Archived: Castle Care Wessex

This inspection was announced and took place on 12, 19 and 21April 2016.

The agency had a registered manager who was in post before the provider became part of Berkeley Home Health. 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.

People told us they felt safe but risks to people’s safety were not identified in their care plan or risk assessments. Medication was not safely being administered and staff had not always received training. Errors were apparent on the medication administration records of one person and medicine was not always given in line with people’s care plans. Protective clothing was not always being worn by staff where appropriate and whilst supporting people with personal care to prevent infections spreading.

People were not always supported by staff who had the correct checks completed or a risk assessment to demonstrate they had considered keeping people safe from being cared for by unsuitable staff.

Staff told us there were enough staff to cover the visits and had time to travel between them. Staff told us they had a good induction and lots of training. However, some training had not been identified to meet the needs of a person with additional health needs. The registered manager had not kept their train the trainer qualification up to date with current legislation and regulations around administering medication.

There were detailed care plans for all individuals including specific information for each visit. These plans had a person centred approach to them and captured the people’s voice. This meant people were central to their care and any decisions made. However, sometimes there were too many versions of the care plan which could cause confusion about which was the most current. The needs of the people were reflected within the plans; most of the time they were responsive to people’s changes. Staff had a good knowledge of the people they were supporting and their needs.

There were limited quality assurance procedures in place to keep people safe and they were mainly informal. When shortfalls had been identified by the provider and registered manager measures had been put in place to rectify the issue. However, the registered manager and provider had not picked up all the concerns we found. However, they were resolved as soon as they were informed and, when required, put measures in place to address the risks.

Staff and the registered manager had understanding about people who lacked capacity to make decisions for themselves. However some people potentially had fluctuating capacity because of their diagnosis and complex needs but the Mental Capacity Act Code of Practice had not always been followed when people’s capacity was in question. People’s capacity had not always been considered when decisions such as administering medicine were part of their personal care.

Staff were aware of their responsibility to protect people from avoidable harm or abuse and had received training in safeguarding. They knew what action to take if they were concerned about the safety or welfare of an individual and told us they would be confident reporting any concerns to a senior person, the provider or whom to contact externally. The provider had put a confidential phone line in place to encourage staff to report concerns. The registered manager understood when they were responsible for informing the local authority and CQC about safeguarding.

The agency made contact with other health and social care professionals to help with people’s care; this was important because many people had complex needs. Staff supported and respected the choices made by people. People’s cultural and religious differences were respected.

People were always informed if a member of staff was delayed and running late and they were regularly seen by the same members of staff. Staff encouraged people to be as independent as possible and provided companionship when it was required.

People and their relatives thought the staff were kind and caring and we observed positive interactions. The privacy and dignity of people was respected and people were encouraged to make choices throughout the visits we went on.

People knew how to complain and there were good systems in place to manage the complaints. The registered manager demonstrated a good understanding of how to respond to complaints and completed them in a timely manner.

The registered manager and provider had a clear vision for the agency and had some systems in place to communicate this.

We made a recommendation that the agency finds out more about national guidance in relation to the Mental Capacity Act.

We found breaches 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.

People felt satisfied and pleased with the service they received from the care staff. Examples of comments made included 'it's one of the best that I've been with' and 'I like them, they are good'.

People were able to plan the care they received and the agency worked with them so a package of support was put in place in the way preferred by the person using the service.

People were safeguarded from abuse because the agency had systems to minimise risks to protect them from harm. Every person we spoke with felt safe with the care staff who visited them in their home. One person said 'I have nothing but praise for them'.

People were protected from the risks of unsuitable staff because the agency had recruitment procedures that ensured they employed suitable staff to provide care and support.

People were assisted by staff who were monitored and supervised. This was to ensure they provided a suitable service. People were supported by staff who were trained to understand people's care needs.

The provider had systems for monitoring the service so that it was safe and suitable. People had their information stored confidentially because the service had made arrangements for the safe storage and retention of electronic and written information.

The agency provided a safe service which promoted the wellbeing of people using the service.

People experienced care and support that was planned around their individual needs. People told us they were involved in making decisions about how they were going to be supported and have their care needs met.

People told us the service listened to them and they knew who to speak to if they had any concerns. People told us they liked the staff that came to their home and described having a good relationship with them.

Staff received training and guidance which helped to ensure they supported people safely. When people told us about the staff team their comments included "they are very good" and one person said "I am so glad I can tell someone how lovely they are.' Staff said they felt supported by the managers and were regularly informed about any changes to the service.

The records held by the service in their offices and people's own home were kept up to date. This helped and supported staff to maintain the comfort and well being of people using the service.

Having assessed the available evidence, we considered the service demonstrated how it met the safety and welfare needs of the people using the service.