Stocks Home Care Services is located in a residential area of Skelmersdale. There is ample space to facilitate meetings, private interviews and staff training. Some car parking spaces are available and on road parking is permitted. At the time of this inspection the service was supporting 215 people in the community and 75 care staff were appointed. Agency workers provide personal care and complete domestic duties for people who live in their own homes, so they are able to remain in the community for as long as possible. Good support is provided by the administrative staff working in the agency office. Stocks Home Care Services is owned by Stocks Hall Care Homes Limited and is inspected by the Care Quality Commission.
An unannounced visit to the agency office was conducted on 3rd December 2014 by an inspector from the Care Quality Commission. An Expert by Experience spoke with 20 people who used the service or their relative by telephone prior to the site visit. An Expert by Experience is a person who has experience of the type of service being inspected. One person commented, “I have been pleased with the service.” Another told us, “They (the staff) are polite and cheerful. They cheer us both up (service user and spouse).” A relative said, “There is nothing negative. All very good with Mum. Personal care is seen to and that means a lot to me.”
The inspector also contacted seven members of staff by telephone prior to our visit to the agency office, in order to ascertain what it was like working for Stocks Home Care Services. All responses were positive. One member of staff commented, “The manager is very nice. She is really supportive. You can ring her at any time.” Another told us, “It’s smashing. I really like it.”
Prior to this inspection we asked seven external professionals, who had worked alongside Stocks Home Care for their views about the service. We received two responses, which were in general positive. However, one of these people told us that although Stocks Home Care was a caring service, they felt it would be better if the managers could attend the homes of people in the community when a new piece of equipment was being introduced. This would then enable the managers to instruct their staff on its correct useage and subsequently monitor the competence of all staff using the new piece of equipment.
The registered manager of the agency was on duty when we visited Stocks Home Care Services. 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.
Records showed the staff team were well trained and those we spoke with provided us with some good examples of modules they had completed. Regular supervision records were retained on staff personnel files. However, we noted an annual appraisal for one staff member had not been completed for several years. The manager of the agency told us that these had fallen behind in some instances, but she advised these would be brought up to date shortly.
We recommend that appraisals are conducted each year for all members of staff. This would enable those who work for Stocks Home Care to discuss their annual work performance with their line manager, so that any areas of good practice or areas for improvement can be noted and action plans developed for the forthcoming year.
Staff were confident in reporting any concerns about a person’s safety and were aware of safeguarding procedures. Recruitment practices were robust, which helped to ensure only suitable people were appointed to work with this vulnerable client group.
The planning of people’s care was based on an assessment of their needs, with information being gathered from a variety of sources. Evidence was available to show people who used the service, or their relatives had been involved in making decisions about the way care and support was being delivered. However, the plans of care could have been more person centred in some areas. For example, one person whose care records we looked at required help with his meals, but there was no indication about his dietary preferences or the type of utensils he liked staff to use when assisting him. The plans of care were not always followed in day to day practice. For example, one person told us their commode was not always emptied, despite the plan of care clearly stating, ‘Empty and clean the commode.’ Therefore this plan of care was not always being followed.
We recommend people’s needs are consistently recorded in a person centred way. This would help to ensure the care and support they receive is in accordance with their individual preferences and wishes. We also recommend that the plans of care are consistently followed in day to day practice by the care staff delivering the service.
Regular reviews of needs were conducted with any changes in circumstances being recorded well. Areas of risk had been identified within the care planning process and assessments had been conducted within a risk management framework, which outlined strategies implemented to help to protect people from harm. However, the records we looked at for one person showed he was at risk of choking and although nutritional risks were included in his plan of care, there was no separate risk assessment in place in relation to choking.
We recommend that any identified risks should be supported by a separate risk assessment, showing what strategies have been implemented to reduce the potential risk factor and therefore promote people’s safety.
People were supported to maintain their independence and their dignity was consistently respected. People said staff were kind and caring towards them and their privacy and dignity was always respected.
Staff spoken with told us they felt well supported by the manager of the agency and were confident to approach her with any concerns, should the need arise.
We found hand written entries on the Medication Administration Records (MAR) had not been signed, witnessed and counter signed, in order to reduce the possibility of medications being transcribed incorrectly.
We recommend that all hand written entries on the MAR charts are signed by the person making the entry, witnessed and countersigned by a second member of staff.