We inspected Esteem Homecare Services on 19 April 2017. This inspection was announced. We informed the registered provider 48 hours before we would be visiting, because we wanted them to be present on the day to provide us with the information we needed. This was the first inspection of the service, which became registered in September 2015.The service is registered to provide personal care to people living in their own homes. At the time of inspection, ten people were provided a service.
The service did not have a registered manager; however, the registered provider had applied to become registered with us. 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.
The registered provider took over the day to day management of the service after the previous manager left the organisation. At this time, the registered provider was asked to develop an improvement plan with the local authority to develop the systems in place to ensure people were cared for safely. The registered provider had worked hard to improve areas such as care plans as well as staff training and support in this period. The registered provider was committed to the on-going development of the service. We found improvements were needed to ensure the service could deliver safe support to more people in the future.
We found the systems to ensure the quality and safety of the service required development. The registered provider did not ensure they understood and implemented good practice robustly as they made changes. We made a recommendation in the area of medicines management that good practice guidance is implemented to ensure the system is robust and people receive their medicines as prescribed safely.
We saw that records in relation to the management of the service were not always kept or were not complete enough to evidence safe process. This related to records around recruitment, rotas, incidents, accidents, safeguarding and communications the staff had with health professionals, people and their relatives. The registered provider purchased a system and developed suitable forms following the inspection to enable this to happen in the future.
New assessments had been undertaken and care plans completed, which contained details around how a person liked to be supported and their preferences. We saw the registered provider had assessed the risks involved in supporting people. The risk assessment process was still being developed and the registered provider told us they would start to use recognised tools to aid the process in the future.
There were enough staff employed to provide support and ensure people’s needs were met. There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice. The registered provider evidenced during and after the inspection that they had safely recruited their staff.
Staff told us the registered provider was supportive. Records confirmed staff had received recent supervision and the registered provider was developing a system of group supervision and appraisal to further support staff to fulfil their role. Staff told us the service had an open, inclusive and positive culture.
Staff told us they had received training, which had provided them with the knowledge and skills to provide care. Records confirmed that staff had received the training the registered provider felt was necessary. A plan to provide more training in topics not yet delivered was in place.
The registered provider had an understanding of the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. Staff were able to demonstrate how they empowered people to make their own decisions which meant they were working within the principles of the MCA.
People and relatives told us staff treated people with dignity and respect. People told us they felt staff were kind and caring.
People were provided with their choice of food and drinks, which helped to ensure their nutritional needs were met. Staff worked with other healthcare professionals to support people.
The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident staff would listen and take action to support them.
A breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the governance of the service was found during this inspection. You can see what action we told the provider to take at the end of this report.