This inspection took place on 06 November 2018 and was announced. 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.
Not everyone using Homecare Southlodge receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection 19 people were receiving care from Homecare Southlodge.
There was a registered manager in post at the time of our inspection. 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 our last inspection of 12 September 2017 we found a breach of regulations in relation to seeking consent from people. Staff were not always clear on the principles of the Mental Capacity Act 2005 (MCA) and how to apply this to their roles.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘Effective’ to at least good. At this inspection we found improvements had been made to enhance staff knowledge of the MCA; however, we identified other areas for improvement.
We found one breach of the regulations in relation to staffing. The provider did not ensure that they obtained staff employment history, nor did they always act to ensure staff provided full professional references. The provider could not always be assured of staff experience in a health and social care role or explain gaps in staff employment history.
Improvements were also needed to ensure that quality assurance systems were effective in ensuring that issues in service delivery were addressed in a timely manner. The registered manager did not ensure that medicines administration records (MAR) were always checked in a timely manner, nor did they identify the issues that we found at this inspection.
Medicines record keeping required improvement to ensure that staff were able to explain reasons for any gaps or omissions in prompting people with their medicines. People’s medicines records did not include a record of medicines prescribed, the reason for taking them and any possible side effects.
We also made a recommendation to the provider in relation to the personalisation of people’s care records. Care plans would benefit from reflecting people’s preferences in relation to any dietary choices or day to day preferences, and we recommended the provider review each person’s care plan to ensure this is updated.
Relatives felt that their family members received safe care from the service, and that staff supported them well. Staff were clear on the steps to take to prevent and control infection. People’s risk assessments clearly highlighted the potential risks that people faced, and guidance was in place to support staff to mitigate their occurrence. Staff knew how to identify and take action should there be any suspected abuse.
Staff were now clear on the principles of the MCA, and how this applied to their role. People were supported by staff to access healthcare professionals at times that they needed them, as well as being supported with their daily food and fluid intake.
People received support from staff that were caring and kind. People felt that their privacy and dignity was respected, and staff accommodated people’s religious and cultural beliefs. People were involved in decisions about the care and support that they received.
Care plans were regularly reviewed to ensure that they reflected people’s needs, with the involvement of the person and people that were important to them. Where people were receiving end of life care the provider accommodated their wishes. A complaints policy was in place to guide people as to how to raise their concern and hold the provider accountable to investigate.
Views of the registered manager were positive in both the care they provided to people, and the support offered to staff. The registered manager ensured that people’s views were sought and was aware of their responsibilities to the Care Quality Commission.