This inspection took place on 23 and 24 October 2018 and was announced.This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults and children. People's care and housing were provided under separate contractual agreements. CQC does not regulate premises used for people supported in their own homes; this inspection looked at people's personal care and support. At the time of the visit there were 140 people who used the service.
The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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 service was last inspected on the 10 and 11 October 2017 and 04 December 2017. At that inspection we made a recommendation that the service developed practice in relation to the application of the principles of the Mental Capacity Act. We checked on this during this inspection and found no action had been taken and no improvements had been made and this is therefore a breach of the regulations. We have also made recommendations in relation to training and action to be taken by the registered manager and provider. As a result, the overall rating for the service has deteriorated to requires improvement.
You can see what action we have told the provider to take at the back of the full version of the report.
Prior to our inspection, we received information of concern in relation to a lack of training for staff. We looked at this during this inspection and have made a recommendation regarding staff training.
Quality and safety audits were not always effective in identifying issues of concern and driving improvements in practice. We made a recommendation regarding this.
All the people we spoke with who used the service told us they felt safe. Staff told us and records we looked at confirmed, staff had received training in safeguarding. Staff knew their responsibilities to report any concerns.
Prior to our inspection, we received information of concern in relation to new staff members commencing employment without the necessary checks being carried out. During this inspection we checked if people were protected by the staff recruitment procedures. We found staff had been adequately checked to ensure they were suitable to work with vulnerable adults.
Risk assessments had been completed to ensure people were safe. Risks were reviewed on a regular basis or when these changed.
Also prior to our inspection, we received information of concern in relation to a shortage of staff and missed visits. None of the staff we spoke with had concerns about staffing levels. Feedback we received from people who used the service showed there was no concerns about missed visits. We had no concerns about staffing levels or missed visits during our inspection.
Staff we spoke with told us they received regular supervisions and appraisals and felt supported in their roles. Records we looked at confirmed that staff had regular supervisions.
Care records we looked at showed people’s needs and choices were assessed prior to commencing a package of care with the service. We noted they did not ask a person’s sexual orientation. We discussed this with the registered manager who told us this could be added in going forward.
We received many positive comments about the care and compassion staff members showed to people. During the inspection we did not have the opportunity to observe interactions whilst staff were supporting people who used the service. However, those staff we spoke with discussed people they supported in a kind and caring manner.
Staff told us how they ensured people’s privacy and dignity was respected when they were providing support with personal care. The service also had privacy and dignity policies and procedures in place to guide staff in their roles.
We looked at audits in place within the service. We saw the registered manager had a different auditing system since our previous inspection, which was not robust. The lack of robust audits in place demonstrated why we found a number of concerning issues during our inspection.
Staff told us, and records we looked at confirmed, regular staff meetings were held. Staff told us they were able to have discussions about anything they wanted to in these meetings.