The inspection took place on 14 and 15 March 2015, and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection. The previous inspection on 22 July 2013 found there were no breaches in the legal requirements.
One Step South Domiciliary Care Agency provides care and support to adults in their own homes. The service is provided mainly to people who have a learning disability, some of whom live on their own and some shared with other people using the service. At the time of this inspection there were 18 people receiving support with their personal care. The service provided one to one support hours to people as well as providing a live-in service for 24 hours a day to support people.
The service is run by a registered manager, who has managed the service since its registration. 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 the time of the inspection the registered manager had submitted an application to cancel their registration and a new manager had recently started who would be submitting an application to register.
People told us they received their medicines when they should and felt their medicines were handled safely. However we found shortfalls in medicines management. Care plans did not always reflect the up to date details of people’s medicines. There was a lack of guidance about how some medicines should be given safely.
Risks associated with people’s care had been identified, but there was not always sufficient guidance in place for staff to keep people safe.
People were involved in their initial assessment and some had chosen to involve their relatives as well. However care plans varied greatly in the level of detail and most required further information to ensure people received care and support consistently and according to their wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan. Care plans were not all reviewed regularly and were not all up to date and reflecting people’s current needs. Care plans were not reviewed in line with the provider’s policy.
People had their needs met by sufficient numbers of staff. People received a service from a small team of staff. Staffing numbers were kept under constant review. People received their support hours, but this was not easy to ascertain from records.
People were happy with the service they received. Most people felt staff had the right skills and experience to meet their needs. Staff felt supported and had opportunities to attend one to one meetings with their manager, although this was not as frequent as the provider’s policy stated. There was also a delay in staff receiving their annual appraisal.
People felt staff were caring. People were relaxed in staffs company and people said staff listened and acted on what they said. People were treated with dignity and respect in person. However records were not always written demonstrating a respectful attitude. People’s privacy was respected.
People felt safe whilst staff were in their homes and whilst using the service. The service had safeguarding procedures in place, for which staff had received training. Staff demonstrated a good understanding of what constituted abuse and how to report any concerns. Accidents and incidents were reported and action was taken to reduce the risk of further occurrences.
People were protected by robust recruitment procedures. Staff files contained the required information. New staff underwent a thorough induction programme, which included reading policies, relevant training courses and shadowing experienced senior staff, until they were competent to work on their own. Staff received training appropriate to their role, although there was a delay in some staff receiving refresher training.
People told us their consent was gained at each visit. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection. Some people had Lasting Power of Attorney in place. The registered manager and staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.
People were supported to maintain good health. The service made appropriate referrals to health care professionals when there were concerns about a person’s health.
People told us they received person centred care that was individual to them. They felt staff understood their specific needs. Staff had built up relationships with people and were familiar with their personal histories and preferences.
People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided. Negative feedback was acted on. People felt the service was well-led and the registered manager adopted an open door policy.
The provider had a personalised strategy. Staff were aware of this and felt the service listened and was caring and promoted people’s independence, privacy, dignity and respect. Staff said they cared for people in a person centred way.
The provider had processes and systems to assess and monitor the quality of the service people received. These systems had identified the shortfalls found during the inspection. An action plan was in place to address these.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.