Archived: Grace Home Care Services

An action plan was submitted by the provider that detailed how they would meet the legal requirements by 9 October 2015.

We undertook an announced inspection on 28 July 2016 to check the provider had made improvements and to confirm that legal requirements had been met. At this inspection we found improvements had been made in relation to notifications. However, improvements were still required in relation to medicines and assessing and monitoring the quality of service that people received. We also found improvements were required in other areas.

We told the provider two days before our visit that we would be coming. We did this because they were sometimes out of the office supporting staff or visiting people who use the service. We needed to be sure that they would be available.

Grace Home Care is a domiciliary care agency that provides care and support services to people in their own homes. At the time of our inspection 17 people were using the service. Some people who used the service lived reasonably independent lives but required support to maintain this independence. Other people required more support due to their long term healthcare needs such as diabetes or the risk of falls. Some people were living with dementia type illnesses.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law. The registered manager was also the owner of the service.

At this inspection we found care plans where information did not reflect people’s current support needs and other care plans did not include the level of detail staff may require to provide people with the appropriate level of support. There were no systems to assess the quality of the service provided and the registered manager had not identified the shortfalls we found.

People told us staff were kind and caring and supported them in the way they chose. Staff knew people well as individuals and had a good understanding of people’s care and support needs. There was information about people’s mental capacity in their care plans but we found when people lacked capacity it was not clear how consent was sought or how decisions were made in their best interest.

Medicines were managed safely however there was no clear guidance about how staff should apply topical creams to people who required them. Staff had not received regular supervision or spot checks to ensure they were supporting people properly.

There were enough staff who had been appropriately recruited to look after people who used the service. The registered manager undertook an assessment before people started using the service to ensure there were enough staff to support them appropriately.

Some people required support from staff to have enough to eat and drink and maintain a healthy diet. This was recorded in their care plans and staff had a good understanding of the support people needed.

People told us the registered manager was approachable and they were able to discuss any concerns or worries with her.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered and used the information to answer the question; Is the service safe?

This is a summary of what we found:-

Is the service safe?

Staff records and other records relevant to the management of the services were accurate and fit for purpose. Records were kept securely and only accessible to those staff that needed to see them. This meant that people's confidential information was kept safely. Recruitment records were fit for purpose which meant that the provider had evidence that a robust recruitment process took place.

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 safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found:-

Is the service safe?

Staff personnel records contained evidence that all the information required by the Health and Social Care Act had been sought prior to employment being offered. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people who used the service. The provider has up to date risk assessments in place which supported staff in keeping people safe. We found that appropriate action was taken where concerns were identified.

Is the service effective?

People told us that they were satisfied with the care that had been delivered and their needs had been met. Comments included "No complaints. They are very helpful and always turn up on time", "The service has improved" and "I find them very good". Staff had received appropriate training to meet the needs of the people who used the service.

Is the service caring?

People told us that the staff were caring and attentive. One person said "They take an interest in me" and another commented "They always ask if there is anything else I need. They treat me with respect". The manager demonstrated a commitment to making sure that people were treated as individuals.

Is the service responsive?

People's needs had been assessed before they used the service. Records confirmed people's preferences and that care and support had been provided in accordance with people's wishes. People told us that communication had improved and that appropriate action was taken if they had any concerns.

Is the service well led?

We saw that people had completed a recent quality assurance survey questionnaire. The manager had responded to any areas of concern which had been identified from the survey. Staff told us that they felt supported by the manager and had received supervision where they could discuss any issues. Appropriate records were in place but we found that recruitment records did not hold copies of all the information that had been sought prior to employment. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found that people who used the service were treated with respect and courtesy by care staff when they came to their home. However, people were not always kept informed about changes to their care schedule.

People told us they were generally happy with the care they received from staff. However, we found there was a lack of reviews of care plans and risk assessments which meant that there was a risk that care was not always planned and delivered in a way which ensured people's safety and welfare.

There were gaps in the recruitment checks for new staff which meant the provider could not be certain about the suitability of applicants for the role of carer.

We found that staff had not received all the mandatory training required for them to carry out their roles effectively. For example, some staff were involved in the preparation of food without food hygiene training.

There was a lack of action taken by the provider to make improvements to the service where they had been identified. People who used the service were asked for their views but it was unclear what action had been taken where it was needed.

We found a number of shortfalls in record keeping. These included training records, care plans and risk assessments. Appropriate and accurate records were not always maintained