Background to this inspection
Updated
24 June 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.
This inspection took place on 16, 17 and 18 May 2016 and was announced with 48 hours’ notice. The inspection carried out by an inspector 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. The expert by experience had personal experience of arranging and monitoring the domiciliary care services of a family member.
The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Prior to the inspection we reviewed this and other information we held about the service, we looked at any notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law.
During the inspection we reviewed people’s records and a variety of documents. These included ten people’s care plans and risk assessments, two staff recruitment files, staff training, supervision and appraisal records, visit and rota schedules, medicine and quality assurance records.
We spoke with twenty people who were using the service, four of which we visited in their own homes, we spoke to six relatives/representatives, the registered manager, the branch manager and nine members of staff.
After the inspection we contacted seven health and social care professionals who had had recent contact with the service and received feedback from four.
Updated
24 June 2016
The inspection took place on 16, 17 and 18 May 2016, and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection. This was the first inspection since the service had moved and registered at the new offices in Chamberlain Manor.
Beech Tree Total Care SKC & Ashford provide care and support to people in their own homes. The service is provided to mainly older people and some younger adults. At the time of the inspection there were approximately 152 people receiving support with their personal care. The service undertakes visits to provide care and support to people in Ashford, Folkestone, Dover, and surrounding areas. In addition it also provides visits to people and 24 hour on call cover in Chamberlain Manor and Joseph Hadlum Court both in Ashford, which are blocks of flats with additional communal facilities available for people that live there.
The service is run by a registered manager who is also the registered manager for another of the provider’s services located in Birchington. 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 received their medicines when they should and felt their medicines were handled safely. However there were shortfalls in some medicine records and a lack of guidance about some areas of medicine management.
Most risks associated with people’s care had been identified, but there was not always sufficient guidance in place for staff and some guidance had not been reviewed to ensure it remained up to date, to ensure people remained safe.
People were involved in the initial assessment and the planning of their care and support and some had chosen to involve their relatives as well. However care plans varied in the level of detail and all required further information to ensure people received care and support consistently and according to their wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan. People did not have regular opportunities to have their care plan reviewed to ensure it remained up to date and reflected their care needs.
People did not receive a service from staff whose knowledge and training were up to date, to enable them to provide effective care and support. Nearly all staff felt well supported, although they did not have regular opportunities for formal supervision, they felt senior staff were always available for them.
Audits had been undertaken and had identified the shortfalls found during this inspection. However regular audits and systems need to be embedded, to monitor the quality of service people received and to ensure they are effective in identifying shortfalls and enabled management to take action in a timely way.
People had signed a consent statement about their care and support and told us their consent was gained at each visit. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection. Some people chose to be supported by family members when making decisions. Most staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process. However where people were subject to restrictions, such as using bedrails and their medicines were kept locked away, the capacity assessments undertaken before the best interest decision had been made was not recorded.
People felt safe using the service and when staff were in their homes. The service had safeguarding procedures in place and most staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.
People felt they had their needs met by sufficient numbers of staff. People received a service from a team of regular staff. Staffing numbers were kept under review and staffing numbers in Chamberlain Manor were the subject of ongoing discussions with the local authority. New staff underwent an induction programme, which included attending training courses and shadowing experienced staff. Some staff had gained qualifications in health and social care.
People were supported to maintain good health. People told us staff were observant in spotting any concerns with their health. The service worked jointly with health care professionals, such as physiotherapists and an occupational therapist.
People felt staff were caring. People said they were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach and knew people and their support needs.
People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Staff had built up relationships with people and were familiar with their personal histories and preferences.
Nearly everyone told us that communication with the office was good and if there were any concerns they called the office who responded. People felt confident in complaining, but did not have any concerns. People felt the service was well-led and well organised.
The provider had a mission statement. To promote a philosophy of total care towards anyone who came into contact with the organisation. Staff felt this was followed through into their practice.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.