The inspection was announced and carried out on the 17, 21 and 24 November 2017.The service was previously inspected in June 2016 during which we identified two breaches of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care records did not contain contemporaneous information, and audit systems were not always robust. At this inspection we found that improvements had been made in these areas; however we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older and younger adults, and provides a lot of support for people who are at the end stages of their lives.
The service has a registered manager in post who had been registered with the CQC since July 2011. 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.
At the last inspection in May 2016 we had made a recommendation to the registered provider around the safe recruitment of staff. However, we found at this inspection, that some of the issues we had identified had not been addressed. Recruitment processes were not robust enough to ensure the safe recruitment of suitable staff. We identified that risk assessments had not been completed for those staff who had previously committed criminal offences. Interview processes had not taken this information into account, and disciplinary processes had not been considered in an example where a member of staff had not disclosed criminal offences. In one example we identified that action had not been taken to verify a reference, sent from a personal email address, despite this member of staff having a previous criminal history.
At the last inspection we identified that care records did not always contain up-to-date information about people’s needs and risk assessments were not being completed in relation to people’s needs. At this inspection we identified that people care records contained accurate and up-to-date information about people’s needs. Risk assessments were in place and provided information to staff around how to manage those risks presented to people. This helped ensure that staff had access to information about supporting people and how to keep them safe.
At our previous inspection we found that audit systems were not robust. At this inspection we identified that improvements had been made in relation to these. Spot checks on staff had been completed by the registered manager and the care record audits were also being completed. However; the registered manager and registered provider had failed to identify issues relating to the recruitment processes.
There were sufficient numbers of staff in post. People commented that staff usually arrived on time, or within an acceptable time frame. People confirmed that staff always turned up for their care call. Staff told us they had enough time to spend with people and did not feel stretched.
Supervisions were carried out with staff. A tick box format was used to rate staff based on their performance. In some examples we found no written commentary had been added to this to demonstrate the rating given to staff, or any discussions around development and progression. We have made a recommendation to the registered manager in relation to this.
Staff had received the training they needed to carry out their role effectively. People and their family members told us staff were good at their jobs and that they used the correct equipment to support them during moving and handling tasks. The service provided end of life support to a number of people. Staff had been provided with the training needed to support meet people’s needs.
People were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable adults and knew how and to whom to report any concerns they may have. This helped to ensure people’s safety.
People told us that positive relationships had been developed between them and staff. They told us staff were “bubbly” and “helpful”. One family member told us that staff made their relative laugh, whilst other people told us they felt relaxed and at ease whilst being supported by people.
People were treated with dignity and respect. People told us that staff conducted themselves respectfully and left their homes clean and tidy. Whilst we did not observe any interaction between staff and people using the service, staff were able to give appropriate example around how they would ensure people’s dignity was maintained.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. This ensured that people’s rights were protected under the Mental Capacity Act 2005.