Background to this inspection
Updated
4 June 2015
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.
The inspection took place on 19 March 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in the office when we visited. The inspection was carried out by one inspector.
Before the inspection, we reviewed the information we held about the service, including notifications about events that providers are required by law to send to us and information shared with us by other agencies, such as local authority commissioning and safeguarding teams. We also spoke with the local authority safeguarding team to discuss this service before the inspection.
We spoke with five people who used the service, two relatives of people using the service, two management staff and four members of care staff. We also looked at five people’s care plans, four staff files and other documentation relevant to the management of the service.
Updated
4 June 2015
This inspection took place on 19 March 2015 and was unannounced. This was the service’s first inspection since it was registered with us on 9 April 2014.
Eleanor Nursing and Social Care Ltd – Kingston Office is a domiciliary care service providing care and support to people in their own homes. At the time of our visit, 122 people were using the service. The service is required to have a registered manager to be in post. 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. At the time of our visit, there was not a registered manager in post because the previous manager had recently left the service. There was a manager who was not yet registered with us, although they told us they had applied for registration.
We identified some safety concerns during our inspection, particularly around medicines management. The service did not have robust enough procedures in place to ensure that people received their medicines safely, including controlled drugs. Medicines were not always administered in a safe way and the methods used to record administration were not always suitable.
The provider did not obtain appropriate references for some staff, which meant they had not taken sufficient steps to assure themselves that staff employed were suitable for the role. The service assessed people’s individual risks and put management plans in place, but some of these were not in place for people who needed them. This meant that people were at risk of coming to harm because risks were not adequately managed.
People told us that the care they received allowed them to remain as independent as possible while taking their safety into account. People felt safe using the service and there were robust procedures in place to protect people from abuse and ill-treatment. The service used these appropriately when required. There were systems in place to protect people from the risk of infection. The provider took steps to ensure that staffing levels were sufficient to meet people’s needs.
People were cared for by staff who received appropriate training, supervision and support to carry out their roles effectively. This included training in specific areas relevant to people using the service, such as dementia care. Staff were familiar with legislation and guidance around mental capacity and consent. They obtained people’s consent before delivering care and ensured people were happy with the care they received.
Staff provided people with appropriate support around food and nutrition, although sometimes their food intake was not robustly monitored where risks of malnutrition had been identified. People were supported to have access to healthcare services when needed and the service shared information with other services as appropriate.
Staff were considerate and caring and developed a good rapport with people who used the service. They understood and respected people’s individual needs and preferences, including cultural needs. People had the information they needed to make informed decisions about their care and were supported to do this so they were involved in their care planning and delivery.
People felt that staff respected their privacy, dignity and independence.
Care was person-centred and designed to meet people’s individual needs. Care plans were reviewed regularly and people were involved in the process to help ensure they received the support they wanted. Care plans took into account people’s hobbies and interests and staff helped to ensure people had opportunities to engage in meaningful activities.
People knew how to raise concerns and felt that the service was responsive to these. There were systems to ensure that people were asked regularly for their views and that any concerns were followed up. The service had an inclusive culture with several different ways of encouraging feedback. People were kept informed of any changes and news about the service.
People felt that while the leadership and quality of the service had been inconsistent in the past, a marked improvement had taken place. Managers had continuous improvement plans, which they used to assess the quality of the service on an ongoing basis and identify areas for improvement. They were able to demonstrate some improvements, but had not identified all of the issues we found around safety.
The provider had arrangements to make sure they kept up to date with current research and guidance and to discuss and share good practice with other providers.
During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.