24 July 2019
During a routine inspection
People’s experience of using this service:
People told us they felt safe with staff; however, people raised concerns about the punctuality of staff. Whilst records showed most calls were completed within 30 minutes of the expected time, people still felt staff punctuality was affecting their life and in some cases their safety.
Risks were assessed in key areas. However, whilst assessments for skin integrity were robust, staff did not keep consistent records to ensure this care was completed safely and as planned. Environmental risk assessments were in place, but these did not include reference as to how to make people safe in an emergency.
The provider had ensured that the local authority had been notified of allegations of potential abuse where needed and investigations were carried out thoroughly. The provider had not always ensured the CQC were notified of these incidents.
People’s medicines were managed safely, although some people were concerned that if calls were late they could miss their medicines. The risk of the spread of infection was safely managed. The provider had systems in place to help staff to learn from mistakes.
People received care in line with their assessed needs. Staff training and supervision were largely up to date. People received the support they needed to maintain a healthy diet, although guidance was not in place to support people with appropriate foods for a diabetic diet. People had access to other health and social care agencies where needed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People and relatives found the staff to be helpful, kind and caring. People liked the staff and described them as kind and caring. People were treated with dignity when personal care was provided. Independence was encouraged. People felt able to contribute to decisions about their care and staff respected their wishes. People’s records were stored securely to protect their privacy.
People’s care records contained person-centred information including people’s preferences for call times, male or female staff and the level of support they wanted with personal care. Where applicable, people were supported with their hobbies and interests and action was taken by the provider to reduce the risk of social isolation.
Complaints were responded to in line with the provider’s complaints policy. People were not currently receiving end of life care. End of life care plans were in place, although more detailed discussions were needed with people to ensure their rights and wishes were respected.
Some people raised concerns about the quality of communication with office-based staff. Not all statutory notifications had been sent to the CQC when required.
Quality assurance processes were in place; along with feedback from people and staff, these were used to help the service to improve and develop. When people had met the registered manager, they found them to be supportive and approachable. The registered manager had a good understanding of most regulatory requirements of their role
Rating at last inspection and update: The last rating for this service was Requires Improvement (published 19 July 2018). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last two consecutive inspections.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations from the last inspection.
However, we have identified one new breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.
More information about this is in the full report and can also be found at www.cqc.org.uk
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.