Archived: Celtic Care Services Ltd (Swindon)

At our last inspection on 23 August 2016 we found the systems to monitor and improve the quality of the service provided were not always effective. There was also a lack of evidence that the registered manager ensured people's feedback was acted upon. Additionally people did not always receive effective care due to communication barriers they experienced with the staff. We also found not all risks to people had been fully assessed and recorded and staff did not have enough guidance on how to support people with administration of prescribed medicines. This resulted in two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After our inspection the provider sent us details of how they would meet their legal requirements relating to these breaches.

At this inspection we found the above issues had been addressed. The provider appointed a new designated registered manager for the Swindon branch. The registered manager ensured the processes to monitor the quality of the service were in place and effective. We found the registered manager assessed, monitored and mitigated risks relating to people’s health, safety and welfare. The provider introduced a new system to manage the administration of medicines and people received their medicines as prescribed. People’s feedback reflected they no longer experienced communication barriers with the staff. The registered manager ensured staff literacy skills had been assessed as a part of the recruitment process.

People told us they felt safe with the service. People were supported by sufficient and regular staff that knew them well. There were systems in place to plan and monitor care visits and manage the risk of late and missed visits. The registered manager followed safe recruitment process that ensured staff’s suitability to work with vulnerable people was checked and they were safe to work with people. Staff understood their responsibilities to identify and report any concerns relating to safeguarding vulnerable people. People were cared for by staff that received training suitable to their roles and were well supported.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The systems in the service supported this practice.

People were supported to meet their nutritional needs. People’s care plans outlined people’s dietary preferences and staff assisted people with preparing their meals when required. People were supported to access health professionals as needed.

People complimented the caring nature of staff. People told us staff were knowledgeable about their needs. People valued the relationships they had developed with staff. Staff were positive about their work and told us they enjoyed working with people. People’s dignity, privacy and confidentiality were respected.

People's needs were assessed prior to commencement of the service to ensure these could be met. People's care records were up to date and contained details of people's personal preferences, wishes and support required. People told us they received support that met their needs and complimented the responsiveness of the service. The provider’s complaints policy was available to people and concerns and complaints were managed appropriately. People’s feedback about the service was sought and acted upon if needed.

There was a positive and open culture at the service. The new registered manager implemented a number of quality assurance systems and they had an on-going action plan to ensure continuous development of the service provided to people. People, relatives, staff and professionals all complimented the service and how it was run.

There was a registered manager in post at the service. 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 to monitor and improve the quality of the service provided were not always effective. There was lack of evidence that the registered manager ensured people’s feedback was acted upon.

People did not always receive effective care due to communication barriers they experienced with the staff. People and relatives told us they found it hard to communicate with the staff and told us there were situations when the staff were not unable to understand when a person was for example in pain.

There were risk assessments in place for people who used the service, but we found not all risks had been fully assessed and recorded. Some risk assessments were not personalised and did not reflect people’s needs. The provider’s systems for management of documentation around medicine management were not robust. Staff did not have enough guidance on how to support people with administration of prescribed creams.

There were systems and policies in place to protect people from the risk of harm. Staff were aware of their responsibility to report any signs of abuse. People and their relatives told us staff treated people with dignity and respect. People told us staff were caring in their approach. Staff worked with other healthcare professionals to support people to maintain their health and wellbeing.

There were enough staff deployed to meet the care needs of people. The recruitment process ensured that staff were checked and were suitable to work with vulnerable people. Staff received training appropriate to their roles and they were aware of people's individual needs. Staff felt supported and received one to one meetings with their line manager.

Staff were mostly knowledgeable about and followed the requirements of the Mental Capacity Act 2005 (MCA). This protected the rights of people who may not be able to make certain decisions themselves. People told us their consent to care was sought by staff and they were involved in making decisions about their care.

People’s needs were assessed prior to commencement of the service. People’s care records contained details of people’s personal preferences, wishes and how they wanted to be supported. The provider had a system in place for responding to people's concerns and complaints. People told us they knew how to make a complaint.

We found two 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 this report.