This inspection took place on 7 July 2016 and was announced. At our last inspection on 10 and 11 September 2015 we identified several concerns with the service. These included protecting people from the risks associated with their conditions, seeking consent in line with current legislation, staff deployment, quality monitoring and record keeping. After our inspection the provider sent us an action plan about how they intended to respond to our concerns. At our latest inspection we noted that the provider had taken action to address our concerns but further improvement was still required.The service provides domiciliary care to 35 people in their own homes within the provider’s housing scheme. There was a registered manager at this location who was present during our visit. 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 and associated Regulations about how the service is run.
All of the people we spoke with told us that they felt the service kept them safe. Staff were encouraged to raise any concerns they might have about a person’s welfare and there was clear guidance for staff to follow if they felt someone was at risk of harm.
Although staff were knowledgeable about how to keep people safe from the risks associated with their specific conditions this information was not detailed in people’s care records. The provider had an effective system to check that staff were suitable to support people who used the service.
There were enough staff to meet people’s care needs. The service had experienced some staff turnover and a reliance on agency staff which regular staff said had made them very busy. The registered manager had taken action to ensure four new care staff would shortly start working at the service.
Staff we spoke to were confident in how to support people to take their medicines safely. The senior managers reviewed people’s medicines to ensure people had received their medicines as prescribed.
Staff had the skills and knowledge they required to meet people’s needs. Staff received ongoing training in relation to topics such as safeguarding, medication, health and safety and first aid.
Staff we spoke with knew and understood how people liked to be supported and people’s conditions were regularly discussed with care staff. Several people raised concerns with the knowledge of agency staff who occasionally supported them.
Staff sought consent before supporting people. The provider had taken action to ensure that people who may lack mental capacity would be supported by other people who had the legal right to make decisions on their behalf.
People were supported to eat and drink enough to keep them well and other professionals such as nutritionists were involved when staff were concerned with a person’s diet.
People told us that staff had supported them to access healthcare services when necessary. The registered manager had also developed a quick reference sheet for use by other health professionals should they need to support anyone who became unwell.
People were generally supported by regular staff and this had enabled them to develop positive relationships and express how they wanted their care to be delivered. The service promoted people’s privacy and dignity.
Staff responded promptly to people’s requests for support. People were given details of the formal complaints process when they started to use the service.
People described an open culture where they felt they could raise and safely discuss issues which could impact on their well-being. Care staff had supervisions and meetings to identify how the service could be developed to improve the care people received. Several members of staff said they felt that several concerns they had raised about the service hadn’t been listened to.
Although there was a clear hierarchy which staff generally understood, there was some confusion amongst care staff about how new staff roles would impact on how they supported people.
The nominated individual and registered manger understood their responsibilities and had taken action in response to concerns raised at our last inspection such as increasing staffing levels, however further action was still required.
The provider was setting up an electronic monitoring system to ensure improvement initiatives were achieved in a timely manner and assess the quality of the service.