Background to this inspection
Updated
11 April 2018
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 was announced. We gave the service 48 hours’ notice of the inspection visit because the manager is sometimes out of the office supporting staff or providing care. We needed to be sure they would be in.
The Inspection started on 30 January and ended on 8 February 2018. We visited the office location on 30 January and 1 February 2018 to see the registered manager and office staff and to review care records and policies and procedures. Following the office inspection, we visited some people in their homes to gain their experiences of care provided and to review their care documentation. We returned to the office on 8 February to give feedback to the registered manager and operations director.
One inspector was present at the office on 30 January and 8 February 2018. An Expert-by Experience supported the inspection team by speaking with people and their relatives by telephone. An Expert-by-Experience is a person who has personal experience of using or caring for someone who uses this type of care service. Two inspectors were present at the office on the 1 February 2018.
Before the inspection, we checked the information held about the service and provider. This included previous inspection reports and any statutory notifications sent to us by the registered manager. A notification is information about important events which the service is required to send to us by law. We also reviewed the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what they do well and improvements they plan to make.
On the day of inspection, we spoke with three people that use the service about their day to day experiences. We spoke with eight relatives, six staff, the two care co-ordinator’s and the registered manager. We spent time reviewing records, which included eight care plans, six staff files, eight medication administration records, staff rotas and training records. Other documentation that related to the management of the service such as policies and procedures, complaints, compliments, accidents and incidents were viewed. We also ‘pathway tracked’ the care for people living at the service. This is where we check that the care detailed in individual plans matches the experience of the person receiving care.
Following inspection we visited four people in their homes and viewed their care plan documentation. We spoke to a healthcare professional regarding their on-going involvement supporting people from Care at Home Services. We sought feedback about the service from the Local Authority Quality Monitoring Team. We also sought advice from a Pharmacist.
Updated
11 April 2018
Care at home services (South East) is a domiciliary care agency. At the time of our inspection they provided care to 108 people living in their own houses and flats. It provides a service to older adults and some younger disabled adults.
Not everyone using Care at home services receives 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 inspection 74 people were receiving support with regulated activities.
This was the first inspection for Care at home services (South East) at their new office location in Polegate.
At the previous inspection in 2016, the service was rated as ‘Requires Improvement’ overall. There was a continued breach of Regulation 17, Good governance; this was due to a lack of auditing tools that monitored the service and the provider not consistently maintaining records. This meant that there was not clear oversight of the service and the people accessing it. There was also a breach of Regulation 11, Need for consent. This was due to the provider not meeting the requirements of those who lacked the mental capacity to make an informed decision. It was evident from this inspection that improvements had been made to these areas identified previously and it was now meeting the required regulations.
Care at Home Services (South East) had a registered manager. ‘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.’
It was recognised that the registered manager had worked hard to address the issues that had been identified at their previous inspection. However a number of shortfalls were found within record keeping which suggested current auditing processes needed to be developed and embedded further. It was clear that staff knew people well. However information was not always clearly detailed within their care plans. This included information to support staff to know how to appropriately manage challenging behaviour or communication needs for people with a sensory impairment.
Some people took medicines on an ‘as required’ basis for pain management. Staff told us how a person indicated they were in pain. However, this was not documented within the person’s medicine assessment about pain relief. There was a potential risk that if unfamiliar carers visited the person, they would not have all the information they required to meet their needs fully.
Current auditing processes had not identified that a person had not received pain relief medicine as prescribed. Audits of people’s care documentation had not yet been implemented, which meant that gaps and inconsistencies in records had not been highlighted.
By the final day of inspection, the registered manager had addressed these issues. This demonstrated a willingness to improve.
People and their relatives felt safe. Staff demonstrated knowledge of safeguarding and the processes to follow if they suspected abuse was happening. There were suitable numbers of staff to meet people’s support needs.
People and their relative’s felt that staff were suitably skilled and trained to do their job effectively. Staff demonstrated a good understanding of seeking consent from people before providing care. Staff also spoke positively about a new and improved induction programme and said that they received regular supervision, spot checks and annual appraisals. Staff felt that positive practise was recognised and areas of improvement identified.
People and their relative’s spoke highly of the staff that supported them. They found them to be kind, compassionate and knowledgeable of people and their support needs. People felt that their independence was promoted and their dignity and privacy was maintained at all times.
Care plan documentation for people was detailed with the specific care needs required during each care call. Any changes to health or support needs were discussed with a relevant health professional. People and their relative’s felt that staff met all of their needs. They were knowledgeable of the complaints procedure and were comfortable raising any concerns. Complaints were resolved in a timely manner and people were satisfied with outcomes.
People, their relatives and staff spoke highly of the management team and how there had been many improvements since the last inspection. The management team sought regular feedback from people which was assessed to identify any trends or patterns and were acted upon. Staff also advised that they had regular staff meetings to discuss areas of good practise and areas for improvement.
Further information is in the detailed findings below.