The inspection took place on 12 and 17July 2017. This was an announced inspection. We gave the provider 48 hours notice of the inspection as this is a domiciliary care agency and we wanted to ensure the manager was available in the office to meet with us. This service was last inspected on 11 and 17 May 2016 when we found the provider was in breach of four regulations, in relation to need for consent, safe care and treatment, good governance and staff supervision.Turkish Cypriot Community Association is a domiciliary care service run by Turkish Cypriot Community Association. At the time of inspection, the service was providing personal care to 105 people with learning disabilities, dementia or mental health issues in their own homes. Most of the people who used the service and the staff spoke Turkish.
The service had a registered manager 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 2008 and associated Regulations about how the service is run.
The service had made improvements since the last inspection but these were not sufficient in providing safe care and treatment and good governance.
The registered provider failed to notify us about two incidents and did not raise safeguarding alert with the local authority on one occasion. Risks associated to people’s care were not reviewed following accidents and incidents, and actions agreed were not followed through. Accidents and incidents records were not reviewed by the management. Environmental risk assessments were completed, however risks assessments related to people’s health conditions were not carried out. Risk assessments and care plans did not give sufficient information and instructions to staff on how to provide safe and personalised care. Medicines administration records (MAR) for people who were prompted with medicines management were not always completed. Care plans were not personalised and lacked information on people’s likes and dislikes.
The data management and monitoring systems to assess the quality and safety of care delivery was ineffective. The registered provider was not auditing systems related to care delivery including daily care logs, MAR, care plans and risk assessments. Some staff references lacked additional paperwork to confirm they had been verified. People’s mental capacity assessment records required supplementary information regarding their power of attorney.
People and their relatives told us they were happy with the service and found staff caring and kind. People were satisfied with staff’s punctuality and found the service reliable and trustworthy, and were happy to recommend the service. The service provided continuity of care and that enabled positive relationships between staff and people using the service. Staff were matched to people with similar cultural backgrounds. People told us staff treated them with and dignity and respect. People were provided with companionship services as and when required.
Staff told us they felt supported by the management and their suggestions were taken on board. Staff received regular supervision and annual appraisal. Induction and training records confirmed staff received mandatory and additional training to do their job effectively. Staff had a good understanding of their role in identifying signs of abuse and reporting any concerns of poor care, neglect and abuse. Staff sought people’s permission before providing care and gave them choices.
People’s nutrition and hydration needs were met. The service worked with health and care professionals in improving people’s physical health.
The service sought formal feedback on the quality of care delivery from people and their relatives via annual feedback survey forms and called people quarterly to find out if there were any concerns.
We found the registered provider was not meeting legal requirements and there were overall two repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 Registration Regulations 2009 notifications of other incidents. These were in relation to safe care and treatment and for systems and processes to improve the quality and safety of the services including accurate records.
You can see what action we told the provider to take at the back of the full version of the report.