Background to this inspection
Updated
12 October 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We carried out this inspection between the 8 and 14 March 2018. We announced the visit with short notice to make sure the manager would be available.
The inspection team consisted of three adult social care inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. This case our expert’s area of expertise was in the care of older people.
Inspection activity started on 8 March 2018 when the expert by experience carried out telephone interviews with people who used the service. We spoke with eight people who used the service and three relatives of people who used the service.
On 13 March 2018, two adult social care inspectors visited the location office. We spoke with the branch manager, the operational support manager the field care supervisor and care coordinators. We looked at a variety of records, which included the care records of five people who used the service, staff recruitment and training files, meeting notes, surveys, complaints and quality assurance records.
On 14 March 2018, an adult social care inspector carried out telephone interviews with 12 care workers.
Prior to the inspection, we spoke with both the local authority commissioning and safeguarding teams. We reviewed information held about the provider; for example, notifications sent to us by the provider. On this occasion we did not ask the provider to complete a Provider Information Return (PIR). The PIR 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.
Updated
12 October 2018
We carried out the inspection between 8 and 14 March 2018. The inspection was announced at short notice.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults and children.
The last inspection was carried out in February 2017; the report was published in September 2017. At that time the service was rated ‘requires improvement’ overall. The provider was in breach of three regulations relating to person centred care, (Regulation 9) staff training, (Regulation 18) and good governance, (Regulation 17). It was the second time the provider had been in breach of the regulations relating to person centred care and good governance and we took enforcement action. The provider sent us an action improvement plan and submitted regular updates on the progress they were making in bringing about the required improvements. During this inspection we found some improvements had been made however found further improvements were needed and the overall rating remained ‘requires improvement’. This was the third consecutive inspection when the overall rating was ‘requires improvement’. However, it was the first ‘requires improvement’ rating since the introduction of our new approach to inspecting services that are repeatedly ‘requires improvement.’
The service did not have a registered manager at the time of our inspection. 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.
Over the past three years, the service has had three changes of manager. The previous registered manager left approximately six months before this inspection. The provider had appointed a new manager but they told us they were leaving at the end of April 2018. We were concerned the lack of consistent leadership was preventing the service from fully implementing and sustained the required improvements.
People told us they felt safe and comfortable with the care workers who provided their support. Staff knew how to recognise and report concerns about people’s safety and welfare. When concerns were raised the service worked with other agencies in an open and transparent way to make sure they were dealt with properly.
All the required checks were done before new staff started work. This helped to protect people from the risk of receiving care and support from staff unsuitable to work with vulnerable people. We found improvements had been made to the way staff training was provided and most people told us they were satisfied staff had the skills they needed to carry out their duties properly.
Risks to people’s safety and welfare were not always properly assessed. This created a risk people would not always receive the right care and support. People’s care records were not always up to date or detailed enough to make sure staff had the information they needed to deliver appropriate care and support.
Overall, we found people were getting the support they needed with their medicines. However, further improvements were needed to ensure people consistently received the right support with prescribed creams and lotions and that records were clear and accurate.
The service had changed the way they organised and allocated staff since the last inspection. Most people told us this had improved the service they received in terms of both the timing of calls and the continuity of staff. The provider had further improvements planned including putting an electronic call logging system in place later in 2018.
People told us staff were caring and treated them with respect and dignity. We saw people were supported to make decisions about their care and treatment. When people were not able to give informed consent decisions taken in their best interests were recorded.
People knew how to make a complaint and the majority of people we spoke with felt their concerns were dealt with properly.
There were systems in place to monitor the quality and safety of the service but they were not always operating effectively. There were processes in place to seek the views of people who used the service. We received mixed feedback from people about how well the provider used their feedback to make improvements to the service.
During this inspection we found two breaches of regulation. These were related to safe care and treatment, (Regulation 12) and governance and record keeping, (Regulation 17). This was the third consecutive inspection where we found the provider in breach of Regulation 17. We are considering the appropriate regulatory response to our findings.