Everyday Recruitment Agency Limited

Everyday Recruitment Agency Limited is a domiciliary care agency providing care to people living in their own homes. Not everyone who used the service received the regulated activity of personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection there were 69 people receiving personal care. Care was provided to younger adults with learning and physical disabilities as well as older adults with a range of conditions including people living with dementia, long term health conditions and complex physical health needs.

People’s experience of using this service and what we found

People told us they felt safe and were cared for by staff who knew them well. Risks to people’s health and safety were assessed and staff were aware of people’s risks and how to manage them. Care and support plans were person centred, promoted independence and provided staff with detailed guidance on how to support people. One person told us the service had, “been a great benefit to my life.”

Accidents and incidents were appropriately reported by staff and investigated as required. Advice was sought from health and social care professionals if people's needs changed. This was implemented by staff and people’s care plans updated to reflect any changes.

Medicines were managed safely and quality assurance systems for monitoring medicines were effective in identifying errors and action taken. Staffing levels were sufficient to meet people’s needs and staff said there was enough time during visits to spend with people. One person told us, “Calls are on time and carers stay full time.” Another explained, “I’ve got a rota with times on it. Timekeeping is good… It’s relatively the same people that visit.”

People’s needs were assessed prior to receiving the service and regularly reviewed. People told us they felt involved in their care and were encouraged to provide regular feedback. Staff completed an induction and underwent training essential to their role. Staff received regular supervision and felt supported by the registered manager and senior care staff.

People were supported to maintain their interests and hobbies and access healthcare services for support. Relative’s views were listened to and respected and staff worked closely with external agencies to provide effective care.

Staff knew people well and showed in depth knowledge and understanding about people and their care. People spoke warmly and positively about staff. One person said when describing staff, “They’re lovely [staff] that usually comes. There’s another [staff] that comes sometimes and they’re marvellous too.” Staff spoke positively about the service and their colleagues. One staff member said, “I would have Everyday Recruitment Agency (ERA) look after my family, all the carers are lovely, they are all trained and have a rapport with customers.”

People and staff spoke positively about the registered manager and the senior staff team. Quality assurance and management systems provided oversight of the service and peoples care. When shortfalls were identified, changes were made to improve and lessons learnt were shared with the team. Staff had established close links with community services and worked effectively with external teams and agencies.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care maximised people’s choice, control and independence. People were involved in their care and support plans were designed to promote a good quality of life. People were supported to make choices about where they go, what they do and to follow their own interests. People were supported to access the local community and local health services.

Right care:

• Care was person-centred and promoted people’s dignity, privacy and human rights. The service focussed on people’s strengths and promoted independence. Staff supported people in a manner which promoted their privacy and dignity. People were cared for in their own homes to which they had unrestricted access and enabled them to continue living where they wanted to be.

Right culture:

• The manager and staff at the service demonstrated values, attitudes and behaviours which supported people to lead confident, inclusive and empowered lives. Staff had received specific training to meet the needs of people with a learning disability and spoke passionately about people and the care and support they provided. The service promoted an open and transparent culture which encouraged people and their families to share their views and make a complaint.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 02 June 2020) and there were six breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Everyday Recruitment Agency Limited on our website at www.cqc.org.uk.

Follow up

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

Everyday Recruitment Agency Limited is a service that provides care to people living in their own homes and is based in Selsey, West Sussex. It is one of two services owned by the provider. Not everyone who used the service received the regulated activity of personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection there were 64 people receiving personal care. Care was provided to younger adults who were living with epilepsy and physical disabilities as well as older adults who had a range of conditions which included those living with dementia, diabetes, learning and physical disabilities.

People’s experience of using this service and what we found

There was a lack of oversight to assure the registered manager and the provider that people were receiving appropriate care to meet their needs. Shortfalls found at the inspection had not been identified by the registered manager or provider. Quality assurance processes were not always effective in identifying areas that required improvement. The registered manager and provider had not notified us of incidents relating to people’s care or that they were no longer providing a regulated activity they were registered to provide. This did not enable us to have oversight and ensure people were receiving appropriate care.

There was a lack of oversight of staff's training and some staff had not undertaken training to ensure they had appropriate skills, knowledge and competence to meet people’s specific needs.

People were not supported to plan for care at the end of their lives. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Risks to people’s care had not always been assessed, considered or mitigated. Lessons had not always been learned to ensure known risks were lessened. One person had not always received safe care and support, we made a safeguarding referral to the local authority for them to consider as part of their safeguarding duties.

People’s needs had not always been assessed or planned for. When reviews of people’s care had taken place, these had not always identified changes in people’s conditions and appropriate actions were not always taken to ensure staff were provided with current guidance to meet people’s changing needs.

People were involved in their care and the registered manager and staff worked in partnership with external health and social care professionals to ensure people received coordinated care. Feedback about people’s care and experiences was welcomed and people told us they felt comfortable raising issues with staff and the registered manager.

There were enough staff to meet people’s needs and ensure care visits were covered. People were protected from the spread of infection. When people required assistance to prepare food and drinks they were provided with choice and visits were scheduled to ensure people received support at mealtimes.

People were supported to retain their skills, interests and hobbies to reduce the risk of social isolation. People and relatives told us staff were kind and caring and our observations of staff’s interactions with people confirmed this. Privacy and dignity were maintained, and people were treated with respect.

Rating at last inspection

The last rating for this service was Good (Published 5 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified six breaches in relation to oversight of risks and safety, person-centred care, consent, staff skills and competence, failure to notify CQC of incidents and the leadership and management of the service.

Please see the action we have told the provider to take at the end of this report.

Follow-up

We will continue to monitor the intelligence we receive about this service. We will request an action plan from the provider to understand what they will do to improve the standards. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Everyday Recruitment Agency Limited on our website at www.cqc.org.uk.

The service did not have a registered manager. Although the person responsible for the day to day management of the agency had applied to be registered with the Care Quality Commission (CQC) and had just undertaken an interview. They were now awaiting approval to be registered. A registered manager is a person who has registered with the 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.

At our last inspection to the service in April 2016 we found one breach of regulations. People were not always protected because risks to their health and safety had not been fully assessed. Where risks were known there was limited written guidance for staff on how to minimise them. We asked the provider to take action and the provider sent us an action plan In June 2016 which told us what action they would be taking. At this inspection we found that improvements had been made and the regulations were now met.

We also made one recommendation that the registered manager and provider review their quality assurance system to ensure that all aspects of the service were monitored and to ensure compliance with the regulations. At this visit we found that quality assurance systems were appropriate.

People received a safe service and risks to people were assessed and reviewed. We saw that care plans contained risk assessments for individuals and the risk assessment contained information on how risks could be minimised. There were also environmental assessments for people’s homes so staff knew any risks and what they should do to keep people and themselves safe.

People told us they were satisfied with the service and the support they received and felt safe with the people who supported them. There were policies and procedures regarding the safeguarding of adults. Staff were aware of the action to take if they considered anyone was being mistreated. . People received their medicines safely. There were sufficient numbers of staff employed to meet people’s needs. Recruitment processes were thorough to help ensure only suitable staff were employed to support people.

Each person had a care plan and a copy was kept in their home. Care plans gave guidance to staff on the support people needed at each visit. Staff received training to enable them to deliver the care people needed. Staff said there was suitable training and support provided so they could support people effectively.

Staff told us they had a good induction, including shadowing experienced staff before they started to provide support to people. They were supported in their roles and professional development by a system of supervision.

The manager and staff understood people’s rights to be involved in decisions about their care. People were involved in decisions about their care and support and were able to express their views. The manager and staff had received training in the Mental Capacity Act (MCA)) 2005 and associated legislation and knew what action to take if they thought a person lacked capacity to consent.

People were supported to eat and drink in line with their individual needs and this was recorded in their care plan. People’s healthcare needs were monitored by staff and the agency supported people to access healthcare professionals when needed.

People were supported by kind caring staff. People said they were encouraged to be independent as possible and that staff treated them with dignity and respect. People and relatives were involved in planning the care and support provided to them and this included information on how people wished to receive support. They spoke positively about the care they received and said staff would assist them with additional tasks if necessary. People’s care was reviewed and updated in line with their needs and wishes.

People said that they generally received care visits at the agreed times, however there were times when they received their visits early or late. People told us they were not always kept informed if staff were running late and were not notified if there had been a change in their carer. People said that care staff stayed for the full allocated time. Staff said that they had sufficient time to care for people safely and they were given time to travel between care calls.

People felt able to contact the manager or staff if they had concerns and a copy of the agencies complaints procedure was contained in their care booklet that was kept at their home. This booklet also had contact details of how to contact the office out of hours and also included important telephone numbers that people may need.

The registered manager and provider monitored the delivery of care and had a system to monitor and review the quality of the service. Suggestions on improvements to the service were welcomed and feedback encouraged.

Everyday Recruitment Agency Limited, also known as ‘ERA’, is a domiciliary care service that provides support to people in West Sussex, including in Bognor Regis, Chichester, Selsey and The Witterings. At the time of our visit the service was supporting 155 people with personal care. This included 14 children between the ages of 4 and 18 years old.

The service had a 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.

People may not have been protected from harm because risks to their health and safety had not always been assessed. Where risks were known there was often a lack of guidance for staff on how to minimise them and monitoring of risks was not always effective.

People received their medicines safely but in a few cases specific guidance on individual support needs was missing.

Staff understood local safeguarding procedures and reported any concerns promptly.

People had confidence in the staff who supported them. There were enough staff employed and the rotas were managed effectively. Staff received training to enable them to deliver effective care. They were supported in their roles and professional development by a system of supervision. Staff understood how consent should be considered in line with the Mental Capacity Act 2005. People and/or their representatives were involved in planning the care that they received. During our visit the registered manager modified the assessment form to ensure that the level of people’s involvement and consent was clearly recorded. Staff supported people to prepare meals and to eat and drink if required.

People spoke highly of the staff and told us that they treated them with dignity and respect. In our survey sent out prior to the inspection, 100 percent of respondents said that staff were caring and kind. A relative wrote a letter of thanks to the provider which read, ‘As you know I am very happy with so much about ERA but it is particularly the carers that make ERA so successful’.

People’s care needs and their satisfaction with the service was regularly reviewed. Staff responded quickly to changes in people’s needs and made referrals to other healthcare professionals such as the GP, district nurses or occupational therapist when additional support was required.

People felt able to contact the registered manager or staff if they had concerns and said that they received a quick response. People told us that they understood how to make a complaint.

The registered manager used feedback from people and staff to monitor the quality of the service and to identify improvements. Suggestions had been acted upon. Although there was a system of quality assurance by senior care workers in the community we found that some care plans were missing information and that checks on daily notes and medication records had failed to identify some issues. We have made a recommendation that the registered manager and provider review their quality audits to ensure that all areas of the service are checked.

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

We spoke to a number of people who used the service by telephone and they told us that they were all very happy with the support they got with their medicines. Comments included, "You cannot beat what we get", "The girls are brilliant" and "The staff in the office are very helpful when you ring them".

Therefore, people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People also told us that they had been involved in making decisions about the service they wanted. For example, one person said, "They listen to you, check you agree with the help they are offering. This makes you feel like they really care". People also told us that they had been asked for their views about how the agency operated. Also that if they raised issues these were usually resolved.

Despite everyone expressing satisfaction with the service they received we found that the agency was not maintaining accurate medication records and was unable to demonstrate that medicines had been taken as prescribed. This placed people at potential risk.

We spoke with five members of staff. They said that they had sufficient time on visits to provide a quality service but mentioned that travelling time was not included in the schedule. This meant that sometimes they had to start a few minutes early, be very efficient on the calls or finish late. One member of staff said of the agency, 'They are good as an employer, I can ring them up and ask any questions I want'.

Despite everyone expressing satisfaction with the service they received we found that the agency was not maintaining accurate records and that this put people at risk of receiving unsafe or inappropriate care. This was a particular concern in the area of medicines where a new policy had recently been introduced but was not being followed. The manager was unable to demonstrate that support with medicine had been given at the appropriate level or that medicine had been taken as prescribed.