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Penhellis Community Care Limited Good

Inspection Summary


Overall summary & rating

Good

Updated 20 April 2017

We carried out this comprehensive inspection on 6, 7 and 9 March 2017. The inspection was announced a few days in advance so we could make arrangements to contact people who used the service to seek their permission to speak with them. At the last inspection, in March 2016, the service was rated Good. We brought forward the planned comprehensive inspection because we had received concerns about the service. These concerns were in relation to the care practice of some staff and the timing of some people’s visits. This included some missed visits, other visits were later than the agreed time and people were not always advised of changes to their times. There were also concerns that the service had given short notice to cancel care packages causing people distress because they were unsure if another provider could be found.

Penhellis Community Care is a Domiciliary Care Agency that provides care and support to adults of all ages, in their own homes. The service provides help with people’s personal care needs throughout Cornwall. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and provide support with meals. These services were funded either privately, through Cornwall Council or NHS funding.

At the time of our inspection 513 people were receiving a personal care service. The care provision for 272 people, who lived in the west of the county, was managed from the registered office in Helston. The care provision for 241people, who lived in the middle and east of the county, was managed from an office in Roche, opened in June 2016. The provider advised us that they intended to register the Roche office as a separate location.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

At this inspection we looked at the concerns raised with us. We found where people had raised concerns with the service about staff practice this had been dealt with appropriately. Records showed that investigations had taken place and disciplinary action had been carried out and some staff had been dismissed from the service.

We found the service had given notice to stop providing care to some people. This had been in specific geographical areas where the service had experienced staff shortages. Records showed the required four weeks notice had been given to the local authority. The quality manager explained that in some cases this message was not relayed to the person. We judged that the service had made these decisions because at the time there were not enough staff available to provide a safe service for people.

We had mixed responses from people in relation to the timing and reliability of their visits. Most people told us they received a reliable service, they knew the times of their visits and were kept informed of any changes. Comments included, “They’re not often late and they’ve never missed”, “They are generally on time”, “The carer arrives at 11.20am. She always phones when she’s on her way”, “I have nothing to complain about”, “A few visits have missed but they’re straight on the phone and get someone to come” and “In the last 18 months, they’ve been on time every day.”

Of the 54 people and 11 relatives we spoke with 14 people told us the service was not always reliable and they were not always informed of changes to times. However, the provider’s records did not confirm these missed visits and we found no evidence that anyone had come to harm as a result of a missed or late visit. People’s comments included, “They don’t always arrive on time and they never ring”, “Two or three times I’ve been left with no-one”, “They’re sometimes late if there’s an emergency. They don’t usually call” and “I am a 10.00am call but they come at 10.30-11.00am, consistency is not good, it would be nicer to have a regular time.”

We found the service did not keep a central log of missed or late visits. From discussions with management and the supervisors it was clear the service took appropriate action when people, or staff, told them that visits had been missed or were late. There was not a robust ‘live’ system in place to identify if visits had been missed, or were late, shortly after the allotted time. This meant people who were unable to alert the service if a care worker did not arrive were at risk. We have made a recommendation about the effectiveness of the monitoring of the service delivery.

Nearly 50% of the people we spoke with commented that they would like to know the names of the staff who were booked to visit them each week. Comments included, “I don’t get told who is coming, we don’t get a list, I would like to know who is coming and when”, “I never know who is coming or when they should be here”, “I don’t know who is coming, apparently they tell me I should get a slip of paper telling me who will be coming but I haven’t got one yet.” Some people told us they received a list of staff names and they appreciated knowing who was coming. The supervisors told us they sent lists to some people who had requested them. We have made a recommendation about the lack of a consistent approach to providing lists for people.

People told us they felt safe using the service. Relatives also said they thought the service was safe. Comments included, “I feel safe when the carers are here. They have an ID badge on their uniforms”, “I feel safe because they are very pleasant and I trust them”, “I feel comfortable and safe” and “Yes I feel safe. They’re quite good.”

Staff were recruited safely, to help ensure they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. Staff received appropriate training and supervision. New staff received an induction, which incorporated the care certificate. At the time of this inspection there were sufficient numbers of suitably qualified staff available to meet the needs of people who used the service.

Appropriate systems were in place to plan rosters and provide staff with details of their work. Rosters were divided into eleven local areas with a service supervisor responsible for each area. Supervisors had good knowledge about the people using the service and local knowledge of the area which meant they could plan work that minimised travel time. We saw that runs of work were being developed in all areas to help ensure people had a consistent and reliable service. Staff were positive about their rosters and the support they received from their supervisor.

People received care from staff who had the knowledge and skills to meet their needs. Comments from people included, “I know they have training as they mention it. When new ones start they have training and shadow an experienced carer. They all know what they are doing”, “I think they are sufficiently trained” and “I feel they know what they are doing.”

People told us staff always treated them respectfully and asked them how they wanted their care and support to be provided. People and their relatives spoke well of staff, commenting, “My husband is treated with dignity. The carers coming here are brilliant. I’m at ease with it all”, “They respect my privacy and dignity. They are very good”, “They treat mum with dignity and respect around personal care” and “With personal care, I feel comfortable and very good.”

Care plans provided staff with direction and guidance about how to meet people’s individual needs and wishes. People’s care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Staff told they were kept informed of people’s changing needs. Any risks in relation to people’s care and support were identified and appropriately managed.

There was a positive culture within the staff team and staff spoke passionately about their work. Staff were complimentary about their managers and how they were supported to carry out their work. There was a management structure in the service which provided clear lines of responsibility and accountability. People told us they were regularly asked for their views about the quality of the service they received. People had details of how to raise a complaint and told us they would be happy to make a complaint if they needed to.

Inspection areas

Safe

Good

Updated 20 April 2017

The service was safe. People told us they felt safe using the service.

Staff knew how to recognise and report the signs of abuse. They knew the correct procedures to follow if they thought someone was being abused.

People were supported with their medicines in a safe way by staff who had been appropriately trained.

There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service.

Effective

Good

Updated 20 April 2017

The service was effective. People received care from staff who had the knowledge and skills to meet their needs.

Staff received training appropriate to their role and there were appropriate procedures in place for the induction of new members of staff.

The management had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

Caring

Good

Updated 20 April 2017

The service was caring. People, and their relatives, were positive about the service and the way staff treated the people they supported.

Staff were kind and compassionate and treated people with dignity and respect. Staff respected people’s wishes and provided care and support in line with those wishes.

Some people were kept informed of the names of staff booked to visit them. However, other people were not given details of the staff carrying out their visits.

Responsive

Good

Updated 20 April 2017

The service was responsive. People received personalised care and support which was responsive to their changing needs.

People were able to make choices and have control over the care and support they received.

People knew how to raise a complaint about the service.

Well-led

Requires improvement

Updated 20 April 2017

The service was well-led. There was a robust management structure that provided staff with effective leadership and support.

There were quality assurance systems in place to help ensure any areas for improvement were identified and addressed. However, the systems for monitoring the reliability and timings of care visits could be more effective.