Background to this inspection
Updated
22 January 2016
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 was 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 visited the agency on 10 December 2015. We gave the registered manager 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that that there was a representative available to assist us with the inspection. On the 15 December 2015, we visited people in their own homes.
Before the inspection we reviewed information we held about the agency. This included information received and statutory notifications. A notification is information about important events which the provider is required to send us by law. Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the agency, what the agency does well and improvements they plan to make. This was detailed and returned when requested.
During our inspection we visited three people in their own homes and we observed how the staff spoke with people. We looked at three care plans and reviewed a range of other records, including daily records, Medicine Administration Record charts, staff files and records about how the quality of the agency was managed.
We spoke with three people who used the agency, one relative, six members of staff and the registered manager. We received feedback from two visiting professionals who worked with the agency.
We last inspected this agency on 12 December 2013. There were no concerns identified at this inspection.
Updated
22 January 2016
This was an announced visit that took place at the agency’s domiciliary care office on 10 December 2015. On 15 December 2015, we visited people in their own homes and spoke with them and their relatives.
The agency provided care and support to adults with a variety of needs living in their own homes. This included people living with dementia and physical disabilities. At the time of the inspection the agency provided personal care for sixteen people. They also provided support for other people with their shopping and activities but this type of support is not regulated by the Care Quality Commission (CQC).
The registered manager, who is also the registered provider, was present at the office during our visit. 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 agency is run.
People's medicines were not always managed as safely as they could be. Some medicine records were not completed and not accurate and there was a shortfall on documenting PRN medicines. New procedures had been put in place to address these shortfalls.
Quality assurance systems did not identify some shortfalls in the agency, such as gaps in records including Medicine Administration Records and a lack of detail in some of the care plans. Recruitment procedures were in place, but gaps in employment had not been recorded for one person.
People were kept safe because they were cared for by staff who knew and understood the signs of abuse and knew what to do to protect people. Individual risks to people were assessed and staff knew how to care for people safely in their own homes.
There were enough skilled and experienced staff to meet people’s needs in a regular and consistent way. People were visited by the same staff members and introduced to staff before they first visited. This gave people reassurance and the opportunity to develop positive relationships with staff. People told us that felt staff knew them well and understood their needs. Staff were given the training they needed and received regular support. New staff underwent a thorough induction and received on-going training.
People’s care was planned around their individual needs and preferences. People were included in planning their care and felt involved. People were given the opportunity to have a say about how they felt they were supported and were confident that any concerns they raised would be acted on immediately.
People spoke positively about the care and support they received. People felt staff were kind and caring and told us that staff treated them with respect. People were provided with care that was responsive to their changing needs and were supported to maintain their independence.
Staff were aware of people’s individual care needs and supported people with any changes in their health care needs. Staff supported people to access their GP or any other healthcare professionals.
People were supported with their nutritional needs. People told us that they chose what they wanted to eat. Staff prepared meals or supported people to cook.
The Care Quality Commission (CQC) monitors the use of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The staff and the registered manager were aware of the principles of the MCA and people were asked to provide their consent to the support being provided.
There was an open and transparent culture that put people at the centre of the agency. Feedback was ongoing and regularly sought from people. People were visited regularly by a senior staff member, and quality assurance questionnaires were sent out on a regular basis. This allowed people to give their opinions of the service. People thought the agency was well-led and efficient.
Staff knew and understood the values of the agency, and there was a commitment to provide a personalised and caring service. Staff told us they felt passionate about their role.
The registered manager led the service well and people and staff felt confident to approach them at any time.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
We have made a recommendation relating to the recording of medicines.