17 February 2021
During an inspection looking at part of the service
Walnut Care at Home is a domiciliary care service providing personal care to people living in their own homes. At the time of inspection there were 445 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided
People’s experience of using this service and what we found
Staff were provided with information about how to reduce risks associated with people's care. The providers own risk assessments were often generic and could have included more person-centred information. We discussed this with the provider who was aware of this and had plans to develop this in the future. Staff were aware of the risks associated with people's care.
People told us there were enough staff to meet their needs. Some people told us staff absence could result in last minute changes and late calls. Some people told us that sometimes staff rushed to deliver their care. We considered the impact the COVID-19 pandemic had on staffing. Staff were recruited safely and in line with requirements.
People were administered medicines by staff who were trained and competent. Records of medicines administration were checked by the provider and errors were addressed.
People confirmed staff wore the correct PPE when providing care to them in their own homes. Records showed staff were provided with infection control training. The provider had reacted and responded to the COVID -19 pandemic in a proactive and dynamic way. Staff were provided with the PPE they needed.
Since the last inspection the provider has developed improved systems to monitor and review care to ensure incidents are escalated and responded to. Staff told us they reported concerns to a senior member of staff during daily handover.
Staff received training to ensure they could recognise and report abuse. Staff described how they would report their concerns to someone more senior.
People's needs were assessed when they commenced using the service. A system was in place to check the information in local authority needs assessments prior to agreeing to provide care. People had care plans which reflected their basic needs.
Systems to support staff learning and development had improved since our last inspection. Training records showed staff received the training they required to carry out their roles.
Records showed staff escalated concerns about people's health and wellbeing. Systems had been improved since the last inspection to ensure information about people was more accessible and could be shared with health and social care partner agencies.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People told us staff treated them with courtesy and respect and were kind to them. People told us they felt involved and consulted about their care. People told us staff respected their privacy and dignity.
The quality of information in care plans and person-centred care guides varied. Some contained a detailed description of people's preferences and wishes, and others were less person centred and required further development.
Records showed peoples care was reviewed and people were consulted about their care and encouraged to contribute ideas and views.
A complaints procedure was in place and records showed complaints were investigated and responded to.
Staff were provided with training and support to recognise frailty and support people who were at the end of their life. The provider had a system to ensure people who were at the end of their life had a palliative care plan in place.
Since our last inspection the provider had developed a clear governance process and had improved systems to ensure they had clearer oversight of the service and risk.
The provider had developed an improvement plan which incorporated actions from service checks, feedback from service users and complaints. The provider and senior management team had worked hard to drive improvements during the COVID-19 pandemic.
Some people told us they found it difficult to contact the office on occasion, others confirmed service checks were carried out and they were asked for feedback about their care.
Staff consistently told us they felt supported in their roles and they felt confident to raise concerns.
The provider has worked extensively with partner agencies and local groups throughout the pandemic and have shared information to support the local care network in the area.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (Published 24 November 2020) and there were multiple breaches of regulation. A Warning Notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 was issued. Due to the COVID-19 pandemic we were unable to return within the specified timescale to check the Warning Notice had been met, therefore this was checked at this inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.