We spoke with twenty nine people who used the service and relatives about day to day care delivery. We did this by carrying out five visits to people who use the service and a relative. The other people we spoke with on the telephone. We also spoke with members of the provider's management team and staff. We viewed records relating to care, staffing and the management of the service. We considered five outcomes during this inspection. These being
Outcome 4 Care and welfare of people who use services
Outcome 9 Management of medicines
Outcome 11 Safety, availability and suitability of equipment
Outcome 13 Staffing
Outcome 16 Assessing and monitoring the quality of the service
We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.
This is a summary of what we found-
Is the service safe?
We found systems were in place to ensure that people who used the service were supported by staff trained to use equipment for moving and handling and assisting people with their mobility. Plans were in place to inform staff on how to use the equipment. We saw a system was in place for servicing the equipment and recording work completed. People were positive about the support they received.
We found the safety of the service was compromised as not all planned responses to people had been put in place. Staff were required to provide support to one person when a known health need arose. Their full needs had not been assessed and a plan had been used based on guidance from health professionals.
Staff were required by the service to be involved in the administration of medicines for some people. Most people told us they received the support they needed. However, the records of prescribed medicines and of their administration were not accurate and had not been rectified through the provider's checks.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to medicines management.
Is the service effective?
People told us they had been asked about the care they wanted before it was provided and care-plans had been put in place. People gave us positive feedback about the service. We received comments such as: 'I agreed my care plan, we work together the staff and I, as I want to keep as independent as I can for as long as I can'; 'It's a really good service, I would recommend them.'
However, from talking with people and viewing records, we found not all people's needs were met. Examples related to assistance with mobility and continence. Care plans did not provide enough or up to date details to ensure staff had current information to provide consistent or effective care.
People told us there had been some changes in the staff who met their needs but their care needs were usually met. The management were taking action to improve the organisation and continuity of staff.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care and welfare.
Is the service caring?
People told us they were provided with staff who had caring attitudes. We received comments such as 'the carers are excellent, very friendly, I am happy with the care I get' and 'they come twice a week and I have a shower, they always keep me warm and cover my 'dignity.' I can't fault them at all'.
Is the service responsive?
Systems were in place to obtain feedback from people who use the service through individual reviews and surveys and the service could evidence they took action when issues were brought to their attention. A member of management staff had been recruited to respond to complaints monitor incidents and ensure that the service could evidence action taken to demonstrate the service was fully responsive.
Is the service well-led
Systems and procedures have been put in place or developed to monitor the service and develop quality assurance. However the processes in place had not ensured that all aspects of the service were well-led. For example issues with care planning had not been picked up in the service's quality monitoring and system in place had not ensured all staff had received regular supervision.
Plans to improve the service were not documented. Action planned to improve the service following complaints, accidents or missed calls were not clearly identified and monitored.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.