The Old Roselyon Domicillary Care Agency

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of the inspection the agency supported 42 people with personal care needs.

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

At the inspection of the service in November 2020 we found breaches relating to the operation of the service. At this inspection we found the service had made improvement in all areas and were no longer in breach of regulations.

At the previous inspection we found the process in place for recruiting staff was not robust. At this inspection recruitment had been reviewed and all staff had the necessary checks in place to ensure they were safe to work in the health and social care sector.

At the previous inspection we found the process for managing risk was not effective. The safe management of medicines had not been assured. At this inspection we found, people’s risks had been recorded and reviewed on a regular basis. Any changes were recorded and shared with staff. Medicine systems had been reviewed and the current system ensured medicines were managed safely.

At the previous inspection we found systems to ensure consent had been sought for care and treatment were not in place. At this inspection we found actions had been taken to seek and report on consent.

At the previous inspection we found staff training and supervision was not always taking place. Some staff had not received the necessary training and updates to support them in their role. At this inspection we found action had been taken by the manager to improve this. Staff training and supervision was being monitored to ensure all staff were supported in their roles.

At the previous inspection we found there had been a lack of oversight to effectively monitor and improve the service provided. At this inspection we found the manager had taken steps to review all areas of governance and oversight to ensure systems were being monitored.

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.

People supported by the agency told us staff who visited them were polite, reliable and professional in their approach to their work. They said, “Can’t do without them” and “Can’t fault any on the staff”.

The service had a complaints procedure which was made available to people they supported. People we spoke with told us they knew how to make a complaint if they had any concerns. One person said, “I have raised an issue before, but it all got sorted out”.

Staff were provided with personal protective equipment to protect people and themselves from the spread of infection.

People’s relatives and staff told us management were approachable and they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service.

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 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

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key questions safe, effective and well led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Old Roselyon Domicillary Care Agency is a care service that provides personal care and support to people living in their own homes in the community. The service provides personal care for people in visits at key times of the day to help people to get up in the morning, go to bed at night and support with meals. Longer visits for a ‘sitting’ service are also provided for some people. 48 people were receiving a service at the time of this inspection.

The registered manager for this service had been shielding at home for the past several months, due to being vulnerable to the Covid-19 virus. Whilst they were available by phone for advice it was not possible for them to manage many aspects of the service remotely. An acting manager was running this and the nursing home to which this service is attached.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to, for example, personal hygiene and eating. Where they do we also consider any wider social care provided.

At the time of this inspection the service was providing the regulated activity, personal care to 48 people, in the Par, Fowey, St Blazey and St Austell areas of Cornwall.

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

At the last inspection staff raised concerns about the rota management. We were assured that the service was in the process of moving the existing paper based rota to a more effective electronic system, to improve scheduling and the monitoring of visits. This had not taken place and meant that the opportunity to improve the service had been missed. Some people's visits were late and a few were missed. The service did not have accurate records of the missed visits reported by people and their families. Relatives were positive about the care provided by care workers but raised some issues about the timing of some visits. Comments included, “There have been one or two missed visits recently. (Person’s name) is not dependent on them but has had falls in the past and not been found for some time, this was one of the reasons that we arranged the visits to start, so that someone would check on (Person’s name) each day and we, who live a long way away, could be assured all was well” and “We did have a missed visit recently. (Person’s name) can get by without them, it is not the end of the world, but it has happened more than once. We understand they have emergencies and sickness to cope with and the challenges of the pandemic on top.” We did not find anyone had been adversely impacted by not having their visit as planned.

Staff were not always provided with people’s preferred times of their visits. Some staff reported regular last minute changes to their rota, communicated by phone and text, and felt it was the reason some people had their visits later than planned or missed.

Staff were not always safely recruited. Two recently recruited care staff, who had not worked in care before, were working alone in the community, following a period of induction and shadowing, before the provider had received any references back from their previous positions.

Staff training was not always robustly monitored and recorded. Some newly recruited staff required necessary training in order to carry out their roles safely. This was addressed immediately by the manager once this concern was raised.

We had been assured at the last inspection that the service would begin to record and monitor all staff supervision in a format that could be monitored effectively. This had not been done. There were no records of staff having had an appraisal.

Staff, people and their families confirmed all people who received a service did have a care plan in their homes. Risk assessments had not always been updated in a timely manner and some required risk assessments had not been completed as required.

The service’s response to Covid-19 was good. For example, the service had a clear infection control policy in place to minimise the impact of the virus. Staff were provided with satisfactory PPE, and training to minimise risk.

There were sufficient staff to meet people’s needs. People, their relatives and staff told us the management were approachable and listened when any concerns or ideas were raised. The oversight of the recording and monitoring of the service provided was not always effective.

Everyone we spoke with spoke positively about the standard of care provided by the care staff. People felt safe with their care staff, who were respectful and kind.

Any changes in people’s health needs were escalated to the relevant professional and relatives were kept informed. Everyone we spoke with confirmed the care staff provided a kind, caring and responsive service. One healthcare professional told us, “They are very responsive, they work closely with us and relatives and go above and beyond to get things done at very short notice. They often will stay over the allocated time to give people what they need.”

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.

People were asked for feedback on the service’s performance. Responses to a recent survey were sent to us and were mostly positive.

The acting manager and the care co-ordinator had been working very long hours under enormous pressure throughout the pandemic. Staffing levels had dropped by nearly half at the peak of the pandemic which had led to the manager having to provide care and support. This had impacted on the records and governance of the service provided. There was no evidence of any input from the providers of this service during the absence of the registered manager.

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

Rating at last inspection.

The last rating for this service was Good. (Report published 28 November 2019)

Why we inspected

We received concerns in relation to the way the service was run prior to this inspection. It was alleged that some visits were late or missed completely, that not everyone had an accurate care plan in place, that new staff were not always safely recruited, and that training support was not effectively provided. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well-led sections of this report. We found no evidence during this inspection that people were at risk of harm from this concern.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Roselyon Domiciliary Care Agency on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to staff recruitment, support and training, audit processes and management oversight of the service, at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Old Roselyon Domiciliary Care Agency is a domiciliary care service that provides care and support to people living in their own homes in the community. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals. Longer visits for a 'sitting' service are provided for some people.

Not everyone who used the service received 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.

When we inspected the service was providing the regulated activity, personal care, to approximately 53 people in the Par, Fowey, St Blazey and St Austell areas of Cornwall.

People’s experience of using this service

People and their relatives told us care was delivered in a safe way. Staff provided care for people in a compassionate and respectful manner. People received a reliable service, had agreed the times of their visits and were kept informed of any changes.

People were supported by a stable staff team who had the skills and knowledge to meet their needs. Staff spoke passionately about the people they supported and were clearly committed to providing a responsive and caring service in line with people’s wishes.

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.

Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. Care plans were personalised to the individual and recorded details about each person’s specific needs and wishes. These were kept under regular review and updated as people’s needs changed.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. The service worked collaboratively with healthcare professionals to access training and advice which helped ensure people’s health needs were met.

There was a positive culture in the service and management and staff were committed to ensuring people received a good service. Staff told us they were well supported and had a good working relationship with each other and the management team. Staff had received appropriate training and support to enable them to carry out their role safely.

People, their relatives and staff told us management were approachable and they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service.

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

Rating at last inspection

The last rating for this service was Good. (Report published on 26 May 2017).

Why we inspected

This was a planned 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.

At the time of our inspection 43 people were receiving a personal care service. These services were funded either privately or through Cornwall Council.

We carried out this announced inspection on 3 and 4 May 2017. The inspection was announced a few days advance in accordance with the Care Quality Commission’s current procedures for inspecting domiciliary care services. At the last inspection, in May 2015, the service was rated Good. At this inspection we found the service remained Good.

People told us they felt safe using the service. Relatives also said they thought the service was safe. Comments included, “I am very pleased with the service”, “No complaints”, “Excellent service” and “I haven’t had any cause to complain.”

Staff treated people respectfully and asked people how they wanted their care and support to be provided. People and their relatives spoke positively about staff, commenting, “They are wonderful”, “I am very happy with all the staff”, “They are all very kind to me” and “They are all brilliant.”

People had a team of regular, reliable staff, they had agreed the times of their visits and were kept informed of any changes. No one reported ever having had any missed visits. People told us, “Staff always turn up”, “If staff are running late they ring and let us know”, “I have regular carers” and “I am very happy as I have the same carer five days a week.”

Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were appropriately trained to support people with their medicines when this was needed.

People had a care plan that provided staff with direction and guidance about how to meet people’s individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person.

Staff were recruited safely, which meant they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. Staff received appropriate training and supervision. New staff received an induction, which was soon to incorporate the care certificate. There were sufficient numbers of suitably qualified staff available to meet the needs of people who used the service.

The service was acting within the legal framework of the Mental Capacity Act 2005(MCA). Management and staff understood how to ensure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

There was a positive culture within the staff team and staff spoke passionately about their work. Staff were complimentary about the management team and how they were supported to carry out their work. The registered and deputy managers were clearly committed to providing a good service for people. Comments from staff included, “I enjoy working for The Old Roselyon”, “They are very well organised” and “You can speak with [Registered manager’s name] and [Deputy manager’s name] at anytime, nothing is too much trouble.”

People and relatives all described the management of the service as open and approachable. Comments from people included, “The service is well managed”, “[Deputy manager’s name] is very good” and “Excellent organisation; there is no aspect of my care that could be improved upon.”

There were effective quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. People told us they were regularly asked for their views about the quality of the service they received. People had details of how to raise a complaint and told us they would be happy to make a complaint if they needed to.

One person told us they were very satisfied with the care delivered but recently there had been a breakdown in communication. A previously planned visit had been withdrawn as deemed unnecessary, yet the relative claimed she had not been informed by either the agency or other professionals involved in making the decision.

Peoples' consent to care had been obtained and documented. We found peoples' views and experiences had been taken into account in the way the service was provided and delivered in relation to their care.

People's privacy and dignity was respected and people experienced care, treatment and support that met their needs and protected their rights.

Old Roselyon Domiciliary Care Agency supported people who used the services or others acting on their behalf, to make comments and complaints.

The agency kept accurate and personalised care and support records secure and confidential for each person who used the service.

People's privacy, dignity and independence were respected.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were safe from the risk of infection because appropriate guidance had been followed.

People were cared for by, suitably qualified, skilled and experienced staff.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.