The inspection was announced and took place on the 6, 7 and 10 October 2016.Homecarers Liverpool Ltd provides a domiciliary care service to people living in their own home. The service operates throughout Liverpool. At the time of the inspection there were 649 people using the service.
There was a manager in post who had been registered with the CQC since December 2010. 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.
The last inspection was carried out in December 2013, during which the registered provider was found to be meeting the standards inspected against.
During the inspection we found examples which demonstrated that good care was being provided to people. However we also found several areas where improvement was needed.
Information within people’s care records was not personalised. Information was task-led and did not contain details around their strengths, likes, dislikes or preferred daily routines. Where information was provided, this did not go into sufficient detail. For example one person’s record stated that they had a diagnosis of Schizophrenia and were alcohol dependent, however there was no detail regarding the severity of this or what impact these conditions had upon them. We raised this with the registered manager who was already in the process of re-writing people’s care records to address this issue.
There were audit systems in place; however these were not always robust or effective. Medication audits had failed to identify and address where medication administration records (MARs) had not been appropriately signed by staff. Audits of care records had failed to identify poor risk assessing, the lack of sufficient depth and personalised detail to the information provided. There was no audit of accidents and incidents for people using the service, which meant that trends could not always be identified and would impact upon the ability of the organisation to take appropriate action. We raised these issues with the registered manager who started to rectify these areas immediately during the inspection.
You can see what action we told the provider to take at the back of the full version of the report.
We have made a recommendation around risk assessments. People’s care records contained generic risk assessments which looked at the risk to people and staff regarding moving and handling tasks, and the environment. These were not personalised, and did not consider all the risks associated with people’s needs. Other factors, for example the risk of developing pressure sores, or supporting people to manage their diabetes had not been assessed.
Staff had received training in the safe administration of medicines, and had been assessed as competent in this subject. People confirmed that they received they received appropriate support with taking their medicines. However medication administration records (MARs) were not always being appropriately signed by staff to show that medicines had been given to people. We raised these issues with the registered manager who told us she would raise this issue with staff.
People were protected from the risk of abuse. Staff had received training in safeguarding vulnerable people and were aware of how and when to report their concerns. There was a whistleblowing policy in place which staff were aware of.
There were sufficient numbers of staff in place to meet people’s needs, and recruitment processes were robust enough to ensure that they were of suitable character. Staff had been required to provide two references including one from their most recent employer, and had also been subject to a check by the disclosure and barring service (DBS).
Staff had received the training needed to carry out their role. They had completed training in subjects including the Mental Capacity Act 2005 (MCA), moving and handling, dementia awareness and first aid. Refresher courses had also been completed to ensure that their knowledge remained up-to-date.
People’s rights and liberties were protected by staff who understood their role in relation to the MCA. People told us that they were given the freedom to choose and that staff were guided by them and followed their preferred routine.
People told us that staff were kind, caring and friendly. People spoke highly of staff who attended them regularly, telling us that they had developed positive relationships with them. However they also told us that they were sometimes supported by staff who they did not know. Despite this people commented that all staff were friendly.
People felt that their dignity and respect was maintained by staff. They told us staff were respectful of their homes and tidied up after themselves. They also commented that they felt at ease with staff supporting them to attend to their personal care needs.
The registered provider had a complaints process in place for people who wanted to raise a concern. People told us that they would be comfortable raising any concerns with the office if they needed to. The registered manager kept a record of complaints. These records showed that responses were timely and appropriate. This demonstrated that people’s concerns were taken seriously.
The registered provider had good links with the community. They had made charitable donations to organisations that aimed to reduce social isolation amongst older people over the Christmas period, and were also engaging with the local college to promote apprenticeships in adult social care within Merseyside.