Bexley Home Care

This inspection took place on 18 and 19 July 2018; and was announced. The last inspection of the service took place 20 July 2017 where we found a breach of regulation of the Health and Social Care Act. The provider had not ensured that staff received appropriate training to enable them carry out their duties effectively. The provider sent us an action plan on how they would improve. At this inspection, we found that the service had made the required improvement and complied with our regulations. We have rated the service Good.

The service had a registered manager at the time of the 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were trained, supported and supervised in their roles. Staff were trained to keep people safe from abuse. They knew the procedure to report any concerns appropriately. People were protected from avoidable harm as risks were assessed and management plans were in place which guided staff on how to reduce risks to people. Staff reported incidents and accidents. The registered manager reviewed them and took actions to address them and reduce reoccurrence.

There were sufficient numbers of experienced staff to support people safely. Staff were appropriately deployed to cover care visits. When staff were recruited they were vetted to ensure they were suitable to work with people. Staff provided people with the support they required to take their medicines safely. The risk of infection was minimised as staff were trained and knew the procedure to reduce infection from spreading.

People received the support they required to eat and drink. Staff supported people to maintain their health and access healthcare professionals as their needs required. Staff liaised with other professionals to ensure people’s needs are met.

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 and the registered manager understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005. Staff involved people in their care delivery and ensured people consented before they were delivered.

People received care from staff who were compassionate and caring. Staff supported people to make day to day decisions about their care. People were involved in planning and delivering their care. People were encouraged to maintain their independence. People’s privacy was respected and their dignity was promoted. Staff knew people well and had developed positive relationship with them. Staff were trained to deliver end of life care in line with people’s wishes.

People had their needs assessed before they started using the service. People’s care needs were reviewed and care plans were updated to reflect people’s current needs. People received the care and support they needed to meet their needs. People knew how to complain if they wished. The service sought the views of people about the care they received and acted on them.

People and staff told us the organisation was well managed. There was an open management style at the service. The provider undertook checks and audits to monitor service delivery and drive up improvements. The provider worked with other organisations to develop and improve the service.

The service is registered with the Care Quality Commission to provide support with personal care to people living in their own homes. At the time of our inspection 86 people were using the service.

The service had a registered manager in place. 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.

During this inspection we found one breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because staff had not received all appropriate training to provide the skills and knowledge for them to carry out their duties in a safe and effective manner. You can see what action we have asked the provider to take at the end of the full version of this report.

There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures were in place and people told us they felt safe using the service. Risk assessments provided information about how to support people in a safe manner. Medicines were managed safely.

People were able to make choices for themselves where they had the capacity to do so and the service operated within spirit of the Mental Capacity Act 2005. Where the service supported people with meal preparation people told us they were able to choose what they ate and drank. People were supported to access relevant healthcare professionals.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

People’s needs were assessed before they began using the service. Care plans were in place which set out how to meet people’s individual needs and these were subject to review. The service had a complaints procedure in place and people knew how to make a complaint.

Staff and people spoke positively about the registered manager. The service had various quality assurance and monitoring systems in place, which included seeking the views of people on the running of the service.

We carried out this announced focused inspection on 03 November 2016 to check that the provider had met the requirements of the warning notice. We gave the service two working days' notice of the inspection because the service provides a domiciliary care service and we wanted to be sure the registered manager would be available.

At this inspection we looked at aspects of the key question 'Is the service safe?' This report only covers our findings in relation to the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Carewatch (Bexley)' on our website at www.cqc.org.uk. The provider was still in the process of addressing other breaches of legal requirements at the time of this inspection, in line with their action plan. We will follow up on these at a later date.

Carewatch (Bexley) provides personal care and support to approximately 100 people in their own homes in the London Borough of Bexley. The service had a 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.

At this inspection we found a breach of regulations because whilst the provider had taken action to address the issues identified at the last inspection, we also found some residual concerns in the recording of people’s medicines support, and medicines audits were not always effective in identifying issues or driving improvements. Following our inspection we wrote to the registered manager regarding these concerns and they submitted further evidence to demonstrate that people’s medicines had been administered safely.

We also identified a further breach of regulations because staff had not identified or acted on a safeguarding concern identified during the inspection process. This related to the support one person required with their medicines whilst not receiving services. You can see what action we told the provider to take at the back of the full version of the report.

Carewatch Bexley provides personal care and support to people in their own homes in the London Borough of Bexley. At the time of our inspection there were approximately 110 people using the service. The service had a 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.

At this inspection we found a breach of regulations because records had not always been maintained to confirm people had received their medicine as prescribed. There was not always guidance in place for staff on when to support people with their ‘as required’ medicines and records showed that one person had been supported to take an ‘as required’ medicine unsafely.

We found further breaches of regulations because systems for monitoring the quality and safety of the service were not always effective, and because there was not always sufficient guidance in place for staff on how to manage risks to people safely. Additionally, we found that risk assessment reviews did not always take into account changes in people’s circumstances.

You can see what action we told the provider to take in respect of these breaches at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Staff told us people were able to make decisions for themselves and that they sought people’s consent when offering them support. Minor improvements were required to ensure the service consistently complied with the requirements of the Mental Capacity Act 2005 because one person had been assessed as lacking capacity without identifying the specific decision the assessment related to. The registered manager confirmed they would address this minor issue promptly following our inspection.

The provider undertook appropriate recruitment checks before new staff started work and there were sufficient staff deployed to meet people’s needs. People were protected from the risk of abuse because staff had received safeguarding adults training and were aware of the action to take if they suspected abuse had occurred.

Staff were supported in their roles through regular supervision and an annual appraisal of their performance. They had received training in areas considered mandatory by the provider which was refreshed on a regular basis. Where required, people were supported to maintain a balanced diet. People told us staff treated them with dignity and respected their privacy. People were involved in making decisions about the support they received and were treated with consideration. The provider supported people to access health care services if needed.

People were aware of how to make a complaint and had confidence any concerns they raised would be addressed. People’s care plans included information about their individual needs and preferences and were reviewed annually or more frequently if their needs changed. The provider sought feedback from people through telephone monitoring and an annual survey and feedback indicated that people were happy with the service they received. Most people spoke positively about the management of the service although two people told us they were not always informed of changes if the staff member who usually supported them was absent from work. Staff spoke positively about the leadership of the service and told us they worked well as a team.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People's needs were assessed and risk assessments were carried out before care was provided. These were regularly reviewed so that staff were aware of the best way to provide support.

The manager and other supervisors were available on a daily basis and out of office hours to oversee the staff, and monitor that people were being safely supported, for example in helping people to be safe during personal care. We were told by 12 staff and by 35 people we spoke with who used the service that staff were usually on time and provided their support safely. For example one person said, 'the staff know me very well and I feel very safe in their hands.' Another person said, 'I can't fault the staff and they seem to be well trained and take care of all my needs.'

There were arrangements in place to deal with emergencies and to make sure people were safe. People's health needs, such as physical disability support were included in their care planning to ensure that important health needs were met.

Staff carried photographic identification issued by the agency, to ensure that people who used the service were able to identify them and feel safe. All of the 35 people we spoke with who used the service or their relatives said that the staff always carried identification, and they felt that this was reassuring and gave them confidence about their security.

Is the service caring?

We spoke with 35 people who used the service or their families and people told us that the staff and supervisors were very caring and supportive. Many said staff always took the time to speak with them and spoke with them in a manner they understood. One person said: 'the staff are very polite and nothing is too much trouble to them.' Another person said:' I think the standard is high, the staff are good people to have in my home.'

Is the service effective?

We saw from 16 people's records we looked at that people's needs were assessed and a plan drawn up to meet those needs. Staff we spoke with were aware of the importance of seeking people's consent for the care provided such as medicines management, and people were asked for their consent before care was provided. People we spoke with told us they were happy with the plan provided. People's support plans were reviewed and changed when necessary in response to changing needs, for example in negotiating higher levels of support when necessary, or in changing the time of visits to accommodate people's needs such as activities. People and their families told us they were involved in the reviews.

There were suitable policies in place for consent to care, assessing and planning care, safeguarding people and managing medicines. All of the people we spoke with told us the staff knew how to support them well. People who used the service were consulted for their views on the service they received on a regular basis, which involved the person, their family or advocate and social services. We saw that any changes they requested were included in a revised care plan.

Staff were provided with adequate support, guidance and training to do their job. They were experienced in supporting people with care needs such as dementia and physical disabilities and they told us that the training they received equipped them to support people with confidence.

Is the service responsive?

People we spoke with who used the service told us that the staff and manager always listened to their concerns and did something to help sort out any problems they were experiencing. Almost all of the people we spoke with told us that the agency took care to ensure that they were happy with the staff allocated to them at the start of, and throughout care provision. For example one person said 'I was not happy with the staff as we didn't seem to understand each other and the agency swapped for another staff and I am happy with them'.

People's complaints and concerns were listened to and acted on promptly by the agency. We saw that complaints received had been recorded and responded to and three people we spoke with who had made a complaint said the agency had acted quickly in changing the time of the care provided to meet their specific personal needs, such as to ensure they were able to be ready to go to church on Sunday.

Is the service well led?

The registered manager was qualified and experienced and was involved in the day to day management of the service. There was an out of office hours on call system in operation to ensure that management support and advice was always available. There was a system for doing spot checks on staff working with people to monitor the quality and safety of care provided. Comments received from people who used the service and families included: 'The supervisors are very good and regularly call in to see how the staff are doing, I once had a problem with one staff and it was dealt with immediately,'

12 staff we spoke with told us that they felt the agency was very well managed and they received direction and training to help them to support people. Regular staff meetings and supervision sessions were held, and staff said they felt able to raise any issues with the management openly and honestly, and felt the manager followed up on any issues quickly.

There were a range of systems in place to monitor the quality of people's care, and to make sure any concerns about staff, management or the way in which care was delivered were addressed. This included quality assurance procedures and processes for checking that people's care was being planned and for asking people for their views about their care. The majority of people who used the service we spoke with told us that they felt the agency was well managed, and that they had regular contact from the office to check that their support was happening as planned.

The three people who used the service that we spoke with were unable to particpate in meaningful discussions due to their medical conditions. However we were able to speak with two family members on the day of our inspection who informed us about their concerns regarding the service.

We found that adequate consent processes and procedures were not in place and did not appear to be used appropriately despite two newly inducted staff informing us that they had, in their induction training, been encouraged to seek consent before providing care.

We also looked at the care records of fifteen people who used the service. A majority of the care plans that we looked at were incomplete or vague and lacking in detail with respect to information to guide staff in the provision of care for example, "sight is poor" or "hearing is ok" with no detail about corrective measure that were in place nor was there any further explanation about what this meant for staff in the provision of their care. The provider co-operated with other healthcare services; however, the recommendations made by other healthcare advisers was not always included in care plans.

We spoke with five members of staff who were "very happy" and appeared to be well supported.

We found that there were ineffective complaints mechanisms and processes for identifying and handling complaints from people who used the service and their carers

People we spoke with told us that staff were always on time and that they felt safe and had no concerns about their care. One person who used the service told us; 'I know the staff and trust them, and the office sort out replacement staff quickly if the usual staff can't come'. All of the people we spoke with said they always got the same carers who knew them well.

All of the people we spoke with who used the service told us they were involved in the planning of their care, and had been asked for their views when reviews were carried out. We reviewed information about eight people's care and found that their care needs were being planned for. We spoke with staff and found that they understood people's care needs and how to protect them from risk and harm.

We found that staff had adequate training and were supported by the management to do their job. Six staff we spoke with said the management were very supportive and the training was good. Staff supervision and training was up to date. The provider used effective systems to regularly check that care was being provided safely and appropriately.