The inspection took place on 23 and 24 October 2016 and was announced. Care at Home Services provides care and support to a wide range of people including, older people, people living with dementia, and people with physical disabilities. The support hours varied from 24 hours a day, to a half hour call and from one to four calls a day, with some people requiring two members of staff at each call. At the time of the inspection over 200 people were receiving care and support from the service.
The service is run by a registered manager, who was present on the day of the inspection visit, together with the training and development manager. The operations director was also present on the second day of the inspection. 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 and associated Regulations about how the service is run.
At the previous announced inspection of this service on 28 and 29 September 2015, three requirement notices was served due to breaches of regulations. The provider did not have sufficient guidance for staff to follow to show how risks to people were mitigated. Medicines were not being administered safely and people were not receiving personalised care. In addition, the systems in place to monitor the quality of the service were not effective. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. The provider sent us an action plan. We undertook this inspection to check that they had followed their plan and to confirm they now met legal requirements. At the time of this inspection some improvements had been made, however, the provider had not taken appropriate action with regard to these issues and the breaches of regulations continued.
There was still insufficient guidance for staff to follow to show how some risks were mitigated especially when moving people. Some people needed support to wash and bath. Risks to them and staff had not been assessed. Measures were not always in place to mitigate risks when supporting people with their epilepsy and diabetes. This had been identified in the previous inspection in September 2015 and remained an ongoing shortfall.
The systems to ensure people received their medicines safely had been reviewed; however, there were still shortfalls in medicines administration and recording. People were not always receiving medicines at the appropriate time as instructed by health care professionals. This had been identified in the previous inspection in September 2015 and remained an ongoing shortfall.
People and relatives told us they were involved in the assessment and planning of their care and support. However, in some care plans there was a lack of information about people’s skills in relation to different tasks and what help they required from staff, to ensure their independence was maintained. Although some improvements had been made to address these shortfalls some care plans did not include this information.
Although generic information had been added to care plans with regard to people’s medical conditions, the plans were not individual to people’s specific needs relating to their epilepsy and diabetes. People’s care plans did not always contain the guidance that staff needed to ensure that people were receiving the care they needed. Health care professionals, like community nurses and doctors, were contacted if there were any health concerns.
People were supported by staff to make their own decisions and mental capacity assessment forms were in place. However, the information in the assessments was not consistent and at times were contradictory saying that people had capacity when they actually needed support to make decisions.
Audits were carried out to monitor the quality of the service, and these had improved since the previous inspection, however, the audits in place were not effective as the shortfalls in this report had not been identified. This had been identified in the previous inspection in September 2015 and remained an ongoing shortfall.
People had opportunities to provide feedback about the service provided. Quality assurance questionnaires were sent out annually by staff at the head office. The results had been summarised but at the time of the inspection people had not been informed of the outcome. However, feedback had not been sought from a wide range of stakeholders such as staff, visiting professionals and professional bodies, to ensure continuous improvement of the service was based on everyone’s views. This had been identified in the previous inspection in September 2015 and no action had been taken to address this issue.
Records were stored safely and some improvements had been made although care plans and risk assessments lacked detailed to ensure people received safe consistent care. This had been identified in the previous inspection in September 2015 and remained an ongoing shortfall.
Staff had received training in how to keep people safe. They were aware of the safeguarding procedures and reported any concerns to the registered manager. Accidents and incidents were reported, investigated and necessary action taken to reduce the risk of further occurrences. Plans were in place to ensure the service would remain running in the event of an emergency. There was also an on-call system outside of office hours for additional support for people and staff should they need it.
The office co-ordinators planned staff schedules to ensure that people received care from regular staff. Staff had permanent rotas and also covered for other staff in times of sickness and annual leave. Ongoing recruitment ensured that there was enough staff employed and all of the calls were covered. There had been no missed calls at the time of the inspection.
Safe staff recruitment processes were followed to ensure that staff were of good character and had the required knowledge and skills to support people. New staff received a three day induction training session, which included shadowing experienced staff. Staff had a range of training specific to their role, but there was a lack of specialised training being provided, such as diabetes and epilepsy awareness training.
Senior staff carried out unannounced checks on staff to monitor that they had the skills and competencies to perform their role. Staff told us they felt supported and attended one to one meetings with their manager to discuss their practice, however not all appraisals were up to date to ensure that staff had discussed their training and development needs for the future.
Staff supported people with their health care needs when required. People told us that staff noticed when they may need to call the doctor or community nurse. Most people required minimal support with their dietary needs. Staff encouraged people to eat and drink during their calls and when required, left drinks and snacks out for them to have later.
People told us that the staff treated them with respect and their privacy and dignity was maintained. People we visited told us the staff were polite, caring and kind. People told us they looked forward to the staff coming and they always asked if there was anything else they needed before they left.
Information on how to make a complaint was part of the care folder in each person’s home. People we visited were confident to complain if necessary but did not have any concerns.
People told us that communication with the office was good. Staff told us that they were fully supported by the management team and were clear about their roles and responsibilities. They said they felt confident to approach senior staff if they needed advice or guidance.
We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
You can see what action we told the provider to take at the back of the full version of this report.