Archived: Custom Care (Wednesbury)

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

All the people we spoke with told us that they felt safe with the staff that supported them. One person told us, 'They (staff) are very good always polite and helpful nothing is too much trouble.' Another person told us, 'Staff know what they are doing I am very happy.'

We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards, which applies to care homes. This is a domiciliary service. No one using this service was subjected to an application to deprive them of their liberty.

Records sampled showed that the provider had systems in place to establish whether people had capacity to give their consent to care and were able to make informed decisions. Staff spoken with understood and supported people to make choices.

All the people we spoke with told us they were happy with the care they received and would speak with the office staff if they had any concerns. All of the staff spoken with were able to tell us about the needs of the people they were supporting.

Is the care effective?

People spoken with told us and records sampled showed that they had been involved in an assessment of their needs and were able to tell staff what support they needed. This meant that people were able to influence the care they received.

All staff spoken with were able to tell us how they supported people and gave them choices about their care. All staff told us, and people confirmed, they asked people what support they wanted at each call. People confirmed that staff always asked them what support they wanted. All the people spoken with told us that they were supported by the same staff on most care calls which meant people received continuity of care from staff they felt comfortable with.

All of the people told us that staff did what they wanted them to do. They told us that if their care workers were going to be late they were kept informed either by the care staff or the office. One person told us, 'Staff only change when my regular staff are on holiday and then they send someone I know.'

Is the service caring?

All the people we spoke with and their relatives told us that the staff were caring. One person told us, 'They (staff) help me when I need help but they always ask if they can do anything.'

All the people we spoke with told us that staff respected their privacy and dignity and that they were given choices about their care. One person told us, 'I cannot praise the staff enough, kind considerate and very helpful'. This meant people were happy with their care.

We saw that reviews of people's care needs were completed to ensure that the service provided to them met their needs. All the people we spoke with gave positive comments about the care staff and their care. One person told us, 'No Worries, I am very happy.'

Is the service responsive?

People told us they were happy with the care they received. We saw from daily records sampled that where staff had concerns about people's health, additional support was provided or other health care professionals were made aware and advice sought.

Records sampled showed that there were systems in place to gather the views of people so that the service was developed taking into consideration the views of staff and people who received a service. All people that we spoke with told us they were happy with the service and had not needed to make any complaints.

Is the service well led?

We saw that the service had a staffing structure that enabled the service to be managed appropriately. This included a manager that had been registered with us and was responsible for the running of the service. There were team leaders and a person who monitored the calls through an electronic monitoring system. This meant that people were always able to contact a senior member of staff if they had any concerns. People were consulted about the quality of service they received. Comments and suggestions were analysed to identify where improvements were needed.

We saw that the provider sought feedback from people who used the service regularly by telephoning people or visiting them. This meant people were listened to and actions taken to address the issues raised.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We found that some improvement was needed regarding care planning and risk assessment processes.

People who used the service told us they felt safe. One person said, 'The staff are all very kind and have not done anything I do not like'.

Staff were knowledgeable about the signs of abuse and what their responsibilities were in respect of reporting any suspicions they had.

Staff we spoke with knew about the Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. No applications regarding DoLS had been submitted by the service. Staff we spoke with were able to explain the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

We found that improvements were needed in relation to the auditing of care plans and risk assessments to ensure the service people received was effective. We saw that a system was used to identify risks in relation to people's care. However, where risk had been identified no risk management plans were in place. This meant staff did not have sufficient information to minimise risks to people who used the service or themselves when providing personal care.

All the people spoken with told us that care calls were often late or early. This meant the service was not always effective in providing care as needed. We saw and people spoken with confirmed that they did not always get the time of call that had been agreed. For example, some people spoken with told us staff were late or too early. One person told us. 'It's like being a child having to go to bed early as they sometimes come at 7 pm which is not my time. My time is 8.30pm.' Out of the eleven people spoken 10 people told us they were not happy with the time staff came to them. We sampled staff rotas which showed staff had no travel time between care calls. This meant the provider did not have adequate processes and systems in place to meet people's care needs as agreed in their care plan.

People spoken with told us and records sampled showed that they had been involved in an assessment of their needs and were able to tell staff what support they needed. This meant that people were able influence the care they received.

Some people told us that they were supported by the same staff on most care calls. Others told us they did not know who would be coming. One person told us, 'It would not be so bad if the office let me know who is coming they just don't tell me.'

Is the service caring?

All of the people and their relatives we spoke with told us that staff were polite and showed respect.

All the staff we spoke with told us how they ensured people's dignity was respected. One staff member told us, 'Even if relatives who provide some care are present I still close the doors so the person has some privacy.' Another staff member told us, 'We are in people's homes, we have to respect them and provide support the way they want. This includes making sure they feel comfortable.' This meant that staff were aware that people's privacy was important to them and provided care so this was maintained.

The people we spoke with told us staff generally supported them in the way that they wanted to be cared for and supported. All the people we spoke with told us that all staff were kind and caring. One person told us, 'All staff are very pleasant I never feel that staff are rude or unwilling to help, I have not had any staff where felt I did not like them.' All the people spoken with told us that care staff were polite and friendly when they visited. All the people spoken with told us that staff asked them what they wanted doing and they thought staff were caring. This showed that staff were caring towards people and provided care in the way people wanted.

We saw from daily records sampled that where staff had concerns about people's health this was reported and other health care professionals were contacted to ensure the person received the right care.

Is the service responsive?

All of the people spoken with told us that staff did what they wanted them to do. Eleven out of the fourteen people spoken with told us that if their care staff were going to be late they were not always kept informed. One person told us, 'If my carers are going to be late they always let me know but it doesn't happen much.' Another person told us, 'I always get my calls some time they (staff) are late but they still come.' This meant that the service had not informed people about delays so that people were kept informed of the changes to their service.

Records sampled showed that there were systems in place to gather the views of people. A recent survey in January 2014 had been carried out. The manager told us that some improvements had been identified. The full report was not available during our inspection.

Before our inspection we had received three complaints about the service. We saw records to show that two had been investigated and concluded and one was still ongoing. There was no record to verify if the complaint had been resolved to the satisfaction of the complainants.

Is the service well led?

Staff rotas showed that there was no travel time between calls and staff time sheets showed that calls were made as per staff rotas. This is known as call cramming. One person told us,' The staff are lovely and try their best to come on time. It's the office they do it to suit them rather than us'. This meant that people who used the service did not always get their calls as per their agreed plan of care. This meant that the service was not planned and delivered to meet people's individual needs.

The manager told us that she had been given additional resources to ensure that people received a good service. This included employing senior care staff to monitor and supervise care staff. The manager told us that an electronic system to monitor calls was being introduced within two weeks of our inspection. The manager told us that she was aware of the failings in call times, care plans and risk assessment. This meant that manager was aware of the need for improvements and actions were being taken to address these shortfalls.