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Inspection carried out on 7 December 2015

During a routine inspection

We inspected Everycare Midsussex on the 7 December 2015. Everycare Midsussex is a domiciliary care agency providing personal care for people with a range of needs living in their own homes. These included people living with dementia, older people and people with a physical disability. At the time of our inspection the service supported 52 people and employed approximately 28 staff. Everycare Midsussex operates as a franchise business, trading as Cura Muneris Limited. Everycare provide domiciliary care franchises and services across the UK.

The service had a registered manager. 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.

Everycare Midsussex was last inspected on 10 September 2014 and concerns were identified around care planning, quality monitoring and record keeping.

Quality assurance was undertaken by the provider to measure and monitor the standard of the service provided. However, we found that despite checks taking place, we could not identify how the provider monitored or analysed information around accidents and incidents over time to determine trends, create learning and to make changes to the way the service was run. This is an area of practice that requires improvement.

The service had good systems in place to keep people safe. Assessments of risks to people had been developed and were continually reviewed. The service employed enough, qualified and trained staff, and ensured safety through appropriate recruitment practices.

People said they always got their care visit, they were happy with the care and the staff that supported them. One person told us, “I get the same group of carers and they are excellent. I feel totally safe with them. They are generally on time and stay for the full time”.

Medicines were managed safely and people received the support they required from staff. There were systems in place to ensure that medicines were administered and reviewed appropriately.

Should people lack mental capacity to make specific decisions, the service was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. Care staff always sought people’s consent before delivering care. One person told us, “They always ask my consent before they start anything for me”.

People told us they were involved in the planning and review of their care. A person told us, “I had a planning meeting when I first came out of hospital and my son was involved”. We were given examples that showed the service had followed good practice and safe procedures in order to keep people safe.

Staff received an induction, basic training and additional specialist training in areas such as dementia care and catheter care. Staff had group and one to one meetings which were held regularly, in order for them to discuss their role and share any information or concerns.

If needed, people were supported with their food and drink and this was monitored if required. One person told us, “They make me some soup and always wash up the tea things”. Another person said, “They prepare my [relative’s] dinner for him and that really helps me”.

The needs and choices of people had been clearly documented in their care plans. Where people’s needs changed the service acted quickly to ensure the person received the care and support they required. A member of staff told us, “I visited a person today and they were not well. We contacted the paramedics”.

People and their family members told us they were supported by kind and caring staff. A person told us, “The carers who come to see me are so thoughtful. They speak pleasantly to me and we always have a laugh”. Another person said, “The care we get is excellent, nothing is too much trouble for them. They are polite and respectful to me and my [relative], she really likes them”. Staff were able to tell us about the people they supported, for example their likes, dislikes and preferences.

People’s personal preferences were recorded on file and staff encouraged people to be involved in their care. A person told us, “We have had a review and about once every four months we get a [feedback] form to say what we think of the service”.

People knew how to raise concerns or complaints and felt they would be listened to.

The management provided good leadership and support to the staff. One member of staff told us, “The management are very open and honest. They care for their staff and keep us informed. They respect us and we respect them”. Quality assurance was undertaken by the provider to measure and monitor the standard of the service provided.

Inspection carried out on 10 September 2014

During a routine inspection

At the time of our inspection we were told Everycare Midsussex was providing personal care to 60 people and employed 23 staff. We reviewed the records of seven people who used the service in depth and sampled the records of a further 26 people. We attempted to speak with 11 staff and gained feedback from six. We also spoke with the registered provider. We used an expert by experience to help us gain feedback from people who used the service. We spoke with 19 people and three relatives to establish their views of the service they received.

The inspection team was made up of a single inspector and an expert by experience. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is it safe?

Without exception everyone we spoke with told us they felt safe when receiving support from the agency. The provider had systems in place to support staff how to prevent, identify and report abuse. All staff knew these systems and had received training. Staff were clear they would report concerns to the manager and these would be actioned. There was a system in place for recording of incidents and accidents and staff could describe to us how this information was used to improve the service for people.

The provider ensured all appropriate recruitment checks were undertaken before staff could start working with people.

Prior to using the service the provider carried out an assessment of people’s needs. This was undertaken with the person and/or their representative. Care plans had been developed for people based on an assessment of needs, however these did not always reflect the person’s current needs. Where there were identified risks associated with people's care and treatment these actions to reduce these risks or manage them if they arose had not been identified or planned for. This meant people received care which was not planned and delivered in a way that was intended to ensure people's safety and welfare.

Records held for people at the time of our visit did not always reflect their current needs. Some records could not be found at the time of our inspection visit and therefore staff could not locate these promptly. Records were not always stored securely. This meant that people may be at risk of receiving care and support that was unsafe or inappropriate to their needs.

We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by law in relation to care planning, care delivery and records.

Is it caring?

All people we spoke with expressed their satisfaction with the care they received from staff. People told us they were treated kindly and with dignity and respect by staff.

Is it responsive?

Care reviews were undertaken and where concerns were raised these were recorded. However we could not see what actions had been taken to resolve the concerns for people. People gave us mixed views about the office. One person we spoke with said when they had a problem, they had raised this and it was "soon sorted". Whereas another person told us of their concerns and said “I have been in touch with the office but they haven’t returned my call”. Staff told us they were confident issues of concern would be acted upon.

Is it effective?

The provider ensured all staff received an effective induction prior to working with people. This included a period of shadowing experienced staff as well as appropriate training.

Is it well led?

The agency had some systems in place to monitor and assess the quality of service. This included staff spot checks, supervisions and staff meetings. Five people we spoke with told us the provider often visited people to keep their skills up to date but also to ensure people were happy with their care.

We could not be assured that learning from incidents and accidents took place to make improvements to the service. Incident records reflected the immediate action taken by the care staff, however there was no evidence of an analysis, learning or appropriate actions having been implemented to reduce the risk of recurrence.

The provider did not have an emergency contingency plan. They told us they had thought about this but did not have one in place. This meant arrangements were not in place to deal with foreseeable emergencies.

We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by law in relation to assessing and monitoring the quality of the service provided.