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Penhellis Community Care Limited Good

Reports


Inspection carried out on 6 March 2017

During a routine inspection

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 carried out on 7 March 2016

During a routine inspection

Penhellis Community Care provides personal care to people who live in their own homes throughout Cornwall. The service’s registered office is in Helston where all care records are stored. An additional office in Liskeard provides support and management to staff in the east of the county.

At the time of our inspection on 7 and 8 March 2016 the service was providing care and support to approximately 650 predominantly older people. The service was previously inspected on 18 and 19 February when it was found to be fully compliant with the regulations.

The organisation was led by five directors, one of whom was the 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 and associated Regulations about how the service is run.

People told us they felt safe and were well cared for by Penhellis Community Care. People’s comments included; “I do feel safe” and “The carers are very good.”

People who used the service were happy with the care they received but some people reported their staff did not consistently arrive on time. People told us that Penhellis Community Care headquarters would “usually” phone them if a care worker was going to be late which gave them reassurance that their visit would still continue. The registered manager was aware of these concerns and had taken appropriate action to resolve them where possible.

A call monitoring system was used to record staff arrival and departure times from each care visit. This information was monitored by office staff to ensure visits were not missed. In addition this data had been used to review the travel time required between consecutive care visits to ensure the care visit schedules were appropriate. Our analysis of call monitoring data, daily care records and staff visit schedules found care staff normally arrived on time and provided the planned care.

The service had robust and effective procedures in place to ensure that all planned care visits were provided. This included on-call management support, arrangements for additional staff to be available at short notice each weekend and a system for monitoring the provision of care visits in real time to ensure all visits were provided.

The service’s visit schedules were well organised and at the time of our inspection there were a sufficient number of staff available to provide people’s care visits in accordance with their preferences.

The registered manager and quality assurance manager were confident about the action to take if they had any safeguarding concerns and had liaised with the safeguarding teams as appropriate. Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

The service’s systems for the induction of new members of staff were effective and fully complied with the requirements of the care certificate. Training was provided in accordance with the 15 fundamental standards. The service had commissioned a training academy to provide the induction and further training courses to their staff team. Staff said they were encouraged to attend training to develop their skills, and their career.

Staff received regular supervisions and annual performance appraisals. In addition ‘spot checks’ by managers were used regularly to confirm each member of staff was providing appropriate standards of care and support.

People were supported by stable and consistent staff teams who knew people well and had received training specific to their needs. People told us they were introduced to new staff before they supported them in their home. People confirmed they had consistent carers to support them and had built up positive relationships with staff.

People’s care plans were detailed, personalised and provided staff with sufficient information to enable them to meet people’s care needs. The care plans included objectives for the planned care that had been agreed between the service and the individual. All of the care plans we reviewed were up to date and accurately reflected each person’s individual needs and wishes.

Penhellis Community Care had a complaints process and details of how to raise concerns was accessible to people, their relatives and staff. We reviewed the services complaint process and found that people’s complaints were responded to promptly and that a full investigation into the concerns they had raised was undertaken. Some relatives told us they had raised concerns with the managers which were usually in respect of the timing of home visits. The majority felt that they were heard and that appropriate action was taken to resolve their issues.

From our conversations with staff, people and records we found that Penhellis Community Care management team provided effective leadership and support to the staff team. Staff told us they could approach their managers with any concerns or suggestions and felt they would be listened too.

Inspection carried out on 18 and 19 February 2015

During a routine inspection

Penhellis Community Care provides personal care to people who live in their own homes throughout Cornwall. The service’s registered office is in Helston where all care records are stored. An additional office in Liskeard provides support and management to staff in the east of the county.

At the time of our inspection on 18 and 19 February the service was providing care and support to approximately 700 predominantly older people. When previously inspected the service was found to be fully compliant with the regulations.

The organisation was led by five directors, one of whom was the 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 and associated Regulations about how the service is run.

Everyone told us they felt safe with their care staff and were treated with respect and kindness. People’s comments included; “I am pleased to have carers who care” and, “The care provided to me from Penhellis has made a very positive difference to my life” and, “they [staff] can’t do enough for me” and relatives told us, “they treat (the person) with a great deal of dignity and respect”.

Staff were well trained and effectively supported. The service’s Helston office was open seven days a week to provide people and staff with support when required. In addition the service’s on call management arrangements were appropriate and responsive to people’s needs.

Care plans were inconsistent and lacked the detailed information required to enable staff to respond to people’s individual care needs. We have made a recommendation about Penhellis Community Care’s care planning systems.

Care visit schedules and staff rosters were well organised and there were sufficient staff available to provide all planned care visits.

A call monitoring system was used to record staff arrival and departure times from each care visit. This information was monitored by office staff to ensure visits were not missed. In addition this data had been used to review the travel time required between consecutive care visits to ensure the care visit schedules were appropriate.

Our analysis of call monitoring data, daily care records and staff visit schedules found carer staff normally arrived on time and provided the planned care. People who used the service were happy with the care they received but some people reported their staff did not consistently arrive on time. People’s comments in relation to visit times included, “care workers were sometimes late” and, “the carers are rushed, no travel time, always asked to squeeze in extra clients due to sickness of carers”. The registered manager was aware of these concerns and had taken appropriate action to resolve them where possible.

Staff recruitment processes were robust and effective induction training was provided to new members of staff. Staff were well trained and effectively supported by managers. Staff told us, “The training is very good” and, “This is the best care company I have ever worked for as the training opportunities are excellent.”

The service had grown significantly since our last inspection. This growth had been well managed and effective quality assurance systems ensured the service continued to meet people’s care needs.

Inspection carried out on 9, 15, 16 April 2014

During a routine inspection

During our routine inspection of this service we used the evidence gathered in relation to the five outcomes we inspected to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on information gathered during conversations with people who used the service , relatives, staff and management of Penhellis Community Care.

Is the service safe?

We found that Penhellis Community Care provided safe care and support to people who used the service. Everyone we communicated with reported that they felt safe with their care staff.

The care staff that we spoke with had a good understanding of local safeguarding procedures. Staff records showed Disclosure and barring service checks had been completed for all staff prior to their employment and training records demonstrated all staff had received formal safeguarding training.

We found most care plans included appropriate risk assessments and all of the care plans we inspected had been regularly reviewed to ensure they accurately reflected people care needs.

Is the service effective?

The service was effective. We sent surveys to 61 people who used the service, 39 of whom provided responses. Our survey asked “over all how would you rate the care provided? 58% reported that the service was “excellent” while 39% reported that the service was “good”.

People and their relatives told us the care they received was effective, their comment included “I am very pleased with the care” and “carers are very good and do everything I want them to do”.

We saw that assessments of care needs had been completed with the person who used the service and that care plans had been developed from this information and information supplied by the commissioners of the care.

We found that although all of the care plans we inspected included sufficient information to direct staff that there was some variation in the quality and quantity of information provided to staff. However, staff that we spoke with told us “I think they have enough information and they do get updated quite often” and “they are pretty good, up to date and have the right info”.

Is the service caring?

We found that the service was caring and that staff were proud of the organisation they worked for. People told us they were well cared for by their regular carers, their comments included “I am so happy with the treatment and what they do for me. I have various carers come, they are all pleasant and cheerful and this sets me up for the day. Before they leave they always ask if there is anything else they can do for me” and “I am absolutely delighted with my carers, I couldn’t wish for better”.

Our survey asked “Do the care workers treat you with respect?” 90 % of people who responded reported they were “always” treated with respect while the remaining 10% reported that they were treated with respect “most of the time”.

The 14 staff we spoke with reported that they enjoyed their work, they told us “It’s my favourite job”, “It’s never boring, I enjoy the job” and “I wouldn’t want to work for any other care company”.

Is the service responsive?

The service was responsive, we found the service had appropriate complaints procedures and people who had previously made complaints were happy with the manner in which their complaints had been resolved.

We saw the service was in the process of completing a survey of everyone who used the service. We reviewed the information responses received at the time of the inspection and found that people were generally satisfied with care they had received.

Some people who used the service told us they were unhappy with the manner in

in which office staff dealt with them on the telephone, these comments have been shared with the provider.

Is the service well led?

Penhellis Community Care was well lead and it’s manager was registered with the Care Quality Commission.

We saw the operations managers had completed an effective investigation into matters that we had raised with them prior to the inspection. As a result of this appropriate arrangements had been made to provide additional support to staff based from the Liskeard office.

The service had appropriate quality assurance systems in place. We saw regular staff spot checks had been completed and that all daily care records had been effectively audited on their return to the office. Where issues had been identified actions had been taken to address them.

Inspection carried out on 22 August 2013

During an inspection in response to concerns

We spoke with 24 people who used the service or their relatives by telephone during the inspection. The majority of people that we spoke with were highly complementary of the care they received from Penhellis Community Care. Comments included, “the whole thing works as it should, I have been very impressed”, “I am more than happy, I would not want another agency” and “They understand my needs, they are reliable, helpful, caring and I am never made to feel a nuisance.”

We also sent a survey to 61 people who used this service, we received 18 responses. The survey asked, “Overall how do you rate the care you receive from Penhellis community care?” 69% of people said the service was “good” or “excellent” with the remainder indicating that the service was “satisfactory”.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people receive and there was an effective complaints system available.

Inspection carried out on 13 July 2012

During a themed inspection looking at Domiciliary Care Services

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies.

The inspection team was led by a CQC inspector joined by an Expert by Experience, who has experience of using or caring for someone who uses this type of service.

We used telephone interviews and home visits to people who used the service and to their main carers (a relative or friends).

We visited four people in their homes. They told us that they were very happy with the care and support they received. Everybody told us that staff were very caring and, “went that extra mile” to ensure everything was done properly and to their liking. Everybody we visited said they met their regular care worker and were always informed if the visit might be later than expected. We observed the staff member who accompanied us on our visits to be very polite and encouraged people to continue to be as independent as possible. All care was provided in a respectful and dignified manner.

One person told us over the telephone, they were very pleased that the same lady came every week unless she was on holiday. However six of the 18 people spoken with over the telephone told us that the number of different people who provided the care was high. One relative told us they felt the care provided was very good but the number of different staff who attended did not allow their relative to make a lasting relationship. They told us “the times of care are always fluid and my mum never seems to see the same person twice, they are all very nice caring young girls but surely for someone who has dementia continuity should be important”.

Everybody spoken to said they felt they could raise concerns with the agency and knew who to talk to. Some people spoken with over the telephone said they had not been asked to comment on the care they received. However during our visit to the office we saw completed surveys, from both clients and relatives with feedback on the service provided.