Blossom Home Care Ltd is a domiciliary care agency. They are registered to provide personal care to people living in their own homes. The service supports younger adults and older people as well as people who may be living with dementia, a learning disability or autistic spectrum disorder, a physical disability, sensory impairment or mental health needs.Not everyone using Blossom Home Care Ltd receives a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
We inspected the service between 13 and 22 March 2018. The inspection was announced. We gave the service 5 days’ notice of the inspection site visits because we needed to be sure the registered manager would be available. At the time of our inspection, the service was supported 56 predominantly older people with personal care.
At the last inspection in November 2016, we identified breaches of regulation relating to safe care and treatment and the governance of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-Led to at least good.
During this inspection, some improvement had been made, but we identified on-going concerns about how risks were assessed and managed. Sufficiently detailed risk management plans were not consistently in place to guide staff on how to safely meet people’s needs. They did not always provide clear instructions about how to respond in the event of an emergency. This placed people who used the service at increased risk of harm.
Audits had not been consistently effective in monitoring and ensuring improvements were made. This is the second consecutive time the service has been rated Requires Improvement. It showed us sufficiently robust action had not been taken in response to concerns raised at our last inspection.
We identified two breaches of Regulation relating to safe care and treatment and the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.
The service had a registered manager. A registered manager is a person who has registered with the 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. The registered manager was supported by the directors, one of whom was the provider’s nominated individual, a deputy manager, field care supervisor, care coordinator and administrator in the management of the service.
People who used the service provided generally positive feedback about the service and management. Staff told us they felt management were supportive and approachable.
People received their prescribed medicines. Audits were being used to identify and address shortfalls and errors in recording on medicine administration records. We made a recommendation about reviewing best practice guidance and implementing protocols for ‘when required medicines’.
Recruitment checks were completed to help ensure suitable staff were employed. Sufficient staff were deployed to meet people’s needs. The registered manager had systems in place to monitor and address issues with reliability and punctuality. Work was on-going to retain staff and improve the consistency of care for people who used the service.
Staff used gloves, aprons and sanitising hand gel to minimise the risk of spreading infections.
Staff understood their responsibility to identify and respond to safeguarding concerns. Accidents and incidents were reported, recorded and analysed to identify any patterns or trends and prevent similar reoccurrences.
People told us staff were kind, caring and maintained their privacy and dignity. Staff supported people to make decisions and respected people’s choices.
Staff provided person-centred care. They knew people well and understood how best to support them to meet their needs. Care plans contained varying levels of person-centred information about people’s likes, dislikes, hobbies and interests. The registered manger was in the process of reviewing and updating care plans and risk assessments and showed us new paperwork they intended to implement in response to our concerns.
Staff received an induction, theoretical and practical training and on-going support through supervisions, appraisals and spot checks.
Staff supported people to make sure they ate and drank enough. There were systems in place to respond when people were unwell so they received appropriate medical attention.
Consent to care was sought in line with relevant legislation and guidance on best practice. This meant people’s rights were protected.
The provider had a system to gather feedback and respond to complaints about the service. People told us they felt able to raise concerns if needed.