This announced inspection took place on 24 January 2019 and continued to 28 January 2019. We gave the service 48 hours' notice of the inspection visit because it is a small domiciliary care agency and the provider works as part of the care team. Silverstars Care provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. This is the first time the service has been rated Requires Improvement.
Not everyone using Silverstars Care receives regulated activity. 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. At the time of our inspection the service was providing personal care support to 14 older adults.
The provider of the service was also the registered manager. 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.’
Robust governance and quality monitoring systems were not established or embedded within the service. Improvements were required in how the service was managed and how arrangements for accountability and delegation of management tasks were recorded. Monthly audits which included reviewing people’s records, staff files and training were not established which would ensure the quality of the service and identify where improvements could be made.
People's safety was potentially put at risk from staff who had not been trained in all aspects of their roles. For example, medicine administration. Action was needed to improve medicine administration, recording and auditing. Where people required medicines with safe gaps in administration the guidance of health professionals and instruction on the medicine administration record were not always followed. Staff did not complete accident forms when medicines had been administered wrongly or inform the provider.
Risk assessments for people's individual care needs were not accurate, personalised and lacked detail of the identified risk. Although staff were aware of people risks, risks were not monitored adequately, or completed within care plans to ensure the effective monitoring and mitigation of the risk.
The quality of the assessment of people's care needs did not routinely take place before the service began. Although people confirmed they had discussions with the provider in regards their care, there were no formal recording of the pre assessments. Further work was needed to ensure a consistent approach to how people showed their agreement to their care by signing their care plans.
People's care plans and associated records did not detail their most current care needs and documents had not been reviewed. Care plans were generic and held no evidence of individualised or person centred care. The provider told us they were not currently supporting anyone who required end of life care.
Systems in place for the recruitment and selection of staff were in place. Recruitment checks were routinely carried out before staff started their employment to ensure they were suitable to work with people using the service. Staff completed an induction process, however there were no further supervisions or competency checks completed or recorded. People told us they felt well supported but the service needed more staff.
We have made a recommendation in regard training, supervision and appraisal.
Silverstars Care had a small group of staff, although people told us they were supported by staff who treated them with kindness, respect and compassion. Some raised concerns in regards time keeping. The provider told us they were investing in a new on line system which would ensure the service was monitored more closely.
Staff understood their safeguarding responsibilities. People were supported by staff who treated them with kindness, respect and compassion. Staff had a good understanding of the people they cared for and supported them in decisions about how they liked to live their lives. People were supported by staff who respected their privacy and dignity.
We checked whether the service was working within the principles of the Mental Capacity Act. People told us that staff sought their consent before providing care. One person told us, “The staff are helpful they always ask me first to check I am happy with the care they are giving me.”
Systems were in place for recording complaints within the service. People’s relatives told us they felt confident to raise complaints but had not needed to.
During our inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to send us an action plan detailing how they were going to improve.