Archived: The Care Bureau Ltd - Domiciliary Care and Nursing Agency - Leamington Spa

There was a registered manager in post when we inspected the service. A requirement of the service’s registration is that they have 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.

We last inspected this service in March 2016 when all five key areas were rated as ‘Good’. At this inspection we found the quality of care had been maintained and people continued to receive a service that was responsive to their needs. We continue to rate the service as ‘Good’ in all areas, giving the service an overall rating of 'Good'.

People were positive about the care they received and were complimentary of the care staff that supported them. People said they felt safe when supported by care staff. Care staff understood how to protect people from the risk of abuse and there were processes in place to minimise risks to people’s safety, which included information about people’s individual risks in their care plans.

Checks were carried out prior to care staff starting work to ensure their suitability to work with people who used the service. New care staff completed induction training and shadowed more experienced care staff to help develop their skills and knowledge before supporting people independently. This ensured they were able to meet people’s needs effectively.

All care staff had been provided with the provider’s policies and procedures to support them to provide safe and effective care to people. Care staff received specialist training on how to manage medicines so they could safely support people to take them.

People received a service based on their personal needs and care staff usually arrived to carry out their care and support within the timeframes agreed.

People told us care staff maintained their privacy and dignity. People’s nutritional needs were met by the service where appropriate.

The registered manager and care staff understood the principles of the Mental Capacity Act (MCA) and how to put these into practice. Care staff told us they gained people’s consent before providing people with care and support.

The provider had processes to monitor the quality of the service and to understand the experiences of people who used the service. This included regular communication with people, staff, and record checks. People knew how to raise concerns if needed, and feedback was acted upon.

The service delivers personal care to people in their own homes. At the time of our inspection 203 people were receiving the service.

The registered manager had recently left the service, but had not yet deregistered with the Commission. A new manager had been appointed but was not yet in post. At the time of our visit there was an interim manager at the Leamington Spa office. We have referred to them as ‘the manager’ throughout the report, because they are not registered for this service.

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. On the day of the inspection, the provider’s regional manager supported the manager to explain how the service operated and was managed.

People told us they felt safe with the care staff that came to their home. The provider had policies and procedures to minimise risks to people’s safety. Staff were trained in safeguarding and understood the signs of abuse and their responsibilities to keep people safe. The manager checked staff’s suitability to deliver personal care during the recruitment process.

Risks to people’s health and wellbeing were identified and care plans were written to minimise the identified risks. Staff understood people’s needs and abilities because they shadowed experienced staff and read the care plans when they started working for the service.

The manager assessed risks in each person’s home and staff knew the actions they should take to minimise the risks. The provider’s medicines’ policy and procedures ensured that staff were trained in medicines management and the manager checked that people received their medicines as prescribed.

Staff received the training and support they needed to meet people’s needs effectively. Staff had regular opportunities to reflect on their practice and consider their personal career development.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People made their own decisions about their care and support. Staff understood they could only care for and support people who consented to receive care.

People were supported to eat meals of their choice and staff understood the importance of people having sufficient drinks. Staff referred people to healthcare professionals for advice and support when their health needs changed.

Staff had regular care calls so they got to know people well. People told us care staff were kind and respected their privacy, dignity and independence. Care staff were thoughtful and recognised and respected people’s cultural values and preferences.

People were confident any complaints would be listened to and action taken to resolve them, Issues that arose were dealt with immediately, before a formal complaint was raised.

The provider’s quality monitoring system included asking people for their views about the quality of the service through telephone conversations, visits by a supervisor and regular questionnaires.

The manager checked people received the care they needed by monitoring calls, reviewing care plans and daily records, and through feedback from supervisors.

People we spoke with told us they were involved in agreeing the care and support they needed. In the three care plans we looked at, we saw that people's care plans were relevant to their needs and abilities. Risks to people's health and well-being were considered and instructions for staff were detailed.

In the three care staff files we looked at we saw that the manager checked that staff were suitable to work with vulnerable people before they started working for the service. Care staff we spoke with told us they had a thorough induction to the work. One member of care staff told us, 'I met people during my induction and shadowed staff. I felt properly prepared.'

Care staff told us they felt supported to work effectively. We found the manager scheduled regular one to one meetings with staff, to make sure they had the opportunity to talk about their work. One member of care staff told us, 'If I am not sure of anything, I ring the office. There is always someone to talk to.'

The manager's quality assurance system included observing staff in practice and making sure that staff received up to date training. The manager telephoned people at home, to check that they were happy with the service. One person told us, 'I've been with them for years and wouldn't go anywhere else for my care.'

We spoke with the area manager, a care supervisor and three care staff about what it was like to work for the service. The area manager told us that although they were registered to deliver nursing care, they currently only delivered personal care. Care staff told us they always had the information they needed when they went out to visit people. Staff described their induction, their training and the support they received to do their work effectively. One member of care staff said, 'No two days are the same, I am appreciated and I love my job.'

A supervisor showed us how people's information was held electronically. We saw people's care plans and daily instructions for staff were recorded. Paper records of the daily care given were signed by people who received the care and scanned onto the system. The supervisor said the paper records were then destroyed because the scanned documents could be reprinted if needed.