Community Care Team Ltd

This comprehensive inspection was announced, which meant that we gave the provider 48 hours' notice of our inspection, in line with CQC guidance for inspection of domiciliary care services. This is so we can arrange for someone to be at the agency office to assist with access to information we need to see. We visited the agency office on 17 July 2018.

At our last inspection we rated the service as requiring improvement and we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulation 11 Need for consent. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well-led to at least good.

At this inspection we found that the provider had completed those actions and we found the service was meeting the fundamental standards of quality and safety. We found improvements had been made in establishing whether people had the capacity to make certain decisions relating to their health and care. Where they could not we saw relevant people had done so or decisions had been made in peoples best interest and were recorded. This meant appropriate consent had been obtained.

Providers of health and social care services are required to inform us of significant events that happen such as allegations of abuse. Whilst the provider had dealt with such events appropriately they had not always notified CQC. The failure to notify us of matters of concern as outlined in the registration regulations is a breach of the provider's condition of registration and this matter is being dealt with outside of the inspection process.

There was a registered manager in post who was on annual leave at the time of our visit. 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 were sufficient numbers of staff available to meet people's needs. Staff training was on going and they had received appropriate training to safely support and care for people in their own homes Staff were regularly supported by senior staff through staff meetings, observations in practise, supervisions and appraisals.

We received mixed comments from people about whether the service was managed well in relation to the planning of visit times and deployment of staff. We have made a recommendation that the provider uses feedback received to take action to improve on areas that could be better for people who use the service and for the morale of the staff employed.

When employing fit and proper persons the recruitment procedures had included all of the required checks of suitability. Hazards to people's safety had been identified and appropriately managed.

People received the support they needed to take their medicines safely. The staff identified if people were unwell and supported them to contact health professionals.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the service provision.

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.

The service is registered to provide personal care for people who live in the community and who have a physical disability, a sensory impairment, older people, younger adults and those with mental health issues.

The well-equipped office is located on an industrial business park in Leyland. It is within easy reach of the City of Preston, Leyland and Chorley town centre. Public transport links are nearby and ample car parking spaces are available.

This location is a new acquisition for Community Care Team Limited and this is the first inspection since their registration. The registered manager was on duty at the time of our inspection. 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 of the Health and Social Care Act and associated regulations about how the service is run.

When asked to describe the care they received in general terms, people who used the service and their relatives did not express any significant concerns. While some described the service as overall ‘very good’, others said, ‘It could be better’ and ‘It’s quite good’. The main issue raised was in relation to the time keeping of staff.

A business continuity plan had been developed, which outlined action to be taken in the event of any environmental emergency, which could affect the operation of the agency.

People’s needs had been assessed prior to a package of care being arranged and the planning of individual support was person centred, in order to accurately reflect specific needs. We found that people were treated in a kind and caring manner, with their privacy, dignity and independence being promoted.

We found that mental capacity assessments had not always been completed for those who were living with dementia, in order to establish if they were able to make specific decisions in relation to the care and support they needed. Therefore, people were not always supported to have maximum choice and control of their lives. However, staff supported them in the least restrictive way possible and the policies and systems in the service supported this practice.

Some care files we saw showed that individuals had signed consent forms for areas, such as support with medications. However, one care file we saw showed that consent for care workers to apply topical creams and to instil eye drops was signed by a relative of a service user who did not lack capacity to make decisions, but was unable to sign the consent form herself because of physical disabilities. We made a recommendation about this.

At this inspection we found that people were satisfied with the support they received around meal preparation.

A structured system for assessing, monitoring and improving the quality of service provided had not been fully developed at the time of this inspection. However, the provider recognised this was needed and therefore had plans to implement a formally recorded system, which would help to mitigate any potential risks and therefore promoted people’s safety. We made a recommendation about this. A wide range of risk assessments had been introduced in relation to people’s health care needs and the safety of the environments in which people lived.

Records showed that people's views about the quality of service provided were sought in the form of surveys. We made a recommendation about introducing surveys for the staff team. Complaints were being managed well and systems were in place for reporting safeguarding incidents.

People we spoke with told us they felt safe using the services of Community Care Team and that care workers were kind and caring. We found that recruitment practices were satisfactory, which helped to protect people from harm. Risk assessments were in place, which outlined actions that staff needed to take.

The staff team were well supported by the management of the home, through the provision of information, induction programmes and a wide range of training modules. The staff members we spoke with had a good understanding of people in their care and were able to discuss their needs well. Staff personnel records showed that regular supervision sessions were provided for staff. However, annual appraisals were not always evident.

It was evident that care staff sought advice from community care professionals, should the need arise. This helped to ensure that people’s health and social care needs were being appropriately met. Medicines were being managed well. However we made a recommendation about hand written entries on the Medication Administration Records (MAR) and protocols for ‘as and when required’ medicines.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for need for consent.

You can see what action we told the provider to take at the back of the full version of this report.