Archived: Carterhatch Domiciliary Care Service

Updated 29 January 2016

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 17 and 18 November 2015. The provider was given 48 hours’ notice because the location provides a domiciliary care service. The inspection was carried out by one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we looked at information that we had received about the service and formal notifications that the service had sent to the CQC. We looked at 13 care records and risk assessments, seven staff files, 23 people's medicines charts and other paperwork related to the management of the service. We spoke with four people who used the service, nine staff and nine people’s relatives.

Updated 29 January 2016

This inspection took place over two days, 17 and 18 November 2015. The provider was given 48 hours’ notice because the location provides a domiciliary care service. Carterhatch Domiciliary Care service is provided by the London Borough of Enfield. It provides care and support for around 70 people in their own home. The service works with people living with dementia, learning disabilities, and people with autistic spectrum disorder, older people and people with sensory and physical impairment.

The service was last inspected 14 November 2013 and was meeting all the regulations inspected. There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider. The registered manager was not present during the inspection.

People were involved in decisions about their care. Where people were unable to have input, best interests meetings and decisions were recorded. Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

There were individualised care plans written from the point of view of the people that were supported. Care plans were detailed and provided enough information for staff to support people. We saw that care plans were regularly reviewed and updated as changes occurred.

Risk assessments gave staff detailed guidance and ensured that risks were mitigated against in the least restrictive way. Risk assessments were reviewed and updated regularly.

People received a continuity of care. The provider always tried to ensure that the same care workers looked after people. This promoted good working relationships with people who used the service.

There was a system in place to monitor any missed visits. Missed visits were investigated and followed up. The provider had begun to introduce a new electronic monitoring system to monitor visits.

People were encouraged to have input into their care and the service. The provider ran a quarterly service user forum where people were encouraged to discuss issues and say what they did and did not like about the service they received.

People and relatives said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity. People were encouraged to be as independent as possible.

Staff received regular, effective supervision and appraisals and attended monthly team meetings. Senior staff completed regular monitoring of care staff via monitoring visits.

We found that there was an open culture that encouraged staff and people to discuss issues and ideas, though team meetings and service user forums. Team leaders supported care staff on a daily basis.

Staff had received training on medicines administration and people were supported to take their medicines safely. Medicines were accurately recorded on medicine administration (MAR) sheets.

Audits were carried out across the service on a monthly and quarterly basis that looked at things like, medicines management, health and safety and quality of care. There was a complaints procedure as well as incident and accident reporting. Where areas for improvement were identified, the registered manager used this as an opportunity for change to improve care for people.