved. They did not always respond to concerns raised by other agencies. Audits had not always identified when errors in record keeping had occurred. Information was not reviewed for trends and to identify learning opportunities. You can see what action we have asked the provider to take at the back of the report.
Medicines were not managed safely. Medication records did not clearly indicate what medication people should be supported to take or when. Staff who were to support people to take their medication had not always indicated they had done so. You can see what action we have asked the provider to take at the back of the report.
Staff we spoke with knew how to recognise the signs of abuse. Care plans identified people’s specific conditions and how staff were to support them to keep them well. When necessary the provider involved and worked with other professionals to meet people’s care needs.
The registered manager sought people’s views of the service. Senior staff conducted spot checks and observations of how staff supported people. We saw the providers response to complaints was not consistent or in line with good practice. You can see what action we have asked the provider to take at the back of the report.
People were generally supported by the same staff which had helped them to develop positive relationships. Staff knew how people liked to be supported and told us how important it was for them to meet people’s needs. People told us they were supported when necessary by staff to eat and drink enough to keep them well.
People we supported to decide how they wanted their care to be delivered. Senior staff would take part in best interest meetings when people were thought to lack mental capacity.