Advanced Homecare is a domiciliary care agency, which provides support with daily living and personal care to 234 people who live in the Fylde and Wyre areas. The service operates out of offices in the centre of Kirkham. The offices are easily accessible for clients.The service had 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. We were informed by the Provider that the manager who is registered with CQC no longer carried out this role. A new manager had taken over the service and was in the process of registering with CQC at the time of our inspection.
Prior to our inspection concerns had been raised with us about nutrition, hydration, medicines, inconsistencies in care records and instability in management. We used the opportunity to ensure the provider had taken action to ensure people who used the service received safe, effective, compassionate, high-quality care.
There had been instability among the management team which had led to communication issues prior to our inspection. The manager was confident they now had the right people in place. Staff and people we spoke with told us the service had improved recently.
The provider had introduced monitoring systems to protect people against the risks of poor nutrition and hydration. People told us staff supported them to make sure they ate and drank enough to keep them well.
We found inconsistencies in the level of detail recorded in people’s written plans of care. The manager was introducing a new care planning system to address this, which contained more detail to guide staff.
The provider had safe systems to ensure people received the right medicines at the right time when supported by staff. The systems were newly introduced and good practice needs to be shown to be sustained in this area.
We last inspected the service in August and September 2015, when we found the provider was meeting the requirements of the regulations. Following that inspection, we made two recommendations.
The first was for the provider to ensure people’s risk assessments were kept up to date in line with any changes in circumstances. The second, for the provider to ensure staff competency with regard to medicines administration recording. We found improvements had been made in both these areas. However, we found there had been recent issues regarding risk assessments including nutrition, hydration and medicines. These were highlighted as part of safeguarding investigations by the local authority. We saw the manager had introduced new systems to try to ensure people received safe care and support.
People had signed their care plans to say they consented to their package of care. However, we found assessments of people’s capacity to consent and decisions made during best interests processes were not clearly recorded. We have made a recommendation about this.
People and their relatives told us they felt safe with staff. Staff had received safeguarding from abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.
The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.
We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who used the service were being met.
New systems to manage risks and plan care and support for individuals had been implemented, following concerns raised through local authority safeguarding investigations. As these systems were new, we were unable to see the impact they had on the quality of care provided.
We found people had access to healthcare professionals and their healthcare needs were being met. We saw the management team had responded promptly when people had experienced health problems.
We observed care staff gained consent from people before any care or support was provided.
Staff told us they felt supported by the management. Staff received regular supervision and appraisal. Staff received training to enable them to undertake their role effectively. Training was under review by the manager.
Everyone we spoke with gave positive feedback about how caring staff and the service they received was. People told us they were treated with dignity and respect.
Staff had a good understanding of people’s individual needs. People told us staff ensured all their care and support needs were met during each visit.
The provider had a suitable complaints procedure. People were given a copy when they started using the service. We saw complaints were handled in line with the provider’s policy.
We received positive feedback from people, their relatives and staff about the management of the service.
The provider had a range of methods to gather people’s views of the service, including surveys and review meetings. The manager had introduced more comprehensive audits and checks to monitor the quality of the service provided to people.