This was an announced inspection which took place on 18 and 19 May 2016. We had previously carried out an inspection in March 2015 when we found seven breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We made requirement actions in relation to staff recruitment procedures, person-centred care, management of medicines, training for staff, need for consent, record keeping and quality assurance systems in the service. Following the inspection in March 2015 the provider sent us an action plan telling us what steps they were going to take to ensure all the regulations were met. They told us they would take action to ensure all the legal requirements were met by May 2015.This inspection was undertaken to check that the required actions had been completed. Ribble Homecare is a domiciliary care agency which at the time of our inspection was providing personal care to 25 people who lived in their own homes. The registered manager told us that they continued to specialise in providing end of life care to people. Since the last inspection the service had moved to new premises in Blackburn.
The service had a registered manager in place as required under the conditions of their registration with the Care Quality Commission. 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.
We found significant improvements had been made since our last inspection to how the service was run. This meant that all the breaches in regulations previously identified had now been met.
People we spoke with during the inspection told us they always felt safe when they were cared for by staff from Ribble Homecare. Records we reviewed showed staff had received training in safeguarding adults. They were able to tell us of the correct action to take to help ensure people who used the service were protected from the risk of abuse. Staff told us they would also be confident to use the whistleblowing procedure in the service should they observe any poor practice. They told us the registered manager regularly reminded them to report any concerns they might have about people who used the service so that appropriate action could be taken.
We found that recruitment processes in the service were sufficiently robust to protect people from the risk of unsuitable staff. People who used the service told us staff always visited at the time agreed and stayed for the correct amount of time. They told us that staff did not appear rushed during their visits and always took the time to complete any tasks they asked of them. Records we reviewed showed that the registered manager placed an emphasis on ensuring that staff took their time when caring for people who used the service. This was confirmed by all the staff we spoke with.
People told us they received the support they needed to take their medicines. We saw that staff had received training in the safe handling of medicines. Staff told us they were regularly observed to check they were competent to administer medicines safely, although these checks were not formally recorded. We found that all medication administration records we reviewed were fully completed to show that people had received their medicines as prescribed.
Risk assessments for physical health needs and environmental risks helped protect the health and welfare of people who used the service. Arrangements were in place to help ensure the prevention and control of infection.
Where necessary people who used the service received support from staff to ensure their health and nutritional needs were met. Staff told us they worked closely with the district nurses who were also involved with many of the people they supported due to their complex health conditions. A health professional we spoke with provided positive feedback regarding staff from Ribble Homecare.
Staff told us they received the induction, training and supervision they needed to be able to deliver effective care. We noted that staff were supported to continue their professional development through gaining additional qualifications.
Both the registered manager and care staff were able to demonstrate an understanding of the principles of the Mental Capacity Act (MCA) 2005. Staff told us they would always ensure they had the consent of people who used the service before they provided any care or support. This was confirmed by all the people we spoke with during the inspection.
All the people we spoke with gave positive feedback regarding the kind and caring nature of staff. Comments people who used the service made to us included, “Staff are kind; they have been very good to us”, “They [staff] can’t seem to do enough for us” and “[Name of staff member] looks after me. She treats me like her own family.” A relative also told us, “I trust them [staff]. I class them as family.” People who used the service told us they were able to make choices about the care they received and staff enabled them to maintain their independence as much as possible.
Staff had received training in end of life care. We saw that the registered manager had completed detailed care plans where people wanted to discuss the care they would like to receive at the end of their life.
People who used the service told us staff always provided the care they required. A relative we spoke with told us they were particularly impressed with how responsive the service was to their requests for additional visits outside of the agreed care plan to ensure their family member received the care they required. The registered manager told us they did not charge people who used the service for any additional visits as they considered such visits were central to ensuring the service provided people with high quality person-centred care.
Care records we looked at showed care plans were regularly reviewed and updated should a person’s needs change. People we spoke with told us they had been involved in reviewing the care they received.
We noted that there was a complaints procedure in place for people to use if they wanted to raise any concerns about the care and support they received. All the people we spoke with told us they considered their views would be listened to and any complaints taken seriously. There had not been any complaints made since the last inspection. The registered manager told us they would always respond immediately if a person raised any concerns in order to resolve the matter to the person’s satisfaction. This was confirmed by a relative we spoke with.
There were a number of quality assurance systems in place to help drive forward improvements in the service. Staff told us they enjoyed working in the service and considered they provided a high quality of care. All the people we spoke with during the inspection spoke highly of the registered manager and their commitment to the service.