This comprehensive inspection carried out by one inspector, commenced on 1 November 2018 and ended on 5 November 2018. At the last inspection in August 2017, the service was rated Requires Improvement and the provider was in breach of three regulations. These related to unsafe recruitment practices, staff training and support and governance; these affected the key questions of Safe, Effective and Well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least good. We checked to see that the action plan had been completed and found progress had been made in some areas, including staff recruitment. However, there continued to be concerns with staff training and a lack of governance systems. This is the second consecutive time the service has been rated requires improvement.
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 and younger adults.
Not everyone using Quality Home Care receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection, five people were receiving a regulated activity.
There was a registered manager in post. 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.
Systems to recruit staff safely had been improved and relevant pre-employment checks were in place. We found the registered manager and provider were now compliant in this area of the regulation. However, staff training and governance, areas they were required to improve during the last inspection, had not been sufficiently improved and they continued to be in breach of the regulations in these areas.
Some small improvements had been made to how the service was run, such as ensuring staff received supervision and an appraisal. Although some training for staff was now planned, assurances that staff had the necessary skills and abilities to carry out their roles effectively could not be provided. There was no evidence new staff had received a thorough induction to equip them with the skills and knowledge for the role.
There continued to be a lack of systems to assess, monitor and improve the quality and safety of the service. This had led to shortfalls in the management and recording of medicines, risks not always being assessed and recorded, and a lack of documentation of how the Mental Capacity Act 2005 (MCA) had been followed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not always support this practice.
Medicines were not always managed and recorded in line with the provider’s policy and best practice guidelines were not always followed by staff, which led to some shortfalls. The provider could not provide evidence that staff had received appropriate training in medicines management and staff’s competency had not been assessed in this area. We have made a recommendation regarding the safe management of medicines.
Staff were aware of how to recognise and respond to safeguarding concerns. Staff knew people well and could tell us how they would recognise a deterioration in people’s health and how they would respond to certain risks. Staff supported people to access appropriate healthcare and supported them to maintain a diet of their choosing.
Overall, people’s care plans contained appropriate information and detail to direct staff to provide person-centred care. These were not always reviewed and updated as people’s needs changed.
Staff supported people to maintain their independence and treated people with dignity and respect. People and their relatives told us staff were kind caring.
People told us they felt able to raise any issues or concerns. The provider had system in place to manage and respond to any complaints.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to staff training and good governance. You can see what action we told the provider to take at the back of the full version of the report.