Below is a summary of what we found. There were 39 people receiving domiciliary type services from the provider on the day of the inspection. During our inspection we spoke with four members of staff who supported people, the manager who was supporting the inspection process and two relatives by phone after the inspection. We were only able to speak with one person as most people within the service were not able to verbally express their views due to their complex care needs. We looked at three people's care records.If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We spoke with one person who told us they felt safe within the service. One relative we spoke with said, "Yes X is safe I have no concerns". Care workers we spoke with had not had safeguarding training in over two years but were able to explain to us how they would keep people safe if they saw abuse happening.
We found that there were risk assessment processes in place with the intention of keeping people safe. Records we looked at were not always clear as to the outcome of these assessments and what it meant for people's safety. This meant that people could potentially be at risk of unsafe support.
The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had been submitted. Care workers we spoke with were unable to explain to us both MCA and DoLS and told us they had not had any training. Records we saw confirmed this. Care workers were able to explain how they would ensure people were safeguarded even though they were not knowledgeable about how people who lacked capacity should be supported in their best interest. The provider confirmed that they were already aware of the lack of training being made available to care workers and action was already in place to rectify the situation. The provider provided us with evidence of some of the actions that were already taking place.
We found that the recruitment processes and the appropriate checks that were needed to ensure potential newly appointed care workers were suitable to work with vulnerable adults needed further improvement to ensure people were safe from harm.
We found that wheel chair lap belts were being used but the appropriate risk assessments and consent documentation was not being completed. This meant that where people needed to be restrained the appropriately documentation was not in place.
We have asked the provider to tell us what further improvements they will make in relation to ensuring that people are safe within the service.
Is the service effective?
Records showed that people all had support plans in place to identify their support needs and how care workers should meet their needs. There was information available about people's health needs and we saw health action plans and hospital passports being used to ensure people's support needs were met. Where people had particular health conditions and risks for example, dysphagia this was being highlighted and care workers were able to explain to us people's risks and how they were supported. This meant that where people needed support from health professionals this was available.
Relatives we spoke with told us they were happy with the support their relatives received. One relative said, "If X was unhappy I would know".
Care workers we spoke with had an understanding of how people should be supported and kept safe where they had a fall. However care workers had no clear process to follow and were not receiving appropriate training to ensue people were supported safely and consistently.
We found that where people's support needs were being reviewed people or their relatives were not consistently contributing to the process and there was no evidence of reviews taking place.
We have asked the provider to tell us what improvements they will make in relation to ensuring the service is effective in meeting people's needs.
Is the service caring?
Care workers we spoke with were able to explain how people gave consent whether they had capacity or not. Record's we looked at were not being signed to show a record of consent. One person we spoke with said, "Staff do get my consent before they support me". This meant that people were giving their consent before they received any support.
Records showed that people's like's, dis-likes and other preferences were being recorded along with their medical history and other relevant information so care workers were able to support them appropriately. One person we spoke with told us that staff supported them to go shopping for clothes and food they liked, and supported them to have a wash and get dressed. This meant that people were able to get the support they wanted.
The provider had adequate systems in place to meet the requirements of the law in ensuring the service was caring.
Is the service responsive?
We found that the provider had systems in place to be able to respond to concerns raised by people or their relatives. Records show that the provider had a quality assurance system where questionnaires were sent to people and relatives to gather their views on the service as part of a process to improve the service to people. We saw evidence of the analysis from a recent questionnaire distribution showing response rates and the positive and negative views people shared about the service. Relatives we spoke with confirmed they had received a questionnaire which they completed and sent back. We also saw an action plan to put in place measures to respond to the views shared by people or their relatives. This meant the provider had a system in place so people's views could be shared.
The provider had a complaints process in place and evidence of complaints being logged so trends could be monitored. One relative told us that they had previously made a complaint which the provider responded to. Relatives told us where they had a concern they knew who to speak to. We found that the complaints process was available in other formats so people had information in a way they could understand.
The provider had adequate systems in place to meet the requirements of the law in ensuring the service was responsive.
Is the service well-led?
The service was led by a manager who had recently been employed and had applied to be registered with the Care Quality Commission. The manager was available throughout the inspection process and assisted us with any information we needed.
We found that the provider's recruitment processes were not being followed consistently in every recruitment situation where staff were being promoted internally. We found that care workers recruitment application forms had gaps where vital information like their work history had not been completed. We found that some care workers had not had any training since May 2010. This meant that the people could not be confident that care workers would have the skills and knowledge to support them safely.