Background to this inspection
Updated
24 October 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the provider 48 hours' notice of our intention to undertake an inspection. This was because the provider delivers a domiciliary care service to people in their own homes, and we needed to be sure that someone would be available in the office.
What we did before the inspection
Before the inspection visit, we reviewed information we had received about the service since the last inspection. This included information about incidents the provider must notify us of, such as any allegations of abuse. We sought feedback on the service from the local authority and local Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
During the inspection
We spoke with the director, registered manager, administrator, trainer and five care staff. We reviewed a range of records. These included six people’s care records, medicines records, staff training records, three staff recruitment records and selected policies. We also reviewed incident and accidents records and records relating to the management of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We also spoke with two people who used the service, three relatives and a community social care professional about their experience of care provided.
Updated
24 October 2019
About the service
Key Staff is a domiciliary care agency based in Ledbury, Herefordshire. The service supports children and younger or older adults, who may have learning disabilities, autistic spectrum disorder, dementia, mental health care needs or physical disabilities. At the time of our inspection, there were 10 people using the service.
People’s experience of using this service and what we found
Procedures for supporting people to manage their medicines safely were not sufficiently robust or always followed by staff. People’s medicines records were not accurate or complete, increasing the risk of medication errors. Assessments of the risks to individuals, including potential hazards within their home environment, were not completed on a consistent basis. Prospective staff were not always subject to appropriate pre-employment checks to confirm their suitability to provide care in people's homes. People did not always receive a consistent and reliable service from the provider, due to staffing issues.
The provider did not fully promote people’s rights under the Mental Capacity Act 2005. The shortfalls in the quality and safety of people's care did not reflect a caring service. The care provided did not always meet people’s individual needs and requirements. The provider did not have effective systems and processes in place to assess, monitor and improve the quality and safety of people’s care. Staff and some of the people and relatives we spoke with expressed concerns about the overall management of the service, highlighting the need for better organisation.
Staff understood how to identify and report potential abuse involving people who used the service. They took steps to protect people from the risk of infections through, for example, making appropriate use of disposable gloves and aprons. Staff understood how to record and report any incidents or accidents involving people who used the service, in order that the management team could review these reports.
The provider had introduced a formal system of staff supervision and appraisal. Staff received training designed to give them the knowledge and skills they needed to work effectively. People’s individual needs and requirements were assessed before their care started. They had the level of support they needed to prepare their meals and drinks. Staff and management recognised the need to work effectively with community health and social care professionals involved in people’s care. People’s health needs were assessed and plans were in place to manage these.
Individual staff treated people in a caring manner and knew the people they supported well. Staff and management recognised the need to promote people’s equality and diversity in delivering their care. People and their relatives had support to express their views about the care provided. People were treated with dignity and respect by staff.
People’s care plans were individual to them and accessible to staff. They included an assessment of people’s communication needs. The provider had a complaints procedure and people and their relatives were clear how to raise any concerns or complaints about the service.
The management team recognised their responsibility to be open and honest with people and relevant others if something went wrong with the care provided. They took steps to engage people, their relatives and staff in the service.
Rating at last inspection
The last rating for this service was Requires improvement (published 18 September 2018).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches at this inspection. These relate to the provider’s failure to manage risks to people who use the service, the lack of consistent pre-employment checks on prospective staff, staff induction procedures and the ineffectiveness of the provider’s quality assurance systems and processes.
You can see what action we have asked the provider to take at the end of this full report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.