Background to this inspection
Updated
21 March 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector, one assistant inspector, a directorate support coordinator 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.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had two managers registered with the Care Quality Commission. One of the registered managers was new, and the other registered manager was no longer involved in the day to day management of the service. This manager had not yet applied to cancel their registration. This manager was now working as the regional quality manager and is referred to as the previous registered manager throughout this report. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed the information we already held about the service in terms of notifications that had been submitted to us. Notifications are information about events providers are required by law to inform us about. We reviewed the action plan the provider had sent us after the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
During the inspection we spoke with 16 people who used the service and five relatives. We spoke with seven care workers, three coordinators, the training manager, the registered manager, the regional quality manager and the nominated individual. We reviewed 13 care files including assessments, care plans and records of care where these were available. We reviewed eight staff files including recruitment records, induction, training and supervision records. We reviewed records of various meetings, complaints, handovers, newsletters, audits and other records relevant to the management of the service.
After the inspection
We received additional information by email from the registered manager. We continued to validate the evidence found during the inspection.
Updated
21 March 2020
About the service
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of the inspection the service was providing personal care to approximately 180 people.
People’s experience of using this service
People told us their experiences of care were affected by timekeeping and scheduling difficulties. People told us they raised these issues with the office but were rarely asked for feedback about their experience of care. People told us, and records confirmed, their care was not regularly reviewed and care plans were not always up to date. The provider did not have effective systems in place to address these issues. The provider had not identified that the systems in place around the management of medicines were not sufficient, safe or robust. They had identified, but not effectively addressed, that care plans and risk assessments were not updated in response to changes in people’s needs and risks.
People were supported to have choice in their day to day lives and staff supported them in the least restrictive way possible and in their best interests. However, the provider had not always followed best practice guidance in terms of seeking consent.
People told us their regular care workers were kind, compassionate and supportive. Staff spoke about the people they supported in a sensitive manner. Staff recognised the importance of ensuring people were supported in a way that did not discriminate and promoted their dignity and independence.
People and relatives told us they were involved in their initial assessments. People told us they knew how to raise concerns.
Staff told us, and records confirmed, they received the training and support they needed to perform their roles. The registered manager had sought additional training from local dentists to support care staff to deliver oral care.
Staff spoke highly of the registered manager and told us there was a welcoming and friendly atmosphere in the office.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection:
The last rating for this service was requires improvement (published February 2019).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to medicines and risk assessments, reviewing and updating care plans, and governance systems at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.