Our inspection team was made up of an inspector who answered our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?During the inspection we spoke with people using the service and five members of staff including two members of the management team. We also reviewed records, policies and procedures.
Is the service safe?
People using the service told us staff treated them with respect and that they felt safe. People told us that if they had any concerns about their safety, they would tell the manager or their care co-ordinator. The service had appropriate policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although at the time of our inspection no applications had needed to be made. The manager was aware of the Deprivation of Liberty (DoLS) legislation and how it applied to the people in their care.
However, we found that staff had not received training in safeguarding vulnerable adults. Staff had limited knowledge on the issue of abuse and the procedures they needed to follow to ensure that people were safe. This meant the provider did not have suitable arrangements in place to ensure that people using the service were protected from the risk of abuse.
We have asked the provider to improve the arrangements they have in place to protect people from abuse and keep them safe.
Is the service effective?
People had individual care plans which set out their care needs. People told us they were involved in the decision making about their care, treatment and support and knew what was in their care plan. One person told us, 'I know what is in my care plan and the staff do what they should be doing"
The care files we reviewed contained comprehensive risk assessments which were reviewed monthly. People using the service had a health action plan and were registered with a local GP practice. Staff worked well with other health professionals such as the district nurse, community psychiatric nurse and physiotherapists. We saw evidence that people were encouraged and supported to attend medical appointments. People were supported by staff to participate in their social interests.
Is the service caring?
We observed that staff treated people with respect. We spoke with people who use the service and they were satisfied with the quality of care they received. Their comments included, 'the carers treat me well"
The care plans we looked at reflected people's personal preferences. People's care files contained their views on the information in their care plan and detailed their expectations of the service.
Is the service responsive?
People's needs were assessed before they began to use the service and were reviewed on a regular basis. People told us the service was delivering the care they needed and was flexible where there was a change in their needs or preferences.
People felt able to express their views and told us their comments and suggestions were acted on by staff. The service sought the views of people using the service as part of their care planning but also by conducting satisfaction surveys.
Is the service well-led?
The manager of the service had been in post for three weeks at the time of our inspection. The manager knew the systems that had to be in place to ensure the service offered the quality of care people required. The provider had appropriate policies and procedures in place in relation to care planning and review, keeping people safe, staff recruitment and development and monitoring the quality of service people received.
However, we were concerned that some of these policies and procedures were not being applied. Records we reviewed demonstrated that appropriate checks were not always carried out on job applicants before they were employed and allowed to work with people using the service. Once employed, staff were not given appropriate training in areas relevant to their role such as, mental health awareness, medicines administration, infection control, and safeguarding vulnerable adults.
This meant there was a risk of people being cared for by staff who lacked the necessary knowledge, skills and experience to do their job and therefore receiving care and support which was inappropriate or unsafe.
We have asked the provider to improve the checks they carry out before staff begin to work with people using the service and to improve the way it supports its staff.