N1C

N1C is a domiciliary care agency providing personal care. The service provides support to adults with dementia, physical disabilities and those who require support with mental health. At the time of our inspection there were 5 people using the service.

People’s experience of the service and what we found:

We identified shortfalls related to the governance of the service. The managerial quality audits were not carried out regularly. These included audits of care plans, risk assessments, medicines competency as well as staff personnel records. Such audits were needed to ensure the care was provided effectively, safely and in line with the current national guidelines.

We identified that some improvements were needed to people’s care plans and risk assessments to ensure these were always person-centred. Nevertheless, we noted that due to the small size of the service, staff knew people’s needs and preferences. This was because people were supported by the same staff who new them well.

People were protected from the risk of harm or abuse. Staff told us they had received regular safeguarding training and were able to explain their understanding of identifying and reporting safeguarding concerns. The registered manager demonstrated knowledge of how to handle safeguarding concerns appropriately and the relevant agencies to notify including CQC.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Support

People told us they were encouraged to maintain independence and had choice over their care.

Right Care

People and their family members told us they were happy with the level of care they received. Staff provided person-centred care and promoted people’s dignity, privacy and human rights.

Right Culture

People and their families said they felt able to raise concerns with their carers and the registered manager. They said, their concerns were listened to and acted upon.

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 6 April 2018).

Why we inspected:

This inspection was prompted by a review of the information we held about this service.

Recommendations

We have made a recommendation about the auditing of staff training records.

Enforcement

We have identified a breach in relation to the governance of the service.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

This is the first inspection of the service since initial registration in February 2017.

At the time of this inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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.

People using the service had a care plan which contained information about the person and their care needs and requirements. As part of the care planning process, the registered manager carried out risk assessments which covered the home environment, personal care needs, moving and handling and health and safety.

Care staff were trained about how to identify types of abuse and there was clear guidance about the actions they should take if they had any concerns.

The registered manager and care staff had a good understanding of the Mental Capacity Act 2005 and how this could impact on the provision of care and support. Care plans demonstrated that mental capacity assessments took place. Neither person using the service lacked capacity.

Care staff received training in the safe administration of medicines. The registered manager monitored medicines recording and administration and there were robust systems in place to ensure this was managed safely.

The service had safe recruitment processes in place. These included obtaining references and the completion of a criminal record check prior to the care staff commencing their employment. Care staff told us that they felt supported in their role and received regular supervision. All of the care staff had been working at the service for a little under six months. Annual appraisals had not yet been completed yet, although the registered manager told us this would occur when they were due but prior to August 2018 when care staff first started working at the service.

Care staff, when they first started working at the service, received an in-house induction and training, which included first aid, safeguarding, moving and handling and medicine administration.

A spot check system was in place in order to monitor the care and support provided to people along with regular reviews of people’s care and support needs. No missed or late visits had occurred.

The service had a complaints policy which was given to people using the service and relatives. The registered manager reported that they had not received any complaints since the service began operating.

Although the service was relatively new, quality assurance questionnaires had been completed. These showed a high degree of satisfaction with the servicer by people using it and their relatives. There was regular contact with people by the registered manager.

As a result of this inspection we found that the provider met all of the key lines of enquiry that we looked at. Please refer to the main body of this report for further details.