Background to this inspection
Updated
23 November 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one 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.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 16 September 2019 and ended on 28 September 2019. We visited the office location on 16 and 17 September 2019.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with seven people and six relatives by phone about their experience of the care provided by the staff. We contacted staff and received feedback from seven staff. At the office we spoke with the management team which included trainers, recruitment, quality assurance and the deputy manager. We also spoke with the providers and nominated individuals. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with a healthcare professional during the inspection.
We reviewed a range of records. This included seven people’s care records and multiple medicines records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records
Updated
23 November 2019
About the service
Home Instead Senior Care Bath and West Wilts is registered to provide personal care to people in their own homes. There were up to 112 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Medicine systems were audited regularly, and action plans were developed where gaps were identified. However, there had been a number of medicine errors where staff had not recorded the medicines administered. The providers were taking action to prevent further errors. An electronic system of recording medicines administered was to be introduced.
People’s needs were assessed before the service agreed to deliver personal care. Care plans were individualised with people’s background information and their preferences. Their abilities to manage their care and how staff delivered personal care was part of the care plan. However, the priorities of care and wishes were not consolidated for one person receiving end of life care. We recommend the provider introduce end of life care plans for people receiving palliative care.
People told us they felt safe with the staff. Safeguarding information and procedures were on display in the office and staff room. Safeguarding referrals were made appropriately.
Systems were in place to manage risk. Where risks were identified individual risk assessments action plans were in place on how to minimise the risk. People’s environment was assessed to ensure the safety of people and others.
There was an online system of recording accidents and incident. Reports were reviewed and the follow-up action to prevent any further reoccurrences was detailed They were also analysed to identify patterns and trends such as persistent medicine errors
Staffing levels were determined by the needs of people.
New staff had an induction when they started work for the service. The staff attended the training that ensured people's needs were met and were supported with their performance and development. Performance was monitored through one to one supervision, observations and annual appraisals.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way. People had capacity to consent to their care and treatment. Some people had nominated Lasting Power of Attorney and the provider had checked the status of the legal document with the office of the public guardian. Where people had capacity and deferred consent to their relatives this needed to be made clear in the documents.
People managed their healthcare. The staff reported concerns about people’s healthcare. There were electronic records of health care visits which included the nature of the visits and the outcome.
People and relatives were complimentary about the service. They told us the staff were kind, caring and they would recommend them. They told us their personal care was delivered by staff that knew their preferences and the matching of people to staff ensured relationships were built.” We saw photos of when the staff were caring towards people. The staff told us there was always time during their visits to sit and chat with people. The deputy manager told us they ensured the staff employed were caring and compassionate.
Complaints were investigated and resolved. People told us their concerns were resolved whenever they raised concerns.
Quality assurance systems were effective. The national office completed audits of outcomes and the providers developed improvement plans on how to meet shortfalls identified. The views of people and staff about the agency was gathered through questionnaires. Actions were added to the improvement plan from feedback received through surveys.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Outstanding (published 7 February 2017) in brackets.
Why we inspected
This was a planned inspection based on the previous rating.