This inspection took place on the 20 June 2018 and was announced. The provider was given 48 hours’ notice as we needed to be sure that someone would be available in the office and to support us to visit people in their own homes. Butterflies Home Care is a domiciliary care agency. It provides personal care to older people living in their own homes in the community within the Hampshire and Dorset area. At the time of the inspection, Butterflies were providing a service to 48 people in the Dorset and Hampshire area to people with a variety of care needs, including people living with physical frailty or memory loss.
There was a registered manager in post. 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.
Robust governance and quality monitoring systems were not established or embedded within the service. Improvements were required in how the service was managed and how arrangements for accountability and delegation of management tasks were recorded. Monthly audits which included reviewing people’s records, staff files and training were not established which would ensure the quality of the service and identify where improvements could be made.
Risks were not monitored adequately, or completed within care plans to ensure the effective monitoring and mitigation of the risk. This meant the provider was not doing all that was reasonably practicable to manage risks.
Some people self-administered their medicines, whilst others needed support. Although people told us they received their medicines as they should, staff had not received spot checks or competency checks to ensure they were administering medicines safely.
We have made a recommendation about the provider refers to current NICE guidance in regards competency and assessment for staff administering medicines.
There was a risk that people may be moved by staff who had not been assessed as competent to move and assist them. Although staff had in date training from previous employers the registered manager had not assured themselves staff were competent to perform specific tasks through monitoring and direct observations.
Although staff received an induction when they started working for the service, which included shadowing staff they were not receiving regular monitoring, supervision or appraisals.
We have made a recommendation that the provider considers good practice guidance to ensure all staff receive appropriate support, training and supervision and appraisal to carry out their roles.
There was a risk people may not be supported in line with their assessed care needs, as there were shortfalls in the information held within care plans. We observed four care plans which had missing information in regards the support people required. The registered manager told us, “I know that the care plans are not as person centred as I would like but I am working through it.”
Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding. Professionals, staff and relatives told us they had no concerns relating to safeguarding.
We checked whether the service was working within the principles of the Mental Capacity Act. People told us that staff sought their consent before providing care. One person said, “They always ask me first”.
Staff demonstrated a kind and caring approach towards people. People told us staff knew them well and treated them as individuals. People were consulted about the care they received and were given opportunities to express their views. People were supported to make decisions about things such as what they wanted to eat or drink, what they wanted to wear, and how they wished to spend their day.
Relevant recruitment checks were conducted before staff started working at Butterflies in Hampshire to make sure staff were of good character and had the necessary skills. There were no gaps in employment history and staff told us they had not been allowed to commence employment until all checks were complete.
Systems were in place for recording complaints within the service. People’s relatives told us they felt confident to raise complaints but had not needed to.
People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with on-going care needs. Where people were being supported with end of life care, staff worked in partnership with GP and district nurses.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.