About the service:

Support Initiatives North West Ltd is a domiciliary care agency, providing personal care to people in their own homes. The service operates from the registered address based in Southport. At the time of this inspection two people were using the service.

People’s experience of using this service:

Safe Care and Treatment was not always consistently provided. Risk assessments did not always indicate the level of risk that needed to be managed or how to keep the person safe.

People’s level of risk was not always assessed or reviewed.

Quality assurance processes were not always effectively monitoring the provision of care people received. Audit tools and checks were not always identifying areas of improvement that needed to take place.

Recruitment practices had improved since the last inspection, however pre-employment checks needed to be further strengthened.

People were protected from the risk of harm and abuse. Staff were supported with training in relation to safeguarding and knew how to report any concerns that presented.

At the time of the inspection people did not need support with medication administration. However, the registered provider ensured that staff were enrolled on to the appropriate medication administration training and there was also a medication administration policy in place.

People received support from consistent members of staff who were familiar with their support needs. Staff received training to help develop their skills, knowledge and development.

Staff understood and respected people’s right to make their own decisions and supported people to make choices. People were involved in the decisions that needed to be made and consent was gained in line with the principles of the Mental Capacity Act, 2005.

People’s privacy, dignity and independence was promoted. Positive relationships had developed between people who received supported and care from staff. We received positive comments about the quality and safety of care people received.

The registered provider had a complaints policy in place; information about the complaints process was provided to people from the outset.

We received positive feedback about the provision of care that was delivered. People also had the opportunity to share their thoughts, opinions and suggestions and the provision of care they received.

Rating at last inspection: Requires Improvement (The last report was published in January 2017)

Why we inspected: This was a planned comprehensive inspection based on the previous rating.

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.

You can see what action we told provider to take at the end of report

This inspection took place on 17 October and 20 November, 2017. The inspection was announced.

Support Initiatives North West Ltd is a domiciliary care agency. It provides care to people living in their own houses and flats in the community. It provides a service to younger adults. At the time of the inspection the registered provider was providing support to four people.

There was no ‘registered’ manager for the service at the time of the inspection. The manager we spoke with during the inspection had submitted their registration documentation and was awaiting approval from the Care Quality Commission. A registered manager is 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.

This inspection was the first comprehensive inspection at the service.

During this inspection we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

The registered provider did not evidence or promote person centred care and support for people. ‘Person centred’ care means that the service tailors its approach to the care which needs to be provided to suit the needs of the person and not the needs of the organisation.

During this inspection we found that the systems and processes in place to maintain the quality and the standard of care being provided had not been effectively implemented. Records were very basic and did not evidence the most relevant information in relation to the support needs of the person.

Care files contained individual care plans and risk assessments. Three out of the four care files we reviewed contained very basic information and did not contain any person centred information. Care plans were being reviewed but they did not highlight the areas of concern we identified during our inspection.

Audits systems and checks were not being used effectively, there were not any measures in place to monitor, assess or improve the delivery of care being provided. Audits/checks which were in place did not effectively measure the quality or standard of support being provided.

Feedback from the people who were being supported or their relatives had not been gathered. This meant that there were not any systems in place to gather feedback about what the registered provider does well or what areas need to be improved on.

On the first day of the inspection we found that records and confidential information was not securely stored as a measure to protect sensitive information. Documents and records for people who were being supported and staff were not stored at the address which had been registered with the CQC.

Recruitment was not being safely or effectively managed. Staff personnel files reviewed failed to demonstrate that robust recruitment practices were sufficiently in place. This meant that some staff that worked for the registered provider did not have suitable and sufficient references and disclosure and barring system checks (DBS) in place. DBS checks ensure that staff who are employed to care and support people are suitable to work within a health and social care setting. This enables the registered manager to assess level of suitability for working with vulnerable adults.

We reviewed the training records that the registered provider told us had been completed. However, the information we were provided with was insufficient and did not confirm what training had taken place in order for staff to fulfil their roles.

Medication was being administered by staff that had not received appropriate training for this task. We were also informed that new staff had not been enrolled to complete the Care Certificate.

You can see what action we told the provider to take at the back of the full version of the report.

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