Background to this inspection
Updated
4 March 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
The service is a domiciliary care agency. It provides personal care to people living in their own homes.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced. We gave the service 48 hours' notice of the inspection as we needed to be sure that the provider or manager would be in the office to support the inspection.
Inspection activity started on 10 February 2020 and ended on 11 February 2020. We visited the office location on 11 February 2020.
What we did before the inspection
We checked the information, we held about the service and the provider. This included notifications the provider had sent to us about incidents at the service. A notification is information about events that by law the registered persons should tell us about. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account in making our judgements in this report. We used all of this information to plan our inspection.
During the inspection
During our inspection we spoke with three people who used the service and two relatives. We also spoke with three members of care staff and the registered manager to check that standards of care were being met.
We looked at care records for three people and medicine records for a further five people. We checked the care they received matched the information in their records. We also looked at records relating to the management of the service, including audits carried out to ensure people received a good service.
Updated
4 March 2020
About the service
The provider is registered with us to provide personal care and support for people who live in their own homes. At the time of our inspection visit, they were supporting 19 people. 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
People continued to receive calls that were not always of the correct duration and people did not always know which staff would be attending their calls. The systems the provider had in place did not always identify these concerns and when they did, action was not always taken to make improvements.
There were several gaps on medicine administration records and the systems in place had not identified these. Action was not always taken to see if people had received these medicines or not.
The systems the provider had introduced since our last inspection were not always effective in identifying areas of improvement or making changes to the service. Not all incidents had been fully investigated or reported by the registered manager. People were asked to give feedback on the service however this was not always considered, and changes made.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.
People were happy with their care and the support they received. Staff knew people well and had adequate training to support them. People were protected from potential harm and individual risks to people were considered and reviewed. Infection control procedures were considered and followed. Some lessons were learnt when things went wrong.
People were encouraged to make choices, remain independent and their privacy and dignity was maintained. People were offered assistance with meals and received support from health professionals when needed. There was a complaint procedure in place and people felt ale to complain. Staff felt supported and listened to.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Requires Improvement. (Published 21 February 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to the governance systems at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.