About the service:

St Michael’s Home Care is a domiciliary care service that was providing personal and nursing care to 110 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People did not always receive a safe service. The provider’s systems to manage medicines safely and protect people from risks were not always effective as medicine’s administration records were not completed correctly.

Management processes were in place to monitor and improve the quality of the service. However, these were not always effective, as they had failed to address shortfalls in the service.

Staff had respectful caring, relationships with people they supported. They respected people’s dignity and privacy, and promoted their independence.

People received care and support which met their needs and preferences. The provider upheld people’s human rights.

Rating at last inspection:

The rating for the service was Requires Improvement. This was the second consecutive Requires Improvement rating.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found that improvements had been made to the provider’s systems to monitor and improve quality and safety in the service. However, there was insufficient evidence to show these improvements had been effective to address the shortfalls in the service.

Enforcement:

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of this report.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on CQC website at www.cqc.org.uk

This inspection took place on 22 January 2018, and was announced. St. Michaels Homecare Limited is a domiciliary care service (DCS). DCS provides support and personal care to people within their homes. This may include specific hours to help promote a person’s independence and well-being. At the time of the inspection 62 people using the service were designated support with personal care. The service is registered to cater for younger and older adults, including those who may have a terminal illness.

This was the first inspection completed for the service. First registered in April 2015, the agency moved location in June 2016.This is the first inspection at the new location.

The service had appointed a new manager in July 2017, who registered in December 2017. 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.

We found that the service was not always safe. The service used some agency staff to assist with delivery of care. People told us that their care and support was not always consistent because they did not have the same carers, or carers that knew them.

Robust recruitment processes were employed by the provision that ensured staff who worked with people were safe to work with vulnerable people. Thorough checks on character including references, disclosure and barring checks were completed prior to staff commencing employment. Staff underwent a comprehensive induction that included completion of mandatory training and shadow shifts prior to being signed off as competent to work independently.

Staff understood how to safeguard people from potential abuse. They reported no hesitation in whistleblowing if the need arose. A large poster was visible in the office that covered the safeguarding protocol, reinforcing the need to report concerns.

Risks to people were recorded and where needed advice on how to manage concerns were provided. We saw that medicines were safely managed, with evidence of when staff had assisted people with medicines.

The staff were reportedly polite, considerate and caring. People and families reported how they maintained people’s dignity when assisting with personal care, speaking to them calmly and advising them what they were going to do next. This meant that people felt involved in their care.

Care plans and reviews were generally completed with people or their families. These were personalised and detailed how people wanted to be supported, although significant time lapses between initial assessments and care plans being written were noted. The service encouraged working in partnership with other agencies to ensure responsive care was delivered.

We found that the service did not always effectively deliver training to assist staff in supporting people. On one occasion it was found that staff had not received specialist training nevertheless continued to deliver support. This put the person at potential risk.

Audits were completed by senior care staff. These did not always illustrate the issues that were prevalent specifically with the time care plans were taking to write. The registered manager was not involved in the audits or action plans when generated. The registered manager was a part of the weekly meeting that were arranged to discuss the audits outcome measures. We found that these were not always comprehensive therefore the registered manager did not have a full understanding of the issues.

Staff reported the service as open and transparent. Staff reported feeling confident that they could visit the office and raise any issues as and when these arose. Similarly, people were confident to raise concerns. The service had a good complaints procedure. We saw evidence of these being appropriately investig