Background to this inspection
Updated
8 February 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 8 and 18 January 2019 and was announced. We gave the service 48 hours’ notice of the inspection visit because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.
The inspection was carried out by one inspector.
Prior to the inspection we reviewed the information we held about the service, for example information shared with us by healthcare professionals and members of the public. We also reviewed information we held about the service such as notifications. These are events that happen in the service that the provider is required to tell us about. We also used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
During the two-day inspection we spoke with the senior team coordinator, acting manager, registered manager, head of quality compliance and the regional manager for the East of England. We reviewed six care plans, five staff files, the complaints file, audits, four Medicines Administration Records (MARs) and other records relating to the management of the service.
After the inspection we contacted four people, two relatives, one staff member and two healthcare professionals to gather their views of the service.
Updated
8 February 2019
This comprehensive inspection took place on 8 and 18 January 2019 and was announced.
We last inspected the service on 6 September 2016 and we rated the service overall Good. At this inspection we rated the service requires improvement in well-led and overall Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults in the borough of Redhill in Surrey. At the time of the inspection the service was providing personal care to 25 people.
The service had a registered manager in place. 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 2008 and associated Regulations about how the service is run.
The systems and processes in place to oversee the service was not always effective. Audits undertaken did not always identify issues and action taken was not always clearly documented. We shared our concerns with the registered manager who on the second day of the inspection had implemented compliance processes to address our concerns. We will review this at our next inspection.
People received their medicines as intended by the prescribing Pharmacist. Medicine records were not always completed in line with good practice. Action taken to address these issues was not always documented.
People continued to be protected against the risk of avoidable harm, as risk management plans in place were regularly reviewed and gave staff clear guidance on how to keep people safe in their own homes.
People were protected against the risk of abuse as staff were aware of how to identify, report and escalate suspected abuse. Staff were aware of the provider’s safeguarding policy and were confident in whistleblowing.
People continued to be protected against the risk of cross contamination as the provider had clear infection control guidelines for staff to follow. Staff received adequate amounts of personal protective equipment to minimise the spread of infection.
Sufficient numbers of staff were deployed to keep people safe. The provider had a robust pre-employment procedure to ensure only suitable staff were employed. Newly employed staff underwent a comprehensive induction process to familiarise themselves with people and the service.
Staff received on-going training to enhance their skills and knowledge. Training provided ensured people’s needs were met by staff equipped with the skills to effectively support them. Staff reflected on their working practices through regularly one-to-one meetings with management and goals were set for the coming months.
Consent to care and treatment was sought prior to being delivered. The service was aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA). People's consent to care and treatment was sought prior to being delivered. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Where agreed in people’s care packages, staff members supported people to access food and drink that met their preferences and dietary requirements. People were also supported to make contact with and attend healthcare professional appointments as and when required.
The service had an embedded culture of treating people with dignity and respect. People’s privacy was maintained and people were treated equally, taking into consideration any cultural or religious needs.
The service monitored people’s dependency levels to ensure appropriate support was given, that enabled people to maintain their independence. People’s confidentiality was respected and both paper and electronic records were stored securely.
Care plans were tailored to people’s individual needs and where possible people and their relatives were encouraged to develop their care plan in line with their wishes and needs. Where agreed in people’s care packages, people were supported to participate in community based activities.
The service had an embedded culture of ensuring complaints were monitored to minimise the risk of repeat occurrences and reach a positive resolution.
People’s views continued to be sought through spot checks and quality monitoring processes. The registered manager was aware of their responsibilities in reporting notifiable incidents to the CQC.
The registered manager continued to encourage partnership working with other healthcare professionals, people and relatives to drive improvements and result in positive outcomes for people.