Archived: Somerset Care Community (Sedgemoor)

The last inspection of the service was carried out on 18 May 2015. At this last inspection a shortage of staff at all levels had impacted on the service’s ability to provide a safe service. At this inspection there had been key appointments made at management level. Recruitment of planners, supervisors and care staff had also been successful. Some vacancies remained and the service continued to pursue targeted recruitment to areas where staff were short. The recruitment of staff was pro-active and professional with a variety of initiatives being used to attract and retain staff.

Somerset Care Sedgemoor provides personal care and support to people living in their own homes. At the time of this inspection this large agency was providing support with personal care to approximately 550 people in Somerset. The area covered by the agency extended from Porlock to Burnham and Cheddar and included towns, villages and widespread rural areas.

There was no registered manager 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.There had been effective interim management arrangements in place. An experienced and enthusiastic manager had taken up post two weeks before the inspection and their registration process with us had commenced. Further time was needed to embed the new structure of the service and to complete planned improvements.

This was a very large service and most people and their relatives were very complimentary about the quality of the service provided and of the management and staff team. Whilst the majority of the people felt safe and comfortable with the way staff supported them they did not always feel the service was delivering a service that was fully responsive to their needs and preferences. Improvements were still required in this area. There were two recurrent themes that had an impact on how satisfied people felt. These were the timing of visits and the continuity of care. This meant having a team of regular staff who knew them well.

People did feel they were cared for by kind and understanding staff. There was a wealth of evidence to show people found staff helpful and supportive. People valued their relationships with the staff team and felt they would help them in any way they could. People told us “Staff are lovely”, “Staff are kind and caring”. “Nothing is too much trouble”. “They couldn’t do anything better”. “They are marvellous. I don’t know what I would do without them.” “They are always cheerful” “They have been absolutely wonderful.”

Staff knew how to recognise signs of abuse and all said they were confident that any issues raised would be appropriately addressed by the manager. People felt safe with the staff who supported them. Where allegations or concerns had been bought to a care manager’s attention they had worked in partnership with relevant authorities to make sure issues were fully investigated and people were protected.

Care was planned and delivered in a way that was personalised to each person. Staff monitored people’s healthcare needs and supported them when they were unwell or had health emergencies. Where changes in needs were identified, care was adjusted to make sure people continued to receive care which met their needs and supported their independence.

New staff received a thorough introduction when they began work and there was a system of training and up-dating staff so they maintained and developed their skills.

There were systems in place for people using the service and staff to make suggestions or complaints about the service. When people made complaints most of them were satisfied with the action taken by the service.

There were systems in place to monitor the quality of the service and plan on-going improvements.

61 questionnaires were sent to people using the service. Each person was also sent an additional questionnaire to give to a relative, friend or advocate for completing. A total of 19 questionnaires were returned.

We contacted 25 people by telephone. 11 people were available to speak with the expert by experience. The inspector spoke with six relatives, 10 people and visited one person in their own home. We spoke with ten members of staff and looked at six support plans. We considered all the evidence we had gathered under the outcomes we inspected.

We found overall that some people were satisfied with the care they received however a small but significant number of people and their relatives were concerned about the reliability of the service.

We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We had received concerns from relatives of people receiving care from the service before we commenced the inspection. They were concerned shortage of staff had led to missed calls and this had put people at risk. We found there was a shortage of staff and this had impacted on several aspects of the service. When visits to people were missed there was the risk people had not received the care and treatment they needed. We were told by relatives of occasions when they had stepped in to provide care because the agency had missed a visit.

Staff tried to ensure people received safe and effective care which was in accordance with people's individual needs. Some staff worked extra shifts to make sure visits were 'covered.' Planning staff worked hard to ensure wherever possible care visits were made on time and as recorded in people's support documents.

The people we spoke with told us they felt safe when receiving support from care staff and they commented on the kindness they received. Comments included 'Yes I feel safe. There are not any that I wouldn't want in my house.' All who responded to our questionnaires felt they were safe when the care workers visited them.

The provider had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns.

Each support plan contained details of how to access the person's home and any necessary information regarding the security of the person and the environment. Support plans contained contact details of relatives or friends who could be contacted in an emergency. Relatives told us they had been contacted when care staff were not available to deliver care.

Is the service effective?

Staff vacancies in all positions had impacted on the effectiveness of the service. The manager told us about the staff shortages that had occurred in all staff positions. There continued to be vacancies for care and support staff. There were vacancies for senior carers. This meant there were fewer experienced staff available to pick up calls, cover sickness and carry out reviews of peoples care.

There were shortages of supervisors and planners in the office. The manager told us additional support from other areas of the company had been arranged. There was still a large amount of 'firefighting to be done each day.' This meant staff were asked to provide care at short notice. People told us that they often did not know who was coming to deliver their care or at what time.

Is the service caring?

People told us staff were kind and caring. We talked with staff who told us how they supported people in a committed and professional manner. Staff talked about working extra hours so people were not 'let down.'

The people we spoke with were complimentary about the care they received and of the staff who supported them. People mentioned regular carers by name. One person said 'They are more like friends than carers.' Everyone we spoke with told us they looked forward to the carer's visits.

Is the service responsive?

When we reviewed the questionnaires returned by people who use the service and their relatives we found over half (66.7%) felt that people got the care and support they expected. People mostly thought their support and care helped them to be as independent as they could be.

Some people who contacted us were not satisfied with the care they received. We heard from relatives who were very concerned about missed or late calls from care staff.

The care records we read showed staff initially assessed people's needs and planned their care with them. There was a system of annual reviews in place so care and support plans could be up-dated. However some of the people we spoke with said they had not had a review within the past year.

Is the service well led?

There was a registered manager in post. A registered manager is a person who has been registered by the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

An experienced deputy manager assisted with the daily running of the service.

There were systems in place which monitored and sort to improve the quality of the service provided. There were plans in place to recruit new staff.

Risks to people were assessed and reviewed. If risks could be reduced then appropriate measures were taken. If any incidents or missed visits occurred they were reviewed to see if any lessons could be learnt or trends identified.