This inspection took place on 05 October 2015 and was announced. Belong at Home Domiciliary Care Agency Atherton provides domiciliary care services to people who live in their own home. At the time of our inspection there were 21 people using the service, with a variety of care needs, including people living with dementia.
The service was last inspected on 12 June 2013 and at the time was meeting all regulations assessed during the inspection.
During this inspection we found two 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 this report.
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.
People were complimentary about the care and support they received. People spoke highly about the care staff and valued having care workers who were consistent and with whom they had built relationships. People and their relatives spoke positively about the skills of the care workers and felt staff were efficient and well trained.
We found the service had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. We reviewed a sample of recruitment records, which demonstrated that staff had been safely and effectively recruited.
The service used a matrix to monitor the training requirements of staff. This showed us that staff were trained in core subjects such as safeguarding, moving and handling, medication, dementia, nutrition and health and safety. Each member of staff we spoke with told us they were happy with the training and support available to them.
There was a positive caring culture, which was promoted by the registered manager. Staff were passionate about providing high quality care and enjoyed caring for people. Care workers felt supported by the registered manager, describing them as approachable and supportive.
People had support plans in place but they did not capture people’s histories and how people preferred their assessed needs to be met. The details in the support plans did not identify how people’s pain would be managed when it had been documented as requiring management and the medicine administration records (MAR) contained conflicting information.
We found that support plans were task orientated and not person centred but despite this,we did not consider it to impact on the care provided. Staff had developed good relationships with people and were knowledgeable about the person they supported enabling them to provide care tailored to the person.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The registered manager and care workers demonstrated a good understanding of MCA and provided examples of when consideration had been given to the legislation in reaching best interest decisions.
Quality assurance systems were not robust. The registered manager had undertaken audits in regards to the practices and records at the service to ensure people were receiving safe care. However, we found that these were not always effective. The systems had not identified gaps in the risk assessments, management of medicines or documentation pertaining to person centred care. The registered manager had also not consistently developed action plans to show how issues identified in audits were being addressed and monitored.
The registered manager demonstrated a commitment to address any issues identified in a planned and structured way.