Background to this inspection
Updated
27 August 2021
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 three inspectors. Two Experts by Experience contacted people and their relatives by telephone to gather their feedback on the care provided. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing.
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
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 2 July 2021 and ended on 19 July 2021. We visited the office location on 6 July 2021 and 13 July 2021.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We spoke with six people who used the service and four relatives about their experience of the care provided. 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 when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with eight people who used the service and four relatives about their experience of the care provided. We spoke with sixteen members of staff including the registered manager, deputy manager, head of the department, care workers, co-ordinators and quality officers.
We reviewed a range of records. This included thirteen people’s care records and multiple medication records. We looked at seven staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at the electronic call monitoring records for 12 people, staff rotas and quality assurance records. We spoke with three professionals who regularly visit the service.
Updated
27 August 2021
About the service
Scotland Road Branch provides personal care to people in their own homes. At the time of our inspection, the service was supporting 413 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
Medicines were not always managed safely. Medication administration records (MAR) were not completed consistently to a high standard. There were no recent records of competency assessments for existing staff to ensure they were able to safely administer medicines.
Not all risks were assessed and mitigated to keep people safe from harm. Some risk assessments had not been completed and some were not detailed enough to guide staff to support people safely. This placed people at avoidable risk of harm.
Systems in place to monitor the quality and safety of the service were not always effective. Some of the recording issues found during this inspection had been identified by the providers systems. However, this had not always resulted in a sufficient and timely response to keep people safe.
Oversight of the safety and quality of the service was not always effective. There was no system in place to monitor staff’s completion of COVID-19 tests. This meant that the provider failed to identify that staff were not completing weekly COVID-19 tests in line with best practice guidance.
Staff followed good infection control practices and used PPE (personal protective equipment) to help prevent the spread of healthcare related infections. One person told us, “[Staff] always come in with masks, gloves and aprons.”
Staff were safely recruited and deployed in sufficient numbers to meet peoples care needs. A dedicated team monitored people’s call times and took action to follow up on late call alerts to ensure peoples care needs were met.
Staff were aware of procedures to follow if they had any safeguarding concerns. The registered manager had oversight of detailed records relating to safeguarding actions and outcomes.
Staff completed regular telephone reviews with people to gather feedback about the care provided. People also told us they received questionnaires. We received mixed feedback from staff in relation to engagement and the support they received. However, we saw evidence of regular staff engagement through team meetings, telephone job chats and appraisals.
The service worked with the local authority to coordinate the care and support people needed. Professionals who work with the service spoke positively about the working relationship and told us staff "try to work with us to get the best outcomes for members of the community." The registered manager acted in accordance with their duty and shared information in an open, honest and timely manner.
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 Good (published 4 January 2018).
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
The provider responded to the concerns we raised during and after the inspection. They provided evidence of immediate improvements to their governance systems and updated risk assessments to mitigate the risks to people’s health and safety.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to the management of medicines and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.