The inspection took place on 10 and 11February 2015 and was announced. ‘48 hours’ notice of the inspection was given, as this is our methodology for inspecting domiciliary care agencies. At the previous inspection on 23 November 2013, we found that there were no breaches of the legal requirements.
Xtracare Ltd provides personal care and support to adults in their own home. It mainly provides a service to older people, some of whom have been discharged from hospital. It also provides a service to younger adults with a physical or learning disability and people with mental health problems. At the time of the inspection it provided a personal care service to around 100 people.
The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (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. Comprehensive checks were not carried out on all staff at the service, to ensure that they were suitable for their role. Applicants were interviewed and criminal record/barring checks were undertaken. However, the provider had not always assessed the person’s suitability to work with people. This included not checking the reference of one person’s last position in a health or social care setting.
Risks to people’s health and welfare had been assessed, but were not always personalised. Where a risk had been identified, details of the risk and how to minimise the risk were recorded on the assessment.
People were informed of their right to raise any concerns about the service and most people were satisfied with the action that the service had taken when they had raised a concern. We have made a recommendation about informing people of their right to independent advice if they are not satisfied with how the service has dealt with a complaint. We have also recommend that the service record all complaints raised by people, to show how they manage complaints.
Systems were in place to review the quality of the service. Feedback from people who used the service was that 83% of people rated the service overall as very good or good. However, the service had not identified and taken action to address shortfalls in relation to the recruitment of new staff and the recording of risks to ensure these were managed effectively.
People told us they received their medicines as they were prescribed. Staff had received training in the administration of medicines and clear procedures were in place which defined staff’s roles and responsibilities.
People felt safe whilst staff were supporting them in their own homes. Safeguarding procedures were in place and staff had received training in this area. Staff and the management team demonstrated a good understanding of what constituted abuse and how to report any concerns swiftly so that people could be kept safe.
The service had a programme to continually recruit staff to ensure that they were available in sufficient numbers. Staffing numbers were kept under constant review. New staff underwent a thorough induction programme, which including relevant training courses and shadowing experienced staff, until they were competent to work on their own. People felt that staff had the right skills and experience to meet their needs. Staff received training appropriate to their role and were encouraged to undertake training to further their knowledge. Staff’s performance was monitored during unannounced checks on their practice by the management team.
Staff were aware of people’s health and dietary needs and took these into consideration when providing care. People told us their consent was gained at each visit and they had also signed their care plan to confirm their consent to their care and support. Staff had received training in the Mental Capacity Act 2005 and supported people to make their own decisions and choices. The MCA 2005 provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. The registered manager knew that when people were assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.
People said the support was delivered by a staff team who were kind, caring, usually knew them well and that staff took time to talk to them. People were treated with dignity and respect and their privacy was respected.
People were involved in the initial assessment and the planning their care and support. They told us that they received personalised care as recorded in their plans of care. Care plans included
people’s preferred routines. People said a member of the management team visited periodically to review their care plan and discuss any changes required.
Staff understood the aims of the service. They said they treated people as they would want to be treated. They had confidence in the management of the service which they said was supportive and there was good communication in the staff team.
We found three breaches of the health and social care act 2008 (Regulated activities 2010). You can see what action we told the provider to take at the back of the full version of the report.