Archived: Kells Domiciliary Care and Nursing Agency

Updated 4 April 2018

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.

We gave the service 48 hours’ notice of the inspection visit because it is a small domiciliary care agency and we needed to be sure that members of the management team would be available to support the inspection.

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 ratings for key questions of safe and effective to at least ‘good’. The action plan dated 15 January 2017 included information around how they would address concerns related to person centred care, risks assessments failing to provide staff with adequate guidance on how to minimise people’s personal risks, failing to assess, monitor and improve the quality of the service, and staff not receiving an annual appraisal.

This inspection took place on 20 and 21 December 2017 and was carried out by one adult social care inspector. Following the inspection, starting on 5 January 2018 we made calls to relatives and staff to gain their feedback.

Before the inspection we looked at information that we had received about the service and formal notifications that the service had sent to us. We also looked at safeguarding notifications that the provider had sent to us. Providers are required by law to inform CQC of any safeguarding issues within their service.

During the inspection we spoke with the training manager. We looked at seven staff files including recruitment, supervision and appraisal’s, five people’s care plans and risk assessments and other paperwork related to the management of the service including staff training, quality assurance and rota systems.

Following the inspection we spoke with one person that used the service and two relatives. It was difficult to speak to people as people were unable to talk to us due to their conditions. We also spoke with five staff members. We also received written information via email from the registered manager.

Updated 4 April 2018

This inspection took place at the providers office on 20 and 21 December 2017. At the time of the inspection Kells Domiciliary Care and Nursing Agency provided domiciliary care and support for six people in their own home. The service worked primarily with older people living with dementia and people with physical and mental health needs. People received varying levels of support depending upon their care needs from 24 hour care to two visits weekly.

The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At our last inspection on 10 October 2016, we identified breaches of regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to risk assessments that failed to provide staff with guidance on minimising the risks; lack of documented person centred care; staff not having received an appraisal; and a lack of management oversight regarding monitoring the service. At this inspection we found that the provider had addressed the breaches regarding person centred care planning, risk assessments and staff appraisal. However, the provider had not adequately addressed the breach around regulation 17 relating to good governance.

We found that there were no regular audits completed to ensure good managerial oversight of the service. Two audits had been completed since the last inspection. However, these were general and failed to provide adequate reassurance of good governance. Medicines were informally audited but this was not documented. Significant information regarding a person’s care had not been documented.

There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider. The registered manager was not present during the inspection as he was on leave. The inspection was supported by the training manager.

Risk assessments were in place that gave staff information on how to minimise people’s personal risks.

Relatives told us that they felt their relative was safe and supported by the service. Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report to if people were at risk of harm.

Staff were aware of infection control procedures and the service provided personal protective equipment (PPE) such as gloves and apron to staff for when assisting people with personal care.

Staff had regular supervision and annual appraisals that helped identify training needs and improve the quality of care.

People were supported to have their medicines.

Staff were recruited safely and there were systems in place to ensure that staff were appropriate for the role.

Relatives told us that they felt that staff were kind and caring and treated their relative with respect.

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 supported this practice.

People and relatives were involved in planning their care. Care plans were person centred and included information on how people wanted their care to be delivered as well as their likes and dislikes.

At this inspection we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.