4 October 2016
During a routine inspection
The service delivers personal care to people in their own homes. At the time of our inspection, 12 people were receiving the service. The service predominantly supports people with a learning disability or with mental health support needs.
There was a registered manager in post. 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. On the day of the inspection visit, the provider's head of care supported the registered manager to explain how the service operated and was managed.
People told us they felt safe with the staff that came to their home. Staff were trained in safeguarding and understood the signs of abuse and their responsibilities to keep people safe. The provider had introduced a safeguarding spot check of the service so staff were kept abreast of the safeguarding policy and procedure. Staff were recruited safely.
Risks of harm to people were identified at the initial assessment of care and their care plans included the actions staff would take to minimise the risks. Staff understood people's needs and abilities because they had the opportunity to get to know people well through shadowing experienced staff during induction before working with them independently.
The manager identified potential risks in each person's home, so staff knew the actions they should take to minimise the risks. Staff were trained in medicines management, to ensure they knew how to support people to take their medicines safely to keep accurate records.
Staff received the training and support they needed to meet people's needs effectively. Staff had regular opportunities to reflect on their practice, to attend training in subjects that interested them and to consider their personal development.
The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People made their own decisions about their care and support.
People were supported to eat meals of their choice and staff understood the importance of people having sufficient nutrition and hydration. Staff referred people to healthcare professionals for advice and support when their health needs changed.
People told us staff were kind and respected their privacy, dignity and independence. Care staff were thoughtful and recognised and respected people's cultural values and preferences.
People and relatives said that the service was responsive to their needs however concerns were raised to us about the use of agency staff, the consistency of care and the lack of proactive support for people when keyworkers were not on duty. A keyworker is a carer who is the main contact and organiser of a person’s care
People were confident any complaints would be listened to and action taken to resolve them. When people raised issues, they would be investigated and resolved.
The service was well led however there was some confusion for care professionals about who was managing the service. A social worker also said the service needed to improve their communication with them.
The provider's quality monitoring system included asking people for their views about the quality of the service through telephone conversations, visits by a supervisor and regular questionnaires.
The manager checked people received the care they needed by monitoring the time staff arrived for scheduled calls, reviewing care plans and daily records, and through feedback from care coordinators.