This inspection took place on 1 June 2017. The provider was given 48 hours’ notice of the inspection.This was the first inspection of the service under its current registration.
Home Instead Senior Care is a domiciliary care agency which provides care services to people in their own homes. When we visited the office the registered manager told us 53 people were receiving a personal care service. The agency provides a service to adults, older people, people living with dementia, people with physical disabilities, learning disabilities, sensory impairment and people with mental health needs.
There was a registered manager in place. 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.
Most of the people we spoke with told us they felt safe. Staff knew how to report concerns about people’s safety and welfare within the organisation. However, safeguarding alerts where people may have been at risk had not always been made by the registered manager and the registered manager had not routinely notified CQC of safeguarding issues.
People reported having experienced missed calls.
Medicines were not always managed safely and risks to people’s safety and welfare were not always identified within care records.
Sufficient numbers of staff were deployed to provide people with the care and support they needed. The required checks were done before new staff started work and this helped to keep people safe. Staff were provided with training and support to help them carry out their roles.
Where necessary, people were supported with their nutrition and hydration. People told us how staff always made sure they had drinks available to them.
We found the service was working in accordance with the Mental Capacity Act 2005 and this helped to make sure people’s rights were protected. People told us their consent was sought but we saw the consent on one occasion had been sought from people's relatives even though the person had capacity to do this
People's ‘Do Not Attempt Resuscitation’ (DNAR) orders were not included in their care records which meant their wishes may not be complied with.
Changes to people's needs were not always communicated to staff.
People who used the service were supported in their health and welfare needs.
People who used the service had mixed views about staff approach. Some found staff to be caring and respectful of their privacy and dignity needs but others did not.
Some people said staff communicated with them very well whilst others had experienced problems with this.
People told us staff supported them in maintaining their independence.
Some people told us they had been involved in the development and review of their care plans whilst others said they had not.
Care plans were not person centred and did not always contain the level of detail staff needed to make sure they delivered the care and support people needed at each visit.
Reviews of people's care were not always incorporated into the care plans. This meant care plans did not always reflect current needs.
There was a system in place to respond to and manage complaints. Some people we spoke with were happy about the way their complaints had been managed but others felt they had not been responded to.
There were systems in place to monitor and improve the quality and safety of the services provided. However these were not sufficiently robust and had not identified issues we found during the inspection.
People we spoke with had mixed views about the effectiveness of the management of the service.
We found two breaches of regulation. These were in relation to safe management of medicines and notification of incidents.