This inspection took place over three days on 23 and 28 September and 1 October 2015 and was unannounced. We last inspected Right at Home (Chorley & West Lancashire) on the 12 and 16 September 2014 and the service was judged to be fully compliant with the previous regulatory standards.
Right at Home (Chorley & West Lancashire) is a domiciliary care agency based near Chorley town centre. The agency supplies staff to work across Chorley, Leyland, Parbold and Standish areas. The service provides support to people living in their own homes. The service is regulated to provide people with support for their personal care needs.
There was a registered manager in place 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.
The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. Staff members spoken with said they would not hesitate to report any concerns they had about care practices. We saw that the service had an up to date safeguarding policy and procedure and staff told us they were familiar with it and knew how to access it.
We found a number of issues relating to recruitment practices. Gaps in employment histories were not always accounted for, suitable references were not always in place and there was no record of a criminal record checks on one person’s file, who provided care for people.
We noted that several people’s care plans contained review dates that had been missed by several months with regards to their medication care plans and risk assessments. We discussed these issues with the proprietor of the service, who told us that there was a need to review people’s care plans and that this had been highlighted within a recent internal audit.
We asked staff if they received appropriate support in the form of supervision, appraisal and training. We received a mixed response from staff in terms of the formal support they received. However they all told us that informal support was good and that members of the management team were always available to speak to if they had any issues.
There was little evidence within staff files to show that people had received a comprehensive induction before starting work. The proprietor and registered manager accepted this and had begun to put systems in place to ensure all new staff received an induction
We discussed consent issues with staff. All were very knowledgeable about how to ensure consent was gained from people before assisting with personal care, prompting medication and helping with day to day tasks. People we spoke with and their relatives spoke positively about how staff communicated with them.
People we spoke with told us the staff that supported them were kind and compassionate and when possible enabled them to make a range of decisions about how their care and support was delivered.
We spoke with staff on issues such as privacy and dignity and how they ensured that people retained as much independence as possible whilst being supported. Staff were knowledgeable in all areas and were able to talk through practical examples with us.
People we spoke with and their relatives told us they knew how to raise issues or make a complaint and that communication with the service was good. They also told us they felt confident that any issues raised would be listened to and addressed.
We looked in detail at six people’s care plans. Care plans did have some good information within them and they were laid out appropriately, so it was clear for staff to follow the instructions and information within them. However, care plans generally lacked detail about the individual person and how to care for them and much of the information within care plans was task orientated and not personalised to the individual. We also saw that some information was generic across all the care plans we looked at.
The care plans we looked at lacked detail around people’s past life history and their likes and dislikes. There was some basic information in some people’s care plans however this was limited. By gaining a better understanding of people’s histories and preferences carers would be able to provide a more personalised service to individuals.
We saw evidence that some audits had taken place however these were infrequent and did not form part of a scheduled quality improvement process and there was little evidence to show that audits were fed back to staff or caused changes or improvements to people’s care or informed care planning.
People we spoke with talked positively about the service they or their loved ones received. People spoke positively about the management of the service and the communication within the service. We spoke with six members of staff, all of whom spoke positively about their employer. Staff had a good understanding of their roles and responsibilities. Staff we spoke with praised the management team.
We saw a wide range of policies and procedures in place which provided staff with clear information about current legislation and good practice guidelines. All policies and procedures were version dated and included a review date. This meant staff had clear information to guide them on good practice in relation to people’s care.
We found several breaches of the Health and Social Care Act (2008) (Regulated Activities) Regulations. These breaches amount to breaches of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014. These related to staffing, fit and proper persons employed, person-centred care and good governance.