Background to this inspection
Updated
12 January 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
On 5 October 2018 an expert-by-experience carried out telephone calls to people or their relatives. Two people’s relatives provided us with feedback, although we did contact other people, this was who was available and willing to speak to us at the time. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
On 8 and 9 October 2018 two inspectors visited the provider’s office to carry out the announced inspection. We gave the provider notice of the inspection to ensure somebody would be available to assist us with our questions. During our visit we spoke with the director and the service manager for adults and adult lead nurse. We conducted telephone interviews with a nurse and five care staff. We reviewed various records of care including six people’s care plans. We also examined documents related to medicines, namely medicine administration records (MAR) charts. We reviewed records related to service audits, the employment and support of staff and the operation of the service.
Prior to the inspection we reviewed the information we held about the service, this included notifications we had received from the provider. Notifications are changes or events that occur at the service which the provider has a legal duty to inform us about. We did not request a Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We covered these areas during our inspection.
Updated
12 January 2019
This service is a domiciliary care agency. It provides personal and nursing care to older adults, younger disabled adults and children, living in their own homes in the community. At the time of our inspection 19 people including 14 children and five adults received a service. Some children and adults had complex health care needs. Some staff worked with both children and adults.
This announced inspection took place on the 8 and 9 October 2018. During our previous inspection in September 2017 we found several breaches of the regulations, this was because records were not always up to date and accurate. Risks had not always been identified or minimised. There were not always sufficient numbers of trained staff available to meet people’s needs. The staff did not always practice in line with the requirements of the Mental Capacity Act 2005.
We also found the provider could not be assured staff had the competence or skills to carry out specific tasks. This was because the staff were not always tested or observed. People complained to us about the poor communication they experienced with the office staff. This had caused some distress. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; safe; effective; responsive and well-led to at least good. During this inspection we found improvements had been made in all areas.
At the time of this inspection there was no registered manager in place, however a candidate had applied to the commission to be registered and was completing the registered manager’s application process. 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’s relatives told us they believed the service was safe. Risk assessments had been completed for care and the environment. Where risks were identified these had been minimised. The risks to people and staff were regularly reviewed. Trends were identified and action taken to prevent a reoccurrence where possible. Care plans gave guidance to staff on how to reduce risk and included people’s needs and preferences. People’s needs were assessed prior to receiving care.
Staff received an induction which included training. They received support through supervision and appraisals. Specialist training was provided to ensure they could meet people’s individual needs. Competency assessments took place to ensure staff where meeting the required level of skills and knowledge.
Staff received training in how to identify signs of abuse. Records showed appropriate action had been taken when concerns were raised. This helped protect people from harm. Safe recruitment systems were in place to minimise any risk that unsuitable staff were employed to work with people.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.
People’s relatives told us the staff were supportive and described them as “Brilliant”, “Gentle” and “Very good”. People’s healthcare needs were met through the involvement of external professionals and the co-operation of Phoenix staff.
People or their relatives were involved in the planning and review of their care. Regular contact was made with people to ensure they were happy with the delivery of care and to discuss any changes that may have been required.
Where people had communication difficulties, staff were trained to ensure their ability to communicate was enhanced. People were assisted to remain as independent as possible and staff understood how to protect people’s privacy and dignity. People received support to participate in their chosen lifestyle. The provider ensured information was made available to people in a format they understood.
The provider’s complaints policy set out how people could make complaints and these would be taken seriously. Where a complaint had been made, this was followed through and used to drive improvements in the service delivery.
There was an open culture of communication, and staff supported each other. Quality assurance checks and feedback from people, relatives’ staff and professionals was used to drive forward improvements to the service.