The inspection took place on 04 and 25 February 2016 and we gave the provider 48 hours’ notice to ensure there would be a member of the management team in the office. The last inspection was carried out on 02 February 2014, when all areas reviewed were meeting requirements.Your Care is a domiciliary care agency based in Bolton. At the time of our inspection the agency was supporting 38, mainly older Asian people in the Bolton areas. The vast majority of these were receiving personal care support from the service
At the time of the inspection there was no registered manager in place. 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. An acting manager was in place during the first day of the inspection and a new manager had been recruited and had started in their post on the second day of the inspection.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities)
Regulations 2014. This breach related to the provider not setting up systems to assess, monitor and improve the quality and safety of the services or to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity.
We found that some care records in an individual’s home had been completed prior to visits being made. We brought this matter to the attention of the provider who dealt with the staff member responsible immediately. Spot checks carried out at all households confirmed that this was an isolated incident and not the usual practice of the service.
The service had an effective recruitment system in place, which helped ensure staff were suitable to work with vulnerable people. There were sufficient staff to ensure people’s needs were met and rotas demonstrated that staff were given travelling time between visits to ensure they spent the required amount of time with people they were supporting.
Appropriate risk assessments were in place within care plans and accidents and incidents were recorded and reported as required.
Staff had undertaken training in safeguarding vulnerable adults and were confident they could recognise and report any concerns in this area. Staff had undertaken training in administering medicines, but there was presently no one who used the service who required more than prompts for their medicines.
We saw evidence that staff had undertaken a thorough induction programme prior to commencing work. There was an on-going programme of training staff.
Supervision sessions were undertaken regularly and these were recorded appropriately.
Care plans included a range of health and personal information and copies were kept in the office and in people’s houses.
Staff had an awareness of Mental Capacity Act (2005) (MCA) but their level of understanding was inconsistent. The new manager booked all staff on MCA training to address this.
People who used the service, their families and professionals involved with the service all told us staff were kind and caring. We observed good, relaxed and friendly interactions between staff and people they supported.
People told us they had been involved with their care planning and in reviews. However, the recording of their involvement was not consistent.
Information was produced in English and Asian languages to help make it accessible to the people who used the service and their families.
Staff were aware of the need for confidentiality and there was an appropriate policy in place regarding this.
People who used the service and their families, with whom we spoke told us the service was flexible and responsive to their needs and requirements.
Complaints and concerns were responded to appropriately and immediately but no overall monitoring of complaints was undertaken to look for any recurring patterns or trends and address these.
Care plans had some personal information but needed to be more person-centred. The new manager agreed to address this within her on-going improvement plan.
At the time of the inspection there was no registered manager in place.
Safeguarding concerns, complaints and accidents and incidents were recorded and responded to individually but there was no overall monitoring of these issues to identify and address any patterns or trends.
There was no system in place to monitor staff attendance and timeliness at visits. This meant that visits could be missed or staff could turn up late or leave early and the management may be unaware of this.
People we spoke with told us they were always able to ring the office and access a member of the management team. They felt their concerns were dealt with in a timely manner.
Staff meetings were held regularly and provided a forum for staff to raise any concerns or issues.