This announced inspection took place on the 08, 09 and 10 February 2016. Appleberry care is a domiciliary care service providing care to children and adults in their own homes. At the time of the inspection they were providing care to 38 people. As part of meeting the registration requirements Appleberry Care had a registered manager in place. 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.
People’s relative’s views of the service provided was very positive. They told us the staff were trained and knew how to care for people. The management were accessible and were approachable and supportive. Staff were kind, caring and professional. However, we found a number of areas we were concerned about.
We found staff’s knowledge or skills were not assessed by the registered manager following training. Checks on staff competency did not always take place and where staff worked with people with specific conditions, specialist training was not provided.
Staff did not receive regular supervision, some staff had received supervision once in the last year. The registered manager told us they had frequent contact with staff, but there was no documentation to verify this.
People’s needs were assessed prior to care being provided, but not everyone had an up to date care plan that accurately reflected their needs. Some risks we identified in the care plans had not been assessed. Care plans and risk assessments were not always available in people’s homes for staff to refer to. This placed people at risk of inconsistent care.
Administration of medicines was not recorded in a safe way. Records did not include the full name, dosage, route, time and signature of the staff member administering the medicine. There were no risk assessments in place for medicines and no protocols for PRN (as required) medicines.
Staff were aware of the indicators of abuse, but records were not available to demonstrate the provider had taken the correct action in relation to an allegation of abuse that had occurred. We have made a recommendation about safeguarding people from abuse.
Staff had a basic understanding of the Mental Capacity Act 2005 (MCA), but the registered manager was not fully aware of how the 2014 Supreme Court judgement applied to Appleberry Care. We have made a recommendation about MCA.
People were supported to maintain their health and access appropriate healthcare support. Staff understood how to support people with food and drinks in order to maintain good health.
We received very positive feedback about the caring attitude of staff. This was supported by actions the staff had taken to ensure people’s needs were met. These included collecting items for the person from shops and pharmacies. One staff member attended school with a child to support them with their swimming and supported them and their family whilst the child was in hospital. Other staff had amended their holiday dates to ensure any disruption to the care being provided was minimised.
Staff understood how to protect people’s privacy and dignity. They were able to give examples of how they showed respect for people and their families. Family members recognised and commented in a positive way about this aspect of care. The care plans we read also acknowledged people’s preferences and choices. Some care plans were regularly reviewed and the person and their relative was part of the review process. Not all care plans were regularly reviewed.
One complaint had been made to the provider in the past year; this had been dealt with professionally by the registered manager. Staff knew how to respond to complaints.
During the inspection we were made aware of a safeguarding concern the provider had failed to inform us of. They failed to supply us with important information following the inspection. We have made a recommendation about notifications.
Systems were not in place to oversee the running of the service, to ensure a quality service was being provided and drive forward improvements.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.