The inspection of Flexi Care and Support took place on 1 November 2017, with follow up telephone calls being made to people who used the service, their relatives and staff on 2 and 3 November 2017. The inspection was announced. The service had been registered with the Care Quality Commission since December 2016 and this was the first inspection of the service.Flexi Care and Support is a domiciliary care provider, providing personal care and support to people living in their own homes, with a focus on supporting and promoting independence and re-ablement. Services are provided to people with a wide range of needs such as adults with learning difficulties, adults whose behaviour is deemed challenging, people with mental health issues, people living with dementia, people with physical disabilities or with multiple diagnosis. There were 12 people using the service at the time of our inspection.
The service did not have a registered manager in post at the time of our inspection, although the substantive manager, in day to day control, had applied to register and their application was being considered by the Care Quality Commission. Since the inspection took place, the manager has registered with the Care Quality Commission. 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 and their family members told us they felt safe. Staff had received safeguarding training in order to keep people safe and staff demonstrated a good understanding of what to do if they were concerned anyone was at risk of abuse or harm. Safe recruitment practices were in place, which meant staff had been recruited safely. Risks had been assessed and reduced where possible.
The registered provider had a system in place to record accidents and incidents. Where an incident had been recorded, appropriate actions had been taken. There was an effective out of hours’ telephone service, which people and staff could use, in case of emergencies.
Staff were trained to manage and administer medicines to people and their competency was regularly assessed. There were some gaps in medication administration records and these required more robust auditing. We have made a recommendation about the management of medicines.
People received effective care and support to meet their needs. People and their relatives felt staff had the necessary skills and training to provide effective care and support. Staff told us they felt supported and we saw staff had received an induction as well as ongoing training, development and supervision.
People were supported to have choice and control of their lives and staff supported people in the least restrictive ways. However, care and support was not always provided in line with the principles of the Mental Capacity Act 2005 and records showed assessments of mental capacity, as required by the Act, were lacking. We have made a recommendation about complying with the requirements of the Mental Capacity Act.
People told us consent was sought prior to care and support being provided and this was evident from the care records we reviewed. However, formal written agreements which the registered provider had devised had not been consistently completed.
People we spoke with told us staff were caring. The staff we spoke with were enthusiastic and were motivated to provide good quality care. People told us staff respected their privacy and dignity. People were encouraged to maintain their independence.
Care and support plans were detailed and personalised, taking into account people’s choices, preferences and diverse needs. People told us they could make their own choices and the service was responsive and flexible to their needs.
Regular audits and quality assurance checks required further development in order for the service to improve. Staff told us they felt supported and people felt able to contact the office in the knowledge they would be listened to. Complaints were managed and responded to effectively.
We found a breach of regulation in relation to good governance. You can see what action we told the provider to take at the back of the full version of the report.