Evolving Care Ltd Crewe

Evolving Care limited is a domiciliary care service providing care and support to people living in their own homes. At the time of our inspection the service was providing personal care to 166 people.

People’s experience of the service and what we found

We received feedback from people and families about requested changes to times that could not be fulfilled and reports of staff being late, frequent breakdown of staff vehicles and staff changes without informing the person or the family member.

People told us that they felt safe whilst receiving care and many were complimentary about the standard of care.

Risks to people's health, safety and well-being were not effectively managed after incidents.

The management of people's medicines remained unsafe. Medicine records and risk assessments were not effectively managed or updated. We were not assured that annual medication competencies for staff and senior staff were effectively managed.

Safeguarding notifications were not always made to CQC. This was corroborated with the local authority and our notifications system.

Staff were not always recruited safely. We were not assured that the quality of the induction training as well as the training courses content was effective. Training compliance information was observed and staff feedback on the process and experience differed.

Rotas were not suitably maintained. We found on two consecutive visits that the rota's were not complete for the following week, and this was corroborated by staff.

We received feedback from people and families about requested changes to times that could not be fulfilled and reports of staff being late, frequent breakdown of staff vehicles and staff changes without informing the person or the family member.

People told us that they felt safe whilst receiving care and many were complimentary about the standard of care.

We saw there had been improvements in the quality systems and auditing processes from the last inspection, the service had made improvements to monitor the care system that staff use daily from the office and on an on-call/out of hours basis, as well as auditing the system and analysing service data periodically with an action plan to complete.

Right Support, Right Care and Right Culture:

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there was people using the service who have a learning disability and or who are autistic.

Right Support

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Risk assessments and care plans had been developed to meet people's needs.

People were supported to access healthcare and other specialist services. Staff worked closely with other professionals and organisations to ensure positive outcomes were achieved for people.

Right Care

People received a caring service and a consistent team of staff to ensure consistency and continuity. Staff protected and respected people's privacy and dignity, understanding and responding to their individual needs. People could communicate with staff because staff supported them consistently

People had opportunities to participate in activities they were interested in as well as regular contact with family members and friends.

Right Culture

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the care and support plan in the service supported this practice.

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 23 August 2021.

We requested an action plan from the last inspection from the provider to understand what they did to improve the standards of quality and safety and the breaches identified.

Why we inspected

The inspection was prompted in part due to concerns received about staffing concerns staff working patterns and workload . A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of Safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Evolving Care Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to reporting notifications, safe care and treatment, staffing and good governance.

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

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

Risks presented to people and staff by the COVID-19 pandemic were not assessed or recorded and staff were not always being tested for COVID-19 in accordance with government guidelines.

Medicines records and governance arrangements did not always assure that medicines were managed safely.

Some people received consistent care and support from staff who knew them well and were familiar with their needs. Six out of fourteen people spoken with told us that they, or their relatives, had received inconsistent care with staff often arriving too early or too late.

An electronic call monitoring system was used to ensure that managers were able to respond when calls were late or missed but this was not being used effectively and the information produced was not always reliable.

The provider's quality systems were not sufficiently robust to identify the concerns we highlighted with lack of COVID-19 risk assessment, medicines and electronic call monitoring records. The provider was very responsive in taking actions to address the issues we found on inspection however we could not fully assess the impact of these actions until they were fully embedded.

Risks to people’s health and well-being other than those associated with the COVID-19 pandemic were clearly identified and care plans set out what support the person needed in the way they wanted their care to be provided.

People told us that they felt safe whilst receiving care and many were complimentary about the standard of care and services they had received.

The providers policies and procedures had been revised in the light of the COVID-19 pandemic and staff had received relevant training and had access to appropriate personal protective equipment (PPE) in accordance with government guidelines.

Rating at last inspection. The last rating for this service was good (published 31 August 2019).

Why we inspected

We received concerns about the reliability and safety of the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well led only.

We reviewed the information we held about the service. No areas of concern were identified in other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We have identified a breach of regulations in relation to governance and record keeping at this inspection. Please see the action we have told the provider to take at the end of this report.

Prompt action was taken by the registered manager after the inspection to mitigate risk and improve the quality of care in response to the concerns we found during our inspection.

Follow up

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 program. If we receive any concerning information we may inspect sooner.

Evolving Care Limited is a domiciliary care service, providing personal care to up to 140 people. The service was providing care to 80 people at the time of the inspection. It provides a service to older people, young disabled adults and children .The service also offers short term ‘rapid cover’ to people requiring emergency care and support until long term service provisions are found. Not everyone who used the service received personal care. The Care Quality Commission only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider wider social care provided.

People’s experience of using this service and what we found

People told us they felt the service was safe. The service had safeguarding policy and staff had received training and knew what signs of abuse to look out for. Staff recruitment was robust and staff told us they had an induction. People were supported to take medicines safely.

Peoples needs were assessed in line with current guidance and people’s preferences, religious and cultural aspects were incorporated into care plan. People felt happy with the skills of the carers. Staff told us they had regular supervision and annual appraisals. Staff worked with health professionals as needed to support people’s needs.

People gave positive feedback about the care they received and the positive staff attitude. There was evidence to show people were involved in the care planning and reviewing of the service provided to them. People told us their privacy and dignity were always respected.

We saw care plans reflected peoples’ individual needs and risk assessments were person-centred, staff knew these. The service had a complaint policy and procedure and we saw complaints were dealt with in line with the policy. We also saw the service had received many compliments.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The management team were open and transparent during the inspection and responded to any requests made. People and staff were involved in the service through surveys and team meetings. The service had an effective quality assurance system in place to monitor and improve key aspect of the service. There was evidence of partnership working with health and social care professionals supporting people’s needs.

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 19 July 2018).

Why we inspected

This was a planned inspection based on the previous rating

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service was a domiciliary care service with 90 service users at the time of our inspection. It provides personal care to people living in their own houses and flats in the. It provides a service to older adults, younger disabled adults and children.

A registered manager was 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.

On the previous inspection on 18 and 19 September 2017 and 11 October 2017 the provider was in breach of multiple regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014.

They were in breach of Regulation 9 Person Centred Care, Regulation 10 Dignity and Respect, Regulation 11 Consent, Regulation 12 Safe Care and Treatment, Regulation 13 Safeguarding, Regulation 16 Complaints, Regulation 17 Good Governance and Regulation 18 for failure to notify under the Registration Regulations. We served enforcement action and imposed a condition on the provider’s registration to prevent them from taking any new care packages or increasing existing care packages without seeking prior permission from the Commission.

On this inspection we found the provider was not in breach of any of the regulations and had met the legal requirement. They had sought the Commission’s permission to increase seven existing care packages since the last inspection and permission had been granted.

Following the last inspection we met with the provider and asked the provider to complete an action plan to show us what they would do and by when to improve the service related to each breach of the regulation. On this inspection we found the provider had implemented all actions set within their action plan according to each key question and breach of the regulation.

The provider had improved the care plans to include likes/dislikes and preferences for a male or female carer. Further improvements were needed to improve times of calls and we made a recommendation about this.

We found the staff were treating people with respect and were promoting people’s dignity. People told us they felt staff respected them. People were being encouraged to be as independent as possible.

People told us they felt safe with the staff providing care and the systems to keep people safe had improved. Analyses of incidents and accidents were being completed.

Further improvements were needed to ensure medication anomalies on medication administration sheets were identified and people received their medicines when they needed to in order to ensure medication practices were always safe.

Recruitment procedures were including checks such as the Disclosure and Barring Service checks. References were sought however, the policy stated two references were needed from previous employers but we found this was not always followed.

Safeguarding procedures were more robust with analyses of safeguarding concerns being undertaken each month.

There were enough staff within the service with no missed care visits evidenced on this inspection. People were not always receiving their care call at a time stipulated in their care plan and we made a recommendation about this.

We viewed people’s daily records and found people were being supported to have enough to eat and drink with monitoring taking place when appropriate.

Healthcare professionals we spoke with spoke highly of the staff and were involved in people’s care.

The service had implemented a new consent form and system of seeking people’s consent for changes to their plan of care. Principles of the Mental Capacity Act 2005 were being followed.

The complaints process was more robust with all complaints seen logged responded to with an outcome letter.

The service was seeking people’s views about the service with a new survey sent to staff, people using the service and family members. Actions were seen from the comments obtained.

New audit tools had been implemented such as a new care plan audit tool to drive improvements.

The leadership was strong. The provider had a clear vision of continuous improvements being implemented going forwards.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was 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. The registered manager was present for the last day of this inspection but the provider was present throughout each day of the inspection.

Evolving Care Limited is a domiciliary care service providing personal care and support to 124 people at the time of our inspection across Crewe and Cheshire East They had 59 care staff providing care.

We checked whether there were enough staff to meet the care needs of people and found mixed views. One relative who we spoke with raised concern regarding staffing levels and consistency of staff. Another relative told us they were short staffed but staffing had improved. Other people we spoke with said they had consistent carers but there were concerns about cover when they were away.

Staff were receiving safeguarding training and could tell us what they would do if they had a safeguarding concern. There was a system of reporting alleged abuse in place however we found some allegations of neglect had not been reported to the safeguarding authority. Safeguarding concerns and investigations were not being analysed for trends to be identified.

Recruitment practices were not robust enough. We were informed by the service interviews were taking place but there was no documentation in place of interviews. We found two staff files contained evidence of a previous conviction without a detailed risk assessment. The provider took action immediately and ensured a risk assessment with control measures were in place during our inspection.

Risks were not always being identified or mitigated for people. Risk assessments were either absent or not detailed or consistent enough for staff to know how to always deliver safe care. The provider took action immediately and put risk assessments in place when we requested them such as for one person with continuous oxygen.

Incident forms were being completed in people’s care plans and there was an accident book. We found no system of analysing incidents for the provider to then be able to identify any patterns emerging to reduce risks with lessons learnt.

Missed visits were not being collated or analysed. Missed calls/late/early visits were an issue for people. We viewed numerous complaints regarding timings of visits.

Most people we spoke with spoke highly of their regular care staff who provided care. We found people had not always been spoken with appropriately by staff and their dignity not always upheld. One relative expressed concern with us a carer had not acted in their relatives best interests and left them alone when they were unwell.

There was a complaints policy and system in place with a number of complaints seen in the complaints file. There was no analysis of complaints. Not all complaints were taken forward and investigated by the service.

People were being supported to drink, eat and with their meal preparation. We observed one person being provided with a choice of what to eat during our visit in their own home. People did not always receive their food and drink due to missed or late visits.

The process of obtaining consent from people in line with the Mental Capacity Act 2005 did not include specific consent for holding key codes, PRN prescribed medicines, changes to care plans or to the 30 minute waiting period either side care visits.

The care plans we checked in people’s homes at the time of our inspection did not contain enough personalised information such as previous employment, preferences, likes or dislikes. When we returned on 11 October 2017 and checked new care plans we found they had improved but further improvements were needed.

There were monthly medication audits being undertaken however they had not identified the concerns we found in relation to instructions and start/end dates being absent. Governance systems did not include analyses of complaints, incidents, missed visits or safeguarding concerns.

At the time of our inspection the provider had identified some improvements were required in relation to care planning and had sourced a private consultant/healthcare professional to devise new care plans.

Additional staff had been recruited to undertake audits of rotas, care records including MARS (medication administration sheets) and reviews with people receiving a service. These new staff had not yet started in their new roles at the start of this inspection.

The provider was seeking the views of people by undertaking surveys and spot check phone calls. Staff meetings were taking place.

Staff were receiving training and the service had a training matrix in place. Their induction included shadow shifts and competency checks which were seen recorded in staff files. Staff supervisions were taking place and there was an appraisal system.

The overall rating for this service is ‘Inadequate’ and the service is therefore in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The inspection was carried out on 17 November 2016 and was announced

There was a registered manager in post who was present during 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.

The provider had not always ensured that staff were effectively deployed to meet people’s needs.

Staff had limited understanding of the Mental Capacity Act and how this affected their practice. Where people lacked the capacity to make their own decisions these were made in their best interest.

People and their relatives told us that they felt the service provided was safe. Staff and the registered manager had received training on how to keep people safe from abuse. They were able to explain the action they would take if they identified any concerns. The provider completed recruitment checks prior to new employees starting work with people to ensure that they were suitable for their role.

Staff were aware of the risks associated with people’s needs and how to minimise these. Staff demonstrated they would take appropriate action in the event of an accident to ensure people’s safety and well-being.

People were satisfied with the support they received to take their medicines. Staff had received training on the safe administration of medicine. Regular competency assessments were completed to ensure they continued to manage medicines safely. Staff monitored people’s health and referred them to health care professionals if they identified any concerns.

People were supported by staff who had received induction into the service and training to meet their individual needs. Staff received support and guidance from management who they found approachable and responsive.

People dietary needs were assessed and monitored and they encouraged people to follow healthy diets to promote their well-being. Where required people were given support to eat and drink.

Staff had developed caring relationships with people and treated people with dignity and respect. People were offered choice and felt listened to.

People were involved in planning and reviewing their care needs. Staff knew people and their preferences well.

People and relatives found staff and management easy to talk with and felt they could raise any concerns they had with them. The provider had a clear complaints process which they followed.

People and their relatives were given opportunities to be involved in the development of the service through care plan reviews, spot checks and yearly surveys of the service.

The provider had a clear vision for the service which was shared by staff. The provider had a range of quality assurance checks to monitor the quality and safety of the service which they used to drive improvements.

We looked at the policies and procedures in place to protect people from harm and abuse. We found that the procedures were up to date and all the staff had received training in safeguarding vulnerable people.

We looked at the support that staff received. We looked at the systems in place and found that staff received various types of support which included regular supervision, a yearly appraisal and all mandatory training as well as specific training to meet particular people's needs.

We looked at the quality assurance systems in place and saw that the service was carrying out sufficient checks to ensure that they were providing a good service.