Archived: Care at Home Services (South East) Limited - West Kent & High Weald

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 service was providing personal care to approximately 180 people.

People’s experience of using this service

People told us their experiences of care were affected by timekeeping and scheduling difficulties. People told us they raised these issues with the office but were rarely asked for feedback about their experience of care. People told us, and records confirmed, their care was not regularly reviewed and care plans were not always up to date. The provider did not have effective systems in place to address these issues. The provider had not identified that the systems in place around the management of medicines were not sufficient, safe or robust. They had identified, but not effectively addressed, that care plans and risk assessments were not updated in response to changes in people’s needs and risks.

People were supported to have choice in their day to day lives and staff supported them in the least restrictive way possible and in their best interests. However, the provider had not always followed best practice guidance in terms of seeking consent.

People told us their regular care workers were kind, compassionate and supportive. Staff spoke about the people they supported in a sensitive manner. Staff recognised the importance of ensuring people were supported in a way that did not discriminate and promoted their dignity and independence.

People and relatives told us they were involved in their initial assessments. People told us they knew how to raise concerns.

Staff told us, and records confirmed, they received the training and support they needed to perform their roles. The registered manager had sought additional training from local dentists to support care staff to deliver oral care.

Staff spoke highly of the registered manager and told us there was a welcoming and friendly atmosphere in the office.

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 requires improvement (published February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines and risk assessments, reviewing and updating care plans, and governance systems at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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 service had a registered manager in post. A registered manager is a person who is 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 received a service that was safe. People felt safe with the staff. Staff understood the importance of keeping people safe and care staff followed the guidance that was in place. However, the registered manager did not notify us of an incident where an alleged theft had been reported to them and that the police were assisting the service with an investigation.

There were enough staff to meet people's assessed needs and staff were recruited safely.

Potential risks posed to people and others had been assessed and mitigated.

Referrals were made to health care professionals when people's needs changed. People were supported to maintain their nutrition and hydration and remain in good health.

Medicines for people were managed safely and administered by staff that were trained. Systems were in place to support people safely and effectively with their medicines.

Staff received the training, support and guidance needed to fulfil their role and meet people's needs. Staff worked alongside external health care professionals to support people that had specialist needs. New staff completed an induction before starting work for the agency.

People's needs had been assessed prior to receiving a service from the agency. People received a personalised service that placed them at the centre of their care and support needs. Care records were regularly reviewed to ensure they continued to meet people's needs.

People's rights were promoted and protected. People were encouraged to make their own choices about their lives. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were kind and caring towards people.

Staff respected people’s privacy and dignity. Staff knew people well and had knowledge about people’s histories, likes and dislikes. People’s equality, diversity and human rights were promoted and respected. People were supported to express their views and were involved in the development of the service they received.

Complaints were investigated and responded to in line with the providers policy. Systems were in place to monitor and improve the quality of the service that people received.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the registered office where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating with the registered office and on their website.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Registration Regulations 2009. You can see what action we have asked the provider to take at the end of this report.

Further information is in the detailed findings below

This is the first time the service has been rated Requires Improvement.

At the last inspection, the service was rated good overall and requires improvement for our question ‘Is the service safe?’

We carried out an unannounced comprehensive inspection of this service on 9 December 2015. A breach of regulation was found relating to safe medicine practice. After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment. We undertook this focused inspection to check that they had followed their plan and to confirm that they were meeting the regulations. This report only covers our findings in relation to this matter. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Care at Home Services (South East) Limited - Tunbridge Wells on our website at www.cqc.org.uk.

The service had improved since the last inspection. Medicines were now managed safely and records relating to medicines were accurate and complete.

Staff knew how to recognise and respond to abuse. There had been no safeguarding incidents since our last inspection. The whistle blowing policy had been reviewed and updated to ensure staff knew how to contact outside agencies if they had concerns about poor practice.

Risks continued to be assessed and minimised where possible. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required.

There was enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively. The registered manager had introduced new systems to monitor the arrival times of staff and the duration of care calls.

Care at Home services - Tunbridge wells is a home care agency based in Tunbridge Wells. The service provides care and support to people in their own homes including people with physical disabilities, people living with dementia and adults over 65 yrs.

The registered manager had recently left their 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. A new manager had been appointed and had applied to be registered with the Commission.

People we spoke with told us they were happy with the service they received. Everyone described their care as either excellent or very good. People’s relatives confirmed that they were happy with the service provided and that they felt their relatives were safe and well cared for.

People medicines were not always managed in a safe way. There were gaps in the records to confirm people had received their prescribed medicines and some records showed people had received an incorrect dose. You can see what action we have asked the provider to take at the end of this report.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns. There was unclear guidance in the policy for staff to follow to report concerns anonymously. We have made a recommendation about this. People told us that they felt safe using the service.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of recurrence could be reduced. Staff responded quickly to changes in people’s health and worked with health care professionals to meet their needs.

There were robust procedures in place for the recruitment of suitable staff. There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs. There were some discrepancies in the consistency of arrival time for some people’s calls. We have made a recommendation about this.

People told us that staff responded to their needs promptly and treated them with kindness and respect. People were satisfied with how their care was delivered. The registered provider and manager had clear person centred values that formed the basis of the service and these were followed by staff in practice.

The registered provider kept up to date with relevant best practice guidance in person centred care and the care of people living with dementia. They encouraged and enabled staff to improve their knowledge and skills on an ongoing basis. Staff had completed the training they needed to care for people in a safe way. They had the opportunity to receive further training and qualifications specific to the needs of the people they supported. All members of staff were regularly supervised in their roles to ensure they were equipped to meet people’s needs.

Clear information about the service and how to complain was provided to people. Information was available in a format that met people’s needs. All staff were knowledgeable in the principles of the Mental Capacity Act 2005 (MCA) and the requirements of the legislation. Staff sought and obtained people’s consent before they provided support.

People’s privacy was respected and people were supported in a way that respected their dignity and independence. The staff promoted people’s independence and encouraged them to do as much as possible for themselves.

Staff knew each person well and understood how to meet their needs. Each person’s needs and personal preferences had been assessed before care was provided. People’s care plans were reviewed regularly with their involvement and updated when their needs changed to make sure they received the support they needed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

The manager took account of people’s comments and suggestions. People’s views were sought and acted upon. The registered provider sent questionnaires annually to people to obtain their feedback on the quality of the service. The results were analysed and action was taken in response to people’s views.

Staff told us they felt supported in their roles. The registered manager notified the Care Quality Commission of any significant events that affected people or the service.