We carried out an unannounced inspection of Cherish UK Ltd on 08, 09 and 11 May 2018. We also gathered the views of people who used the service, their relatives and staff members via telephone calls and questionnaires between the 09 and 22 May 2018. The inspection was brought forwards as a result of concerns raised by people, relatives and staff working at the service directly contacting CQC and the local authority. Prior to our inspection the local authority had introduced a service improvement plan and were supporting the service with making the necessary improvements.Cherish UK Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults, younger adults and adults with learning disabilities or autistic spectrum disorder. The service is a member of the local authorities ‘Ethical Community Services Framework’ and was awarded the contract for provision of care in Atherton, Golborne and Lowton. The service also provides support to people in other areas including Wigan and Leigh. At the time of inspection 297 people were using the service.
The service was last inspected in April 2017 when it was rated as good. At this inspection we identified six breaches in four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment (two parts), staffing (two parts), person-centred care and good governance. You can see what actions we told the provider to take in the full version of this report.
At the time of the inspection there was a registered manger in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 received mixed views from people and their relatives in relation to feeling safe as a result of using the service. Some of the people we spoke with spoke positively about the care provided, whereas others commented on the staff being rushed and there being inconsistencies with carers.
We saw the service had safeguarding policies and procedures in place. Staff had all received training in safeguarding vulnerable adults and were able to demonstrate a good understanding of how to report both safeguarding and whistleblowing concerns. However we noted incidents had not been consistently reported to both the local authority and CQC.
We were aware the service had experienced issues with managing calls during the early part of the year, which had triggered the involvement of the local authority. Reviews of records and monitoring from February and March 2018 showed a number of calls had been missed or staff had attended the visit late. From speaking to people and their relatives, it was apparent some geographical areas had been more affected than others, as some people living in certain areas expressed no concerns with late or missed calls, whilst others in other areas reported feeling let down by the service.
Staff told us they had experienced problems with their rotas, both in terms of the feasibility of making the calls in a timely manner, and the lack of communication from office staff when these had been altered, which they stated was done ‘at short notice, often the night before or on the same day’. Again some staff had experienced more issues than others, which they attributed to the co-ordination of the calls.
We saw that robust recruitment procedures were in place to ensure staff working for the service met the required standards. This involved all staff having a DBS (Disclosure and Baring Service) check, at least two references and work history documented.
The service had systems in place for the management of medicines. However we received mixed feedback from the people we spoke with, with some having experienced no issues and receiving their medicines as required, whilst others reported their relatives had taken over this task, due to the service being inconsistent. Reviews of Medicine Administration Record (MAR) charts, showed these had not always been completed consistently and in line with company policy. Auditing of MAR charts had not taken place consistently until recently, which meant historical issues had not been identified timely.
Staff reported receiving the necessary level of training to carry out their role. We saw all staff completed an in depth induction programme, followed by a period of time shadowing experienced care staff, before being allowed to work independently with people who used the service. Staff told us ongoing and refresher training had improved over time and welcomed the practical sessions provided. However we found staff supervision had not been completed in line with the provider’s policy.
People spoke positively about the standard of care received and the caring nature of their ‘regular’ staff. They were reported to treat people with kindness, dignity and respect. Staff we contacted were knowledgeable about the importance of promoting people’s independence and people we spoke with confirmed they were encouraged by staff to do as much for themselves as possible.
We looked at 12 care files, which contained detailed and personalised information about people who used the service, including detailed guidance on the support people wished to receive during each visit. We saw that people or their representatives had been involved initially in planning the care provided, although reviews of care had not been completed consistently.
We received conflicting reports from people, relatives and staff in regards to the management of concerns and complaints. Whilst some people reported having nothing to complain about, or their concerns being addressed, others commented on not feeling listened to, not being happy with outcomes to their complaints or frustrated at having to continually raise the same issues.
The provider utilised a range of systems and processes to monitor the quality and safety of the service. However these had not identified some of the issues we identified during the inspection and we noted a number of audits had been completed retrospectively, due to not being done at the time. This meant issues from six to 12 months ago, were only just being identified.