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 adults of all ages, including people with dementia or physical disabilities. This was an announced inspection of the service.Not everyone using the service receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, which is help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the start of our inspection there was one people using the service in this respect.
The service had a registered manager, which 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.
At our previous inspection of this service in October 2017, a breach of legal requirements was found. This was in respect of both record-keeping and effective governance, particularly around supporting people with medicines. The provider completed an action plan to show what they would do and by when to improve the rating of key questions of 'Is it Safe?' and ‘Is it Well-led?’ to at least ‘Good.’
At this inspection, we found the service was no longer providing anyone receiving regulated activity with medicines support. However, when the service last provided that support, in the summer of 2018, we found medicine administration records were still not accurately and fully completed. The service’s medicines audits had not identified this. Risks to the care and welfare of that person had not, therefore, been identified and addressed. This means the breach of legal requirements was continuing.
The service had systems to assess and manage risks to people’s safety. However, the risk assessments relating to the care and welfare of the person using the service had not been reviewed since November 2016. Audit systems had not identified this. This meant the provider was not taking all practical steps to ensure the person’s safety was kept under regular review.
The service had systems for regular staff supervision and appraisal, but these had not been kept up-to-date for the staff member working with the person using the service, to help ensure staff were being supported to carry out their duties effectively.
Governance systems had been set up but they had not identified the concerns we found at this inspection. There was little the registered manager otherwise showed us to demonstrate that service delivery risks were identified and mitigated, that the service enabled sustainability and supported continuous learning and improvement, or that there was partnership working with other agencies to support the development of the service. We therefore concluded the service was not well-led.
The service was caring and responsive. It ensured that people were treated with kindness, respect and compassion, and that they were given emotional support when needed. There was consistency of trained care staff, which helped trusting relationships to develop and people’s individual needs and preferences to be understood and addressed.
Where appropriate, the service supported people to maintain good health and nutrition and access appropriate community services.
Systems, processes and practices were in place to safeguard people from abuse, prevent or control infection, and ensure that ongoing learning took place when accidents occurred.
The service was working within the principles of the Mental Capacity Act 2005 in terms of acquiring appropriate consent for care.
This is the third consecutive time the service has been rated ‘Requires Improvement’. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.