This was an announced inspection carried out on 18, 19 and 21 December 2017. At the last inspection in September 2016 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance. At this inspection we found ongoing concerns with governance arrangements. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults.
There was a registered manager 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.
Medicines were not always managed safely. Records of people’s medicines were not always accurate; therefore we could not be assured people received their medicines as prescribed. We saw that in other areas of medicines management and administration there was good practice.
We have made a recommendation about the management of medicines at the service.
The service provided good training and support for staff, which included mandatory training, induction, supervisions and appraisals. People told us they felt confident staff were trained to a good standard. However, we found that in the area of stoma and catheter care, there was a training gap which had not been identified.
There were systems and processes in place to monitor the quality of the service and identify and act upon issues found, however audits did not always take place as scheduled. Audits did not pick up the issues we identified in medicines recording and training needs.
People told us they felt safe in the care of staff, and there were systems and processes in place to protect vulnerable people from harm. Risks to people were appropriately assessed and managed.
There were enough staff to deliver care safely, and the service was actively recruiting to make sure staffing levels were increased to help cope with sickness, leave and absence.
People were supported to eat and drink enough to maintain a healthy diet, and people’s preferences were taken into account. People also told us they felt well supported to access healthcare services by staff who knew when to make an appropriate referral.
People told us they were cared for by kind and compassionate staff. People told us their independence and dignity were protected and promoted by knowledgeable and considerate staff.
The service was working under the principles of the accessible information standard by including information about the principles of the standard and what support people needed to accessible information in an equitable way.
Care plans were person centred, with clear guidance for staff on how to care for people in the way they wanted. Care plans included information about people’s life history, cultural and religious preferences and interests.
People told us they knew how to make a complaint, and complaints were responded to appropriately.
Staff supported people to maintain active social lives and participate in meaningful activities, and consulted with people of similar age groups to ensure activities were appropriate for them.
The service sought feedback from people who used the service and acted upon their responses accordingly, analysing data for trends and themes. Staff told us they felt well supported, and that there were plenty of meetings and communications from the service, which kept them up to date with important information and developments.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Good governance. You can see what action we have told the provider to take at the back of the full version of this report.