Solutions in Service Ltd

Updated 6 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 25 January and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that staff would be available on the day.

The inspection team consisted of one adult social care inspector and an ‘Expert by Experience’. An ‘Expert by Experience’ is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection visit we reviewed the information which was held on Solutions in Service Ltd. This included notifications we had received from the registered provider such as incidents which had occurred in relation to the people who were being supported. A notification is information about important events which the service is required to send to us by law.

A Provider Information Return (PIR) was also submitted and reviewed prior to the inspection. This is the form that asks the provider to give some key information in relation to the service, what the service does well and what improvements need to be made. We also contacted commissioners and the local authority prior to the inspection. We used all of this information to plan how the inspection should be conducted.

During the inspection we spoke with the one director, two registered managers, the deputy manager, two clinical leads, one healthcare professional, three members of staff, four people who were being supported by the registered provider and one relative by telephone.

We also spent time looking at specific records and documents, including four care records of people who were being supported, four staff personnel files, staff training records, medication administration records and audits, compliments and complaints, accidents and incidents, policies and procedures, safeguarding records and other documentation relating to the management of the service.

Updated 6 March 2018

This inspection took place on 25 January, 2018. The inspection was announced.

Solutions in Service Ltd is registered to provide domiciliary care to younger and older people who have complex support needs. The registered provider supports 54 people across five separate shared houses. Each person within each shared house has their own separate tenancy agreements and are supported by staff 24 hours a day, seven days a week.

At the time of the inspection there were two registered managers in post. 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.

The registered managers had a number of different systems in place to assess and monitor the quality of the homes, ensuring that people were receiving safe, compassionate and effective care. Such systems included weekly, monthly, annual audits and the relevant health and safety and infection control checks.

We reviewed medication management processes which were in place. Medication was administered safely by staff who had received the appropriate medication training. Medication audits were being completed on a weekly basis. However, we did discuss with the registered managers at the time of the inspection that the medication audit could be further developed in order to capture all aspects of the medication processes and procedures.

We recommend that the medication audit process is further reviewed.

People we spoke with during the inspection expressed that they felt safe. People explained that they felt staff were approachable, responsive and would listen to their views and opinions. Staff were knowledgeable around the area of safeguarding procedures and knew how to report concerns and who they would report their concerns to. Staff had completed the necessary safeguarding training and there was an up to date safeguarding policy in place.

Care files contained individual care plans and risk assessments were in place for people who were being supported by the registered provider. Care records we reviewed contained important information about the person and staff were familiar with people’s care needs, risks and support measures which needed to be implemented.

Recruitment was safely managed. Staff personnel files which were reviewed during the inspection demonstrated that safe recruitment practices were in place. This meant that all staff who were working for the registered provider had sufficient references and Disclosure and Barring System checks (DBS) in place.

There was an up to date ‘Accidents and incidents’ reporting policy and procedure. Accidents/incidents including safeguarding incidents were being routinely recorded by all staff and trends were being monitored and analysed. People’s care records were being updated accordingly and actions were being taken by the registered provider when trends had been established.

The registered provider operated within the principles of the Mental Capacity Act 2005 (MCA) People were supported to remain independent, to have ‘choices’ and to be fully involved in the decisions about the care which needed to be provided. People who were being supported by the registered provider had all consented to the care being provided. Staff were also aware that any decisions made on behalf of people, due to fluctuating/lack capacity must be made in their ‘best interests’.

Staff expressed how they were fully supported in their roles. Staff had received all the necessary training needed to perform to the best of their abilities and regular supervision and appraisals were taking place.

Staff supported people to make their own decisions around their own nutrition and hydration. People’s choices, preferences, likes and dislikes were taking in to account and people told us that staff would provide advice and guidance around balanced diets.

People expressed that staff were caring, kind and compassionate towards them. People felt they were treated with respect and staff provided dignified and compassionate care. Relatives we spoke with told us they felt the staff were kind, caring and provided good quality care. The registered provider has appointed a dedicated dignity champion, this was an area of care which was being prioritised for people who were being supported.

There was a complaints policy and procedure in place and people knew how to make a complaint. Complaints were also reviewed as part of the registered providers ‘annual review’ as to ensure trends were being established and managed accordingly.

The registered managers had a number of different systems in place to ensure the provision of care was being routinely assessed. Systems included quality checks and audits, health and safety checks, care plan and risk assessment reviews, staff, ‘service user’ and external professional surveys. There was also a rolling ‘live’ action plan which was continuously being reviewed and updated.

The registered provider worked in conjunction with the local housing association to ensure the environment was well maintained and the health and safety measures provisions were being safely managed. Health and Safety audit tools were in place to monitor, assess and improve the quality and standards of the home.

The shared living accommodation we visited was clean and well maintained. There was a daily and weekly cleaning rota in place and there was evidence to suggest that infection control policies were being adhered to. This meant that people were living in a safe and well maintained environment.

Policies and procedures we reviewed during the inspection were up to date, relevant and contained the necessary guidance for staff to follow. Policies and procedures were available to all staff and they were able to discuss specific procedures and processes with us during the inspection.

The service was well-led and staff and managers promoted a culture of warmth, kindness and compassion towards the people who were being supported. Staff expressed that they felt supported by the registered managers and explained that the team worked collaboratively for the benefit of the people they were providing care for.

The registered managers were aware of their regulatory responsibilities and were aware that CQC needed to be notified of events and incidents that occurred in accordance with the CQC’s statutory notifications procedures.