Peace of Mind Home Care Solutions

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Our previous inspection of the service on 5 January 2018 found two breaches of regulation in respect of staff support and quality assurance and we also made a recommendation in respect of medicines management. We previously rated the service as "requires improvement". Following the inspection, the service sent us an action plan detailing the action they would take to make improvements.

During this inspection 6 February 2019, we found the service had made improvements in respect of medicines management, supervision sessions and appraisals. The service had introduced quality checks and audits. However, we found that some of these did not always identify issues for example; Medication Administration Records (MARs).

People and relatives spoke positively about care workers and the service. They told us they were satisfied with the level of care provided and how the service operated. People told us they were treated with respect and dignity. Relatives told us they were confident that people were safe in the presence of care workers and were well looked after.

Our previous inspection found that MARs were not completed fully with details of medicines administered and we made a recommendation in respect of this. During this inspection on 6 February 2019, we found the service had introduced new format MARs which included details of the medicines included in the blister pack. These new format MARs clearly detailed the name of the person, their address, the name and dose of the medicines prescribed and allergies.

Care workers received medicines training and policies and procedures were in place. We looked at a sample of Medication Administration Records (MARs) and found that the majority of these were completed fully to indicate that medicines had been administered as prescribed.

Risk assessments were in place and were personalised and included information specific to each person and their needs.

People and relatives told us there were no issues with regards to care worker's punctuality and attendance. They told us care workers were mostly on time and if they were running late, the office contacted them to inform them of the delay. They also told us people experienced consistency in the level of care they received and received care from regular care workers. At the time of the previous inspection in January 2018, the service did not have an electronic system for monitoring care worker's timekeeping and duration of their visit. During this inspection in February 2019, the service had an electronic system in place which flagged up if a care worker had not logged a call to indicate they had arrived at the person's home or that they were running late.

Systems and processes were in place to help protect people from the risk of harm and care workers demonstrated that they were aware of these. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

We looked at the recruitment records and found background checks for safer recruitment had been carried out to ensure staff were suitable to care for people.

Our previous inspection found staff were not consistently supported to fulfil their roles and responsibilities through supervisions and appraisals and we found a breach of regulation in respect of this. During this inspection in February 2019, we found the service had taken appropriate action to make improvements to address the breach of regulation. The service had implemented a system to ensure staff received supervisions, spot checks and appraisals and we saw that these were carried out regularly.

People and relatives told us they were confident that care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers spoke positively about their experiences working for the service. They told us that they received continuous support from management and morale amongst staff was good. Spot checks were in place to assess care worker's competency.

Care support plans were person centred and individualised. They addressed areas such as people’s personal care, what tasks needed to be done each day, time of visits, people’s needs and how these needs were to be met. They also included details of people’s preferences and details of their history and interests.

Our previous inspection found the service did not have effective systems and processes in place to assess, monitor and improve the quality of the services provided. We previously found a breach of regulation in respect of this. During this inspection in February 2019, we found the service had taken action and made improvements.

Following our previous inspection, the service had introduced systems to check and monitor various aspects of the service which included staff training, staff supervisions and spot checks. This enabled the service to continuously monitor this to ensure that these were carried out consistently. The service had also introduced a formal quality monitoring system which was carried out at various intervals over a year. This included two telephone calls and two visits annually and enabled the service to continuously obtain feedback from people and their relatives.

The service had also introduced a MAR audit which was carried out monthly. However, we found this audit was not sufficiently comprehensive. The service had also introduced an electronic system to monitor staff punctuality and attendance. This system enabled the service to print off data in order to monitor punctuality and attendance. However, we noted the service did not have a formulised system in place to review these on a regular basis. We discussed this with management who confirmed they would introduce these checks formally and revise the MARs audit.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The previous inspection of the service on 6 January 2016 rated the service as Good with no breaches of Regulation.

People who used the service spoke positively about the care provided. They said they felt safe in the presence of care workers and were happy with the care provided. This was also confirmed by relatives we spoke with who told us that they were satisfied with the level of care.

We looked at the arrangements for the management of medicines during the inspection. Care workers received medicines training and policies and procedures were in place. We looked at a sample of Medication Administration Records (MARs) and found that these were not completed fully with details of medicines administered. We discussed this with the service and they advised that they would take immediate action. We made a recommendation in respect of this.

Systems and processes were in place to help protect people from the risk of harm. Identified risks associated with people's care had been assessed and plans were in place to minimise the potential risks to people.

There were comprehensive and effective recruitment and selection procedures in place to ensure people were safe and not at risk of being supported by staff who were unsuitable.

People and relatives we spoke with told us their care workers were punctual and raised no concerns in respect of care worker’s timekeeping. They also told us they received care from the same care worker on a regular basis. However, we noted that there was no evidence that demonstrated management carried out regular checks in relation to care worker’s attendance and timekeeping.

Care workers had completed relevant training. However, we noted that supervision sessions were not carried out consistently and on a regular basis. There was no evidence to indicate that staff had received an annual appraisal. We found a breach of regulation in respect of this.

Feedback from people indicated that positive and close relationships had developed between people using the service and their care worker. Care workers were aware of the importance of treating people with respect and dignity.

Care plans provided information about people’s life history and medical background. People's support plan outlined the support people needed with various aspects of their daily life such as personal care, continence, eating and drinking, communication, mobility, medicines, religious and cultural needs. Care plans detailed people’s care preferences, daily routine likes and dislikes and people that were important to them.

The majority of care workers had received training in the Mental Capacity Assessment (MCA). Care workers we spoke with were aware of the importance of ensuring people were able to make their own decisions as much as possible. Care plans included information about people's communication and their capacity to make decisions.

A complaints procedure was in place. People and relatives spoke positively about the service and told us they thought it was well managed and raised no concerns.

There was a management structure in place with a team of care workers, office staff, the manager and director. All staff spoke positively about the management and culture of the service and told us the management were approachable if they needed to raise any concerns.

The service did not have an effective system in place to monitor the quality of the service being provided to people using the service and to manage risk effectively. The service had failed to effectively check essential aspects of the care provided in respect of MARs, punctuality and staff support. We found a breach of regulation in respect of this.

During the inspection, management explained to us that they would make the necessary improvements to aspects of the care identified. However we needed to be sure that these processes had been implemented consistently over a significant period of time.

We found two breaches 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.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 200 and associated Regulations about how the service is run.' The registered manager was on duty on the day of our inspection and we also met with one of the directors, who was also the owner of the domiciliary care agency.

People told us they felt safe with the support they received from care staff. There were arrangements in place to help safeguard people from the risk of abuse. Care staff understood what constituted abuse and were aware of the steps to take to protect people.

The service ensured there were safe recruitment procedures in place to help protect people from the risks of being cared for by care staff assessed to be unfit or unsuitable.

People had risk assessments and risk management plans to reduce the likelihood of harm. The risk assessments identified the risks and the actions required of staff to minimise the risk.

Care staff told us and we saw from their records that they had received training in relevant areas of their work. This training enabled care staff to support people effectively.

Care staff understood their responsibilities in relation to the Mental Capacity Act 2005. People were involved in making decisions about their care and support and their consent was sought and documented.

People were supported to eat and drink sufficiently to maintain a balanced diet. The registered manager explained care staff checked if people had enough food and let the office and family representatives know if supplies are running low.

People told us they were treated with dignity and respect. Care staff understood the need to protect people's privacy and dignity. People told us care staff knocked on their doors and requested permission before they entered their homes.

The service encouraged people to raise any concerns they had and responded to them in a timely manner.

Care staff gave positive feedback about the management of the service. The registered manager was approachable and fully engaged with providing good quality care for people who used the service.

The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions and action plans were developed where required to address areas for improvements.