Homecarers Liverpool

Homecarers Liverpool Limited is a domiciliary care agency providing personal care to 521 people at the time of the inspection. The service supports people living in Liverpool, Knowsley and Wirral.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People's experience of using the service was mostly positive. People were happy with the staff who visited them and felt safe with the support they provided. People received visits from regular staff most of the time. However, some people were unhappy at not being able to get through to the office to amend their service or report a late or missed call. We found that the number of office staff available to answer telephone calls had reduced during the current times. To manage a sudden outbreak of COVID-19; half of the office staff were working at home so that continuity of the service would be maintained. This meant that people were left waiting for their call, uncertain if the carer was due to arrive.

People spoke positively about the staff. Their comments included, “I like the help I get. I feel safe when they are helping me (having a shower)”, “The service is brilliant. We have no problems.”, “I’m happy with the support. I feel safe because the carers wear masks and gloves”, “I feel safe around my carer, but it does worry me that it takes so long for the office to answer calls” and “I’m very happy. The staff are very clean, polite and respectful”.

Staff had received additional training for infection control because of the COVID-19 pandemic. They had a regular supply of personal protective equipment (PPE) such as masks, aprons and people told us staff always wore this.

People using the service and staff were involved in the development of their care through regular reviews meetings and surveys. The latest survey showed that people were satisfied with their care.

Staff had been recruited safely. There were sufficient numbers of staff employed to support people. Staff received regular training and support. Staff told us they enjoyed working for the service.

The management team completed regular quality audits and where actions were identified these were addressed to bring about improvements. The service worked effectively with other professionals.

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 good (published 21/11/2017)

Why we inspected

This was a planned inspection based on the previous rating. We undertook a focused inspection to review the key questions of safe and well-led only. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

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 had a manager who was registered with the Commission. 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 service had a registered manager who had been in place since 2010. The registered manager and the company director were in attendance throughout the inspection.

At our last comprehensive inspection of the service in October 2016 we found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person centred care and ensuring the quality of the service. The provider had produced an action plan that had led to us seeing that during this inspection improvement had been made in both of these areas.

The care and risk assessment records we looked at contained good information about the support people required and recognised people’s needs. All records we saw were complete, up to date and regularly audited. We found that people were involved in decisions about their care and support.

The service had quality assurance processes in place including audits, staff meetings and quality questionnaires. Homecarers Liverpool Limited also had up to date policies in place that were updated regularly. The provider regularly checked the quality of care through home visits, spot checks and audits. This demonstrated the service had robust quality assurance systems in place and people’s care records were maintained to a good standard.

We saw that the provider had systems in place to ensure that people were protected from the risk of harm or abuse. There were procedures in place to guide staff in relation to safeguarding adults and all staff had undergone training about both safeguarding and whistleblowing. The feedback from people we spoke with was positive and people told us they felt safe with the staff visiting them.

Staff were recruited safely and there was sufficient evidence that staff had received a proper induction and suitable training to do their job role effectively. All staff had been supervised and appraised.

People's medicines were handled safely by trained staff and were given to them in accordance with their prescriptions. People's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary.

We saw that infection control standards were monitored and managed appropriately. We saw that the provider had an infection control policy in place to minimise the spread of infection, all staff had attended infection control training and were provided with appropriate personal protective equipment such as gloves and aprons.

The provider was active in partnership working to improve the social care sector as a whole and had implemented healthy living initiatives for staff and people using the service, developed partnerships to improve recruitment and retention and was part of a cadet pilot programme that would encourage staff to choose social care as a career.

The service had policies and procedures in place in relation to the Mental Capacity Act 2005 and staff had received basic training. The registered manager and director were fully aware of their responsibilities concerning mental capacity and people we spoke with told us staff always asked for consent before carrying out care activities. We saw in people’s care files that they had given consent to their care.

Homecarers Liverpool Ltd provides a domiciliary care service to people living in their own home. The service operates throughout Liverpool. At the time of the inspection there were 649 people using the service.

There was a manager in post who had been registered with the CQC since December 2010. 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 last inspection was carried out in December 2013, during which the registered provider was found to be meeting the standards inspected against.

During the inspection we found examples which demonstrated that good care was being provided to people. However we also found several areas where improvement was needed.

Information within people’s care records was not personalised. Information was task-led and did not contain details around their strengths, likes, dislikes or preferred daily routines. Where information was provided, this did not go into sufficient detail. For example one person’s record stated that they had a diagnosis of Schizophrenia and were alcohol dependent, however there was no detail regarding the severity of this or what impact these conditions had upon them. We raised this with the registered manager who was already in the process of re-writing people’s care records to address this issue.

There were audit systems in place; however these were not always robust or effective. Medication audits had failed to identify and address where medication administration records (MARs) had not been appropriately signed by staff. Audits of care records had failed to identify poor risk assessing, the lack of sufficient depth and personalised detail to the information provided. There was no audit of accidents and incidents for people using the service, which meant that trends could not always be identified and would impact upon the ability of the organisation to take appropriate action. We raised these issues with the registered manager who started to rectify these areas immediately during the inspection.

You can see what action we told the provider to take at the back of the full version of the report.

We have made a recommendation around risk assessments. People’s care records contained generic risk assessments which looked at the risk to people and staff regarding moving and handling tasks, and the environment. These were not personalised, and did not consider all the risks associated with people’s needs. Other factors, for example the risk of developing pressure sores, or supporting people to manage their diabetes had not been assessed.

Staff had received training in the safe administration of medicines, and had been assessed as competent in this subject. People confirmed that they received they received appropriate support with taking their medicines. However medication administration records (MARs) were not always being appropriately signed by staff to show that medicines had been given to people. We raised these issues with the registered manager who told us she would raise this issue with staff.

People were protected from the risk of abuse. Staff had received training in safeguarding vulnerable people and were aware of how and when to report their concerns. There was a whistleblowing policy in place which staff were aware of.

There were sufficient numbers of staff in place to meet people’s needs, and recruitment processes were robust enough to ensure that they were of suitable character. Staff had been required to provide two references including one from their most recent employer, and had also been subject to a check by the disclosure and barring service (DBS).

Staff had received the training needed to carry out their role. They had completed training in subjects including the Mental Capacity Act 2005 (MCA), moving and handling, dementia awareness and first aid. Refresher courses had also been completed to ensure that their knowledge remained up-to-date.

People’s rights and liberties were protected by staff who understood their role in relation to the MCA. People told us that they were given the freedom to choose and that staff were guided by them and followed their preferred routine.

People told us that staff were kind, caring and friendly. People spoke highly of staff who attended them regularly, telling us that they had developed positive relationships with them. However they also told us that they were sometimes supported by staff who they did not know. Despite this people commented that all staff were friendly.

People felt that their dignity and respect was maintained by staff. They told us staff were respectful of their homes and tidied up after themselves. They also commented that they felt at ease with staff supporting them to attend to their personal care needs.

The registered provider had a complaints process in place for people who wanted to raise a concern. People told us that they would be comfortable raising any concerns with the office if they needed to. The registered manager kept a record of complaints. These records showed that responses were timely and appropriate. This demonstrated that people’s concerns were taken seriously.

The registered provider had good links with the community. They had made charitable donations to organisations that aimed to reduce social isolation amongst older people over the Christmas period, and were also engaging with the local college to promote apprenticeships in adult social care within Merseyside.

When the provider was given a contract a care plan and risk assessment had already been completed. We saw evidence that where people's needs had changed the provider's review team had put new plans in place and notified the council appropriately. There were systems in place to notify the relevant body if a person required more care than the contract detailed or if their capacity to consent to care or support was in question.

Equipment related to people's care was provided by the council. There was a system in place to report faulty equipment.

The provider had an effective recruitment system in place to make sure staff had the relevant experience and qualifications and were of good character.

There were systems in place to monitor the quality of the service that was provided.

The people we spoke with were positive about the service they received. Their comments included 'You can't go wrong with Homecarers. They all know what they're doing', 'The carers are very good. All of them know what to do and I need a lot of help' and 'They always ask what I want and I get it'.

We found that action had been taken in response to a recent concern about the care and welfare of people who used the service. People told us that care staff had always provided them with the care they needed.

We found that action had been taken in response to a recent concern about staffing levels. People told us that the right amount of care staff had provided their care and support.

Prior to our visit we were told that people who used the service had been cared for by care staff who were not suitably qualified. People we spoke with during our inspection told us they had confidence in the ability of care staff and that in their opinion care staff were suitably trained in all areas of their work.

Prior to our visit we were told complaints made about the service had not been appropriately dealt with. People we spoke with during our inspection said they had been given information about how to complain. People who had complained told us that their complaint had been dealt with quickly and to their satisfaction.

We found that action had been taken in response to a recent concern about record keeping. People told us care staff had kept their records up to date.

Most people told us they see the same staff which they liked and appreciated as it gave them greater stability. They advised that during holiday periods they sometimes had to have different staff which they understood was inevitable at times to provide cover for their usual team members.

Throughout the inspection we were shown lots of ways the service were monitoring and managing the support provided. We were also told of future initiatives and developments that they were constantly striving to do to ensure the service continued in promoting good practice and good levels of service to people in the community.