Immaculate Grace Care Ltd is a domiciliary care agency registered to provide personal care to people living in their own home. At the time of this inspection visit they provided personal care to 30 people and employed approximately 28 care staff. At the last comprehensive inspection in October 2015, we rated effective as requires improvement as we found care staff had not always received an induction at the start of their employment that prepared them for their role, or received the training required to effectively carry out the duties they were employed to perform. This was a breach of the regulations. We undertook a focused inspection in December 2016 to check the provider had made the required improvements and found they had met their legal requirements and were no longer in breach of the regulations and we rated the service as good.
Since our last inspection we have reviewed and refined our assessment framework, which was published in October 2017. For this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.
The office visit took place on 11 and 12 April 2018 and was announced. We told the provider we were coming so they could arrange to be there and arrange for staff to be available to talk with us about the service. The provider and registered manager were unavailable on the first day of inspection but were available on the second day.
Prior to our inspection visit we had received complaints from some relatives about the care and support provided to their family members. Their concerns were mainly about inconsistency of care staff and visit times, and staff not using a hoist safely. We referred the complaints to the local authority for investigation. People we contacted during our inspection reported similar concerns. We reviewed people’s concerns during our inspection.
A requirement of the provider’s registration is that they have a registered manager. There was a registered manager in post at the time of our inspection. 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.
There were enough staff to provide the care and support people required. However, people had different experiences in the punctuality and continuity of care staff. Some people received care from staff they knew well and who arrived around the time expected. Others had experienced late calls and received care from unfamiliar staff, particularly at weekends. All the people we spoke with said care staff stayed long enough to provide the care they required.
People's right to make their own decisions about their care were supported by managers who understood the principles of the Mental Capacity Act. Some staff had little understanding of the Act, however, they respected decisions people made about their care and gained consent before assisting people with care or support. Care plans did not include an assessment of people’s capacity to make decisions or, where required, how people were supported to make decisions about their care and support.
People said they felt safe using the service and staff understood how to keep people safe from abuse. There were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely. The suitability of staff was checked during recruitment procedures to make sure they were safe to work with people who used the service.
Staff received an induction when they started working for the service and completed training to support them in meeting people’s needs effectively. Most people said staff had the right skills to provide the care they required, although some people said not all staff were able to use a hoist to move people competently. Staff were provided with protective clothing, such as disposable gloves and aprons to wear when providing personal care to reduce the risk of infection being passed from one person to another.
People told us they received care from staff that were friendly and caring, and who treated them with dignity and respect. All staff we spoke with knew the people they visited well, and spoke about people in a caring and considerate manner. When needed, arrangements were in place to support people to have enough to eat and drink and remain in good health.
People had an assessment completed at the start of their service to make sure staff could meet their care and support needs. Care plans provided information for staff about people’s individual care needs and plans were regularly reviewed and updated when needs changed. Not all identified risks had plans completed for staff to follow.
People knew how to complain, and information about making a complaint was available for people.
Staff felt supported to do their work effectively and said the managers were approachable and available. There was an ‘out of hours’ on call system which ensured support and advice was always available for staff. Staff had regular supervision and observations of their practice to make sure they carried out their role safely.
Since the last inspection the provider had increased the management team. An assistant manager had been appointed and they had recently introduced the role of care supervisor to assist with staff observations and supervisions, and to carry out reviews of people’s care. The management team worked well together and were clear about their roles and responsibilities.
The provider’s quality monitoring system included asking people for their views about the quality of the service. This was through telephone conversations, visits to people to review their care and satisfaction questionnaires. The management team checked people received the care they needed by observing staff during visits to people and through feedback from people and staff.
There was a programme of other checks and audits which the provider used to monitor the service.