About the service:

Pegail Care Limited is a domiciliary care agency providing personal care to people in their own homes. At the time of inspection there were 31 people using the service.

People’s experience of using this service:

Feedback from people was generally quite poor with particular reference to the timing of care visits and management of the service. People reported experiencing late visits and some had missed visits. Poor communication between themselves and the management team around the timing of the visits and dealing with people’s concerns also impacted on people’s experience of using the service.

There were systems in place to respond to complaints but people were not always satisfied with how their complaints were dealt with. Lessons had not always been learned as the complaints and safeguarding alerts showed ongoing failings which had not been addressed. Whilst there was evidence of the service engaging with people to invite their feedback on the service, for example, sending out annual satisfaction surveys. This along with other quality assurance mechanisms had not been effective at picking up on concerns and failings to make required improvements.

Risks to people had been assessed, however these lacked detail and were not always tailored to reflect people’s individual needs, particularly with regard to people’s health conditions.

We made a recommendation about risk assessment and management.

Staff received training in how to administer medicines but we noted inconsistencies in how staff competence was assessed. The current electronic system of recording and auditing medicines was not robust and required strengthening.

We made a recommendation about safe medicine management.

At our previous inspection we found unsafe recruitment practices in place which meant the service was in breach of regulation 19. At this inspection we found staff were recruited safely and the service was no longer in breach.

Staff had received training in safeguarding and knew how to recognise and report abuse. The care manager understood their safeguarding responsibilities and had shared concerns with the local authority appropriately.

A positive feature of the service was the fact that people were supported by a regular group of four to five care staff. This meant people benefitted by being cared for by staff with whom they were familiar.

Staff completed training in infection control and had access to protective clothing to prevent the spread of infection. There was a system in place to record and manage any accidents and incidents.

Staff were provided with training, supervisions and appraisals. However, we received mixed feedback from people about the knowledge, skills and abilities of staff. Staff received training in the mental capacity act and understood how to help people make their own decisions.

We made a recommendation about staff skills and training.

Not all people had an assessment when they joined the service. People's choices were not always explored and documented. Late care visits meant that peoples routines and preferences were not always respected. Where care plans were in place these lacked detail to support a person-centred approach. Regular reviews of people’s care were not completed. This meant that people were not always included in decisions about their care and support.

We made a recommendation about the assessment and care planning and review process.

Staff supported people with eating and drinking, however care plans for nutrition and hydration lacked detail. Staff were vigilant in noticing and reporting concerns about people health and the service worked with other health and social care professionals to manage these concerns.

We received mixed feedback regarding the qualities of the staff team. Most people said staff were kind and caring and treated them with dignity and respect. However, some people felt staff could be friendlier and be mindful to ensure people’s privacy was maint

This inspection took place between 21 November and 06 December 2017 and was announced. We gave the registered manager 48 hours to make sure someone was available in the office to meet with us as office staff sometimes provide personal care.

This was our first inspection of the service since it registered with the Care Quality Commission on 15 December 2016. Pegail Care Limited is a domiciliary care agency that provides personal care and support to people living in their own homes. Most people using the service were older people, there were also younger adults with physical disabilities. There were 14 people receiving services from Pegail Care Limited at the time of our inspection.

We found two 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 the report.

Concerns by the funding authority had been raised about the provider’s recruitment processes and we found that three members of staff had been recruited without Disclosure and Barring Service (DBS) in place and other staff did not have suitable references. The registered manager has now addressed this.

The provider did not always submit statutory notifications to CQC as required by law which meant they did not support us to carry out our role in monitoring services. These notifications were subsequently submitted.

The provider had a complaints process in place. During the inspection, people identified concerns they told us had been dealt with. However, we did not see that these had been recorded. We made a recommendation that the provider review their complaints management process to ensure that complaints are handled effectively, including a timely response and explanation of the outcome, and concerns or complaints are formally recorded.

We found the provider had not ensured all aspects of the service were safe or that the quality of the service was monitored robustly. Quality monitoring systems were not always sufficient to identify areas that required improvement. We made a recommendation that the provider reviews their quality assurance processes to ensure that effective systems are in place to monitor the safety and the quality of the service provided.

A registered manager was in post. 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. The registered manager was also the provider.

Staff had access to regular training to support them to maintain and develop their skills and knowledge. We made a recommendation that the provider review aspects of their training programme to include training subjects specific to the needs of people that use the service.

People were safeguarded from abuse and neglect. Staff received training in safeguarding adults at risk to help them understood how to respond if they suspected people may be being abused to keep them safe.

People were supported by sufficient numbers of staff who were aware of the risks to them on a daily basis and knew how to support them safely.

People who used the service and their representatives were happy with the care they received. They told us that staff arrived on time and stayed the agreed length of time. They explained that staff did everything they asked and offered them choices. They were happy with support they received with medicines and in preparing meals, as well as with support with their personal care.