Background to this inspection
Updated
2 April 2020
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.
Service and service type
This service is a domiciliary care agency. It provides nursing and personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of the inspection the registered manager was away from the service and the service was being managed by the deputy manager with the support from senior staff with over sight from the provider’s nominated individual. The nominated individual is a person responsible for supervising the management of the service on behalf of the provider.
Notice of inspection
We gave the service one weeks’ notice of the inspection. This was because we wanted to be able to arrange to visit or speak with people and their families to gather feedback on their views. We also needed to be sure that there would be staff in the office to support the inspection.
What we did before the inspection
Before the inspection we reviewed the information we held about the service. This included details about incidents the provider must tell us about, such as any safeguarding alerts they had raised. We also contacted the local authority commissioning and safeguarding teams to ask for their views about the service. We used all of this information to plan our inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We visited the office and spoke with the deputy manager, a nurse, a care coordinator, the provider’s clinical lead, an operational lead and the providers quality and compliance manager. We also spoke with two care workers and visited one person and two relatives and spoke with a care worker on one of these visits.
We reviewed a range of records. This included three care plans and staff recruitment and training records. We also reviewed records used to manage the service, for example, medicines administration records and meeting minutes.
After the inspection
We requested some further information to be sent to us. We contacted four health care professionals to obtain their views about the service.
Updated
2 April 2020
About the service
This service is a domiciliary care agency. It is registered to provide nursing and personal care to children and adults living in their own houses and flats. People using the service have complex and multiple health care needs. At the time of the inspection five people were using the service and receiving a regulated activity.
People’s experience of using this service
We identified concerns in relation to the assessment and management of some risks, the management of medicines and the systems to monitor the quality and safety of the service were not always operated effectively.
People were supported to have choice and control of their lives. However, decisions were not always taken in line with the Mental Capacity Act 2005 code of practice or in people’s best interests; the systems in the service did not always support this practice.
We have made two recommendations that the provider consult and act on best practice guidance in respect of assessing people’s needs and in relation to end of life care.
People told us they felt safe using the service and staff understood their responsibilities under safeguarding. The service looked to identify learning from accidents and incidents and share learning. There were robust infection control measures in place.
Staff worked with health professionals to ensure people’s health needs were met. Staff used new technology with support and training to support people’s rehabilitation. Health professionals spoke positively of the flexible attitude of the agency in supporting people’s needs.
People and their relatives told us staff were kind and caring and responsive to their individual needs and in accordance with their protected characteristics. They said they were involved in decisions about their care and that staff treated them with dignity and encouraged their independence.
People had a plan for their care and staff worked in a person-centred way to support them. People’s needs for social stimulation were met when this was part of their assessed plan of care.
The service had a clear ethos and set of principles that staff understood. Staff told us they felt well supported by office staff and the senior management team. The service worked in partnership with a number of agencies and professionals and sought feedback on service delivery from people their families and stake holders.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection:
This service was registered with us on 29 January 2019 and this is the first inspection.
Why we inspected
This was a planned inspection based on when the service registered with us.
Enforcement
We have identified three breaches of regulation in relation to risk management and medicines, following the Mental Capacity Act code of practice and the way quality assurance processes were operated at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.