Background to this inspection
Updated
12 October 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.
This inspection took place on 22 August and was announced. The provider was given 48 hours' notice because the location provides a domiciliary care service; we needed to ensure that someone would be available.
The inspection team consisted of one inspector and an expert-by-experience with experience in adult social care. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Due to technical problems, a PIR was not available and we took this into account when we inspected the service and made the judgements in this report. We looked at the notifications and other intelligence the Care Quality Commission had received about the home. This included statutory notifications sent to us by the provider about incidents and events that had occurred at the service. A notification is information about important events, which the service is required to send to us by law.
During our inspection, we went to the office and spoke with the provider who was also the registered manager. We also spoke with the deputy manager, a senior care coordinator, two care coordinators, two healthcare assistants and the education officer. The expert-by-experience made phone calls to one person and four relatives to request their feedback about what it was like to receive care from the staff at Insignia Healthcare (Norwich). They agreed for their comments to be included in this report.
We reviewed the care records of five people receiving support. We looked at service records including four staff recruitment, supervision and training records. Policies and procedures, complaints and compliments records and records of checks that had been completed to monitor the quality of the service being delivered.
Updated
12 October 2017
The inspection was announced and took place on 22 August 2017.
Insignia Healthcare (Norwich) was registered by the Care Quality Commission (CQC) on 3 December 2015. New services are assessed to check they are likely to be safe, effective, caring, responsive and well-led. This was the first comprehensive inspection since the provider registered with CQC to provide personal care to people. As such, they had not yet received a CQC rating.
Insignia Healthcare (Norwich) is a domiciliary care agency which provides personal care to people with a variety of needs including older people, people living with dementia, younger adults, people with a learning disability, physical disability and people who need support with their mental health. The agency's office is located in St. Andrew, Norwich. At the time of our inspection, the service was providing personal care to 19 people.
There was a registered manager in post who was also the provider of the service. 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. In this report when we speak about both the company and the registered manager, we refer to them as being, 'the registered persons'. The provider had recently appointed a manager with the intention they become registered and manage the service on a day to day basis. They had also submitted an application to register with the Care Quality Commission (CQC).
People and healthcare assistants spoke highly of the care co-ordinators and the company. People expressed satisfaction with the service they received. However, the provider had found that quality assurance systems were not always being used to ensure accurate records were maintained and to drive improvements. The provider had implemented computer software 10 days prior to the inspection to improve this, however we will need to assess how this improvement has been embedded and sustained at our next inspection. We found no evidence that the lack of audits and gaps in records had impacted on the quality of service people received.
Risks to people's wellbeing and safety had been effectively mitigated. We found individual risks had been assessed and recorded in people's care plans. Examples of risk assessments relating to personal care included moving and handling, nutrition, falls and continence support. Health care needs were met well, with prompt referrals made when necessary.
People told us they felt safe receiving the care and support provided by the service. Staff understood and knew the signs of potential abuse and knew what to do if they needed to raise a safeguarding concern. Training schedules confirmed staff had received training in safeguarding adults at risk.
Robust recruitment and selection procedures were in place and appropriate checks had been made before staff began work at the service. This contributed to protecting people from the employment of staff who were not suitable to work in care. There were enough staff to protect people's health, safety and welfare in a consistent and reliable way.
Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed safely.
The management team and staff had an understanding of the Mental Capacity Act 2005 and consent to care and treatment.
People chose their own food and drink and were supported to maintain a balanced diet where this was required.
People said staff were caring and kind and their individual needs were met. Staff knew people well and demonstrated they had a good understanding of people's needs and choices. Staff treated people with kindness, compassion and respect. Staff recognised people's right to privacy and promoted their dignity.
We looked at care records and found good standards of person centred care planning. Care plans represented people's needs, preferences and life stories to enable staff to fully understand people's needs and wishes. The good level of person centred care meant people led independent lifestyles, maintained relationships and were fully involved in the local community.
There was a complaints policy and information regarding the complaints procedure was available. There was one complaint in the past 12 months. Records demonstrated this was listened to, investigated in a timely manner, and used to improve the service. Feedback from people was positive regarding the standard of care they received.
Staff felt supported by management, they said they were well trained and understood what was expected of them. Staff were encouraged to provide feedback and report concerns to improve the service.
The provider had developed an open and positive culture, which focused on improving the experience for people and staff. The provider welcomed suggestions for improvement and acted on these.