This inspection took place between 4 and 12 November 2015 and was announced. At the last inspection on 6 January 2014 the service was found to be meeting the requirements we assessed.
Carlton Home Care provides care services to adults throughout the Bradford area. Their main office is based in Shipley. The service provides people with personal care and support to enable them to live in their own homes. Most people who used the service were older people or people living with a learning disability.
A registered manager was in place. However, they were on maternity leave at the time of this inspection so an interim manager was covering the manager’s position. 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.
Accidents and incidents were being monitored and analysed. However, information was not always being translated into care records to ensure care staff had up to date information to ensure appropriate action was taken to mitigate risk.
Our review of records, discussions with staff and people who used the service led us to conclude there were not sufficient care staff available to ensure people received consistent and person centred care.
The records, policies and procedures for managing medicines needed improvement to ensure staff practices and the process for administering medicines was safe.
The provider had appropriate arrangements in place to help reduce the likelihood of abuse going unnoticed and help protect people from the risk of abuse.
Staff received thorough training, on-going support and development to ensure they had the skills and knowledge to provide effective care.
Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and had a good knowledge of the people they supported and their capacity to make decisions.
Staff supported people to ensure their healthcare needs were met and where support with meals was required helped people to have a healthy balanced diet.
Many people told us they received a good standard of care and provided positive feedback about the staff who supported them. However, people said the quality of carers and standard of care they received was not consistent. Most people said their experience was influenced by staffing issues which led to inconsistencies in the time of their calls and the carers who supported them.
Most people told us staff treated them and their home with respect and dignity. However, as the quality of care staff was variable improvements were needed to ensure consistency in the attitude and approach of care staff.
Care records contained person centred information which demonstrated they had been developed in consultation with people. People told us they felt involved in making decisions about how their care was provided on a day to day basis but were not consistently involved in the formal care planning process.
Records showed and people told us call times were often inconsistent. This meant people did not always receive care and support which was responsive to their needs. People told us this was due to “staff shortages” and the fact the provider did not include travel time on the call run rota, which often caused staff to run late.
Formal complaints were investigated and responded to in line with the provider’s complaints policy. However, where people raised informal concerns it was not always clear what action had been taken to respond to the issues raised. Systems were in place to seek people’s feedback. We saw examples where the provider had taken effective action make improvements based on people’s feedback, however this was not always the case. People told us the management team should be more “visible” and consistently clear about what action they had taken to respond to feedback.
We found the provider’s audit system was not sufficiently robust. We identified concerns with a number of aspects of service delivery including; the management of medicines, staffing, incomplete and ineffective care records. These had not been addressed prior to our visit were not included on the provider’s action plan.
The system for archiving documents was not robust. Some care records contained information which was no longer relevant and other documentation could not be located. Effective systems were not in place to ensure daily notes were checked. This meant important information and changes to people’s needs were not always identified and acted upon.
Staff and people who used the service provided positive feedback about the acting manager. However, due to staffing shortages said they often had to provide hands on care which we saw had a negative impact upon the quality of care records and consistency of management checks.
We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take in relation to this at the back of the full version of the report.