This inspection took place on 15 and 22 February, 22 March and 28 April 2016. The first day of the inspection was unannounced. At our previous inspection on 2 May 2013 we found the provider was meeting the regulations we inspected.Ashbourne Healthcare Services is a domiciliary care agency providing personal care and support to people living in their own home. At the time of this inspection the provider was providing personal care services for 20 people.
The service has a registered manager. 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.
People did not always feel safe using the service and one person was intimidated by a care worker after they reported their concerns. Staff did not demonstrate a clear understanding of how to protect people from abuse and the provider did not consistently inform appropriate organisations about safeguarding concerns. Staff were not aware of how to whistleblow about any concerns relating to the conduct of the service.
Staff had received medicines training, however records showed that the policy and practices for applying prescribed topical creams and lotions were not safe.
There were sufficient staff to meet people’s needs and a detailed recruitment process was carried out prior to staff commencing employment.
We received mixed opinions from people in relation to their experiences of staff punctuality and reliability, although people confirmed that they were supported by a small number of staff so that consistency and stability was achieved.
Records showed that staff had received training but events at the service indicated staff needed additional training. The provider evidenced that staff gained practical experience of care and were monitored during a placement at a care home for nursing. However, we did not find robust systems to show that the provider checked on people’s learning after they had completed training.
Monitoring visits to people’s home included some checks in regards to staff performance and conduct but there was no evidence of one to one formal supervision, so that staff had individual support to effectively undertake their responsibilities.
Care planning records showed that people’s capacity was assessed, however staff did not appear to be familiar with the Mental Capacity Act 2005 (MCA). This meant staff did not understand the principles about people’s rights to make choices and decisions.
People were provided with the support they required to meet their needs with meals and healthcare. We received positive comments about how the provider had met the needs of people receiving palliative care.
People’s entitlement to dignity and confidentiality were not always respected. There were clear issues of concern about how some staff disregarded professional boundaries in terms of how they spoke about people who used the service and there was a lack of compassion for people who were vulnerable due to their healthcare needs.
The terms and conditions for people who were self-funding contained stringent requirements for people to report any discrepancies or queries about timesheets they had signed within four days. This did not appear realistic or sensitive to the needs of people who used the service, and did not appear to consider that the impact of their ill-health, frailty or disability could lead to extended periods when they were unable to check timesheets.
Assessments and care plans did not evidence that staff knew people’s needs and wishes well. There was a lack of details about people’s wishes, interests, cultural requirements and other preferences to enable staff to provide a personalised service.
People’s needs were assessed before they received care and this information was used for care planning. However, we found that one person did not have an appropriate care plan and accompanying risk assessments because the provider had not understood that they were providing personal care to the person. This resulted in the person not receiving the care and support they needed.
People’s views were sought through the use of questionnaires and telephone monitoring calls.
The management team did not demonstrate a comprehensive knowledge of the responsibilities associated with providing a regulated service.
We have made a recommendation to the provider regarding information within the provider’s terms and conditions for self-funding people, which did not appear to take into account the circumstances of people who require support with their personal care needs.
We found six breaches of Regulations. One was in relation to the provider not informing the Care Quality Commission about safeguarding allegations. The other breaches related to one to one formal staff supervision, the provision of respect, dignity and confidentiality for people who use the service, the need for the provider to correctly identify and address people’s needs for personal care, effective identification of complaints and the need for better systems to assess, monitor and improve the quality of the service people receive.
You can see what actions we asked the provider to take at the back of the main report.