Archived: Kamino Homecare Ltd

This service was last inspected on 12 May 2016 where it was rated Requires Improvement. At the last inspection breaches of legal requirements were found. This was because the service did not carry out mental capacity assessments for people living with dementia and cognitive impairment and thereby did not act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice. The service did not assess and mitigate individual risks identified as part of the care and support plan and followed unsafe and improper management of medicines. We also made recommendations in relation to organising MCA staff training and assessing staff knowledge and competency, and developing and implementing effective management systems to assess and evaluate care provision. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At this inspection, we found that the provider had not fully followed their plan which they had told us would be completed by the 26 June 2016 and overall, we found that the provider had not addressed the breaches of the abovementioned regulations and there were repeated breaches in relation to safe care and treatment.

The service had a registered manager who has registered with the Care Quality Commission (CQC) to manage the service. At the time of inspection, the registered manager was out of the country and had submitted us with the required notification of their absence. The provider had appointed a new manager in June 2017 who was undergoing registration process with CQC and was managing the service in the registered manager’s absence. 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 provider had made some improvements since the last inspection but they were not sufficient and there were on-going concerns in relation to providing need for consent and safe care and treatment. We also found the provider had not met recommendations made in relation to staff training and good governance.

The provider had not identified and assessed all the risks involved in supporting people and providing safe care. The risk assessments and associated care documents did not give staff comprehensive information on how to support people safely whilst meeting their individual health and care needs. The provider did not maintain accurate medicines administration records (MAR) for people who were supported with medicines administration and prompting.

Not all staff received adequate induction and role specific training before they started working with people. Staff received supervision and appraisal but the records showed that these were not always regularly completed.

Complaints and safeguarding records did not give full details regarding how they were resolved and the investigation outcomes. The data management and monitoring systems to assess the quality and safety of care delivery was ineffective. The provider was not auditing systems and processes related to care delivery including daily care logs and MAR. Some staff recruitment checks were not verified as per the provider’s policy. People’s care plans did not make reference to their mental capacity to make their own decisions.

People and their relatives told us staff were kind and helpful and treated them with dignity and respect. People were mostly happy with staff’s timekeeping and generally received care from the same team of staff. People were provided with companionship services as and when required. People were happy with nutrition and hydration support and received support accessing health and care services when requested.

Staff told us they enjoyed working with the provider and were well supported by the management. They knew types and signs of abuse and the importance of reporting concerns of abuse and neglect. Staff understood people’s right to make decisions; they asked their consent before providing care and gave them choices.

The provider sought feedback from people on the quality of care on a quarterly basis. The feedback mainly had been positive and the provider used the negative comments and feedback to improve their service such as informing people when staff were running late.

We found the registered provider was not meeting legal requirements and there were overall three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, staff training and supervision, 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.

This was the first inspection of the service since it was registered with the Care Quality Commission (CQC) in March 2015.

Kamino Homecare Ltd provides personal care to people living in the community with their own homes and in supported living schemes. There were currently 37 people using the service. The service provides care to older people including people living with dementia, people with physical disabilities and other high care needs.

A registered manager was in post at the time of the inspection. 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.

Each person had a care plan which included basic details about the person and the care and support they required. A pre-service assessment had been completed which incorporated an environmental risk assessment and an assessment of the internal area of the persons home in which care would be provided. However, the service did not identify and assess people’s individual risks associated with their care support such as risk of falls, skin breakdown, urinary infections and use of oxygen supply machines.

The service had an accident and incident book to record any accidents or incidents that occurred whilst providing personal care. The service had no recorded accidents or incidents since they began providing a regulated activity.

Care staff that we spoke with had limited understanding of the basic principles of the Mental Capacity Act 2005 (MCA). One care staff told us that they had not received any training in this area. In addition to this care plans that we looked at, consent to care had not been obtained and the service had not identified or completed any mental capacity assessments for those people who lacked capacity to make certain decisions.

Care plans were not detailed and were not person-centred. People’s likes and dislikes had not been noted. There was lack of information and detail about how people wanted their care and support to be delivered.

People and relatives that we spoke with were happy with the care that they received and felt safe with the carers that supported them. People told us that staff were caring.

The service had a safeguarding policy in place which gave information and direction on the different types of abuse and how and when to report suspected abuse. Care staff were aware of what constituted abuse and where abuse was suspected whom to report this to.

People were supported with their medicines by the care staff. We confirmed that staff had received appropriate training to undertake this activity. However, the service did not always record sufficient information about the different types of medicines people had been prescribed, any possible side effects and how staff were to support them. We did see that on two care plans a medicine administration risk assessment had been completed but this was not consistent for all the people that were provided with a service where appropriate. We also observed at two people’s homes, that there was a medicine recording sheet for carers to sign when medicines had been prompted or administered. This was not consistent for all the people receiving a service when this was required.

The service had safe recruitment processes to ensure that only suitable staff were employed. Each staff member received induction training of all the mandatory topics including moving and handling, first aid, medicines management and fire safety. The service had identified that for the majority of the care staff employed, English was a second language. However, reading and writing skills were not of a standard that the service required to ensure the provision of safe and effective care. As a result the service had begun work with an external company to implement training on enhancing people’s functional skills which specifically included reading and writing.

Care staff told us that they felt supported in their role and received regular supervision. Records we looked at confirmed this.

A complaints policy was in place which gave people information on how to complain and the process and timescale in which a person’s complaint would be dealt with. We saw that complaints were kept and managed on a management system as part of the person’s care records. We saw an audit trail of how the registered manager had dealt with complaints that had been received. However, the registered manager did not have an overview of complaints and when asked how many complaints had been received since they started providing care, was unable to provide a definitive answer and had to refer to people’s care plan records.

The service had recently started to carry out spot checks and follow up visits to people receiving care and support to monitor the quality of care being provided with a view to making improvements. The registered manager also had a supervision overview in place which allowed them to monitor when supervisions were due. However, the registered manager lacked management oversight in relation to reviewing complaints, missed, late visits and the work being completed by the staff working within the office. The registered manager told us that they planned to introduce audits and checks for care plans to ensure that the information contained within them was relevant and most current.

Quality assurance questionnaires were sent out to people who used the service and relatives. The first one was sent in December 2015 and will then be sent on a quarterly basis. The format of the questionnaires and the questions that were asked were based on each of the CQC key lines of enquiry. However the service did not hold an overview of the responses received so as to learn from make improvements.

We have made two recommendations in relation to staff training in the area of MCA and management oversight.

We have also identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to assessing risks associated to people’s care and support needs, safe medicine management, obtaining consent to care and completing mental capacity assessments. You can see what action we told the provider to take at the back of the full version of the report.