Archived: Meridian Health and Social Care - Coventry

People’s experience of using this service:

Staff understood how to keep people safe and protect them from avoidable harm. There were safe procedures to manage people’s medicines and to prevent the spread of infection.

People’s needs were assessed to ensure they could be met by the service. Staff knew about the risks associated with people’s care and management plans had been completed for all identified risks.

Staff were recruited safely, and there were enough staff to provide the care and support people required. However, some people had not always received their care visits at the times expected.

Staff received training and support to be effective in their role.

People made their own decisions about their care and were supported by staff who understood the principles of the Mental Capacity Act 2005.

Where required, people were supported with their nutritional needs and to maintain their health and well-being.

Staff were caring and respected people’s rights to privacy and dignity.

People were involved in planning their care and were consulted about the care provided.

Care plans contained the information staff needed to provide personalised care.

Systems were in place to manage and respond to any complaints or concerns raised. The recording of outcomes and any learning from complaints needed improvement.

The provider understood their regulatory responsibilities and had effective processes for assessing and monitoring the quality of the service.

Rating at last inspection: Requires Improvement. We found three breaches of the regulations and rated the service requires improvement in the key areas of, safe, effective, responsive and well led. The last inspection report was published on 1 June 2018.

Why we inspected: This was a planned inspection based on the date and the rating of the previous inspection. We had also received concerns about the service that we had referred to the local authority and to the provider to investigate, which we needed to review. The overall rating for the service has changed to good, with improvement required in the key area of responsive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

Sevacare-Coventry is registered to provide personal care support to people. At the time of our inspection the agency supported approximately 270 people with personal care and employed approximately 106 care workers. The service is located in Coventry in the West Midlands and provides long and short term care packages.

This service is a domiciliary care agency. It provides personal care to people living in their own homes, including, older people, people living with dementia, physical and learning disabilities and mental health problems.

We last inspected Sevacare-Coventry in April 2017 and gave the home an overall rating of 'Requires Improvement'. This was because we found some risk related to people’s planned care had not always been assessed and some people did not receive their care visits at the times they needed. People’s capacity to make decisions had not been established in line with the requirements of the Mental Health Act 2005 and the provider’s quality monitoring systems were not always effective.

At this inspection on 19 April 2018 we checked to see if improvements had been made and if they were effective. We found the provider had taken some action. However, we also identified areas which remained in need of improvement and areas where standards previously demonstrated compliance with regulations had not been maintained.

This is the third consecutive time the service has been rated as requires improvement.

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.

Risk associated with the delivery of people’s planned care had not always been assessed to ensure care workers had the information needed to keep people and themselves safe.

The provider had not ensured people’s medicines were always managed and administered safely and in line with their procedure. Action was being taken to address this.

The provider’s systems to check monitor and improve the quality and safety of the service provided were not always effective. Some people and relatives were dissatisfied with the service provided and the way complaints were managed. Action was being taken to address this.

The management team and care workers understood how to protect people from abuse and their responsibilities to raise any concerns. People felt safe with the care workers and there were enough care workers to provide people’s planned care visits. The provider’s recruitment procedure checked staff were of suitable character to work with people’s in their own homes.

The management team had an understanding of, but had not ensured they were consistently working within the requirements of the Mental Capacity Act 2005 and the provider’s procedure. Care workers did not have the information they needed to understand which decisions people could make and those they needed support with. Care workers sought people’s consent before care was provided.

Care workers completed an induction and on-going training the provider considered essential to meet people’s needs safely and effectively. However, people and relatives had mixed opinions about the skills and knowledge of the care worker who supported them.

People’s care plans were personalised and contained information about how people preferred their care and support to be provided. However, some care plans contained inaccurate information.

Information about the service was available in a range of different formats to meet people’s communication needs. Most people and where appropriate relatives were involved in planning and reviewing their care and support.

There were enough care workers to provide all planned care visits. Some people did not receive

their care calls at the times they needed. People told us care workers stayed the agreed length of time at care calls and knew how they liked to receive their care.

Care workers respected people’s life style choices, privacy and dignity and supported people to maintain their independence. People and relatives spoke positively about care workers with whom they had developed friendships. Care workers supported people to maintain their nutritional and health care needs where this was part of their planned care.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service was last inspected on 20 June 2016 when we found the provider was not meeting the required standards. We identified a breach in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Good governance. This was because the provider was not ensuring the quality and safety of the service provided was being effectively monitored, and had not made improvements to the service based on feedback from people who used the service.

We gave the home an overall rating of requires improvement and asked the provider to send us a report, to tell us how improvements were going to be made to the service. The provider sent us their action plan which detailed the actions they were taking to improve the service. The provider told us these actions would be completed by 31 October 2016.

At this inspection on 11 April 2017 we checked to see if the actions identified by the provider had been implemented and if they were effective. We found sufficient action had been taken and there was no longer a breach in Regulations of the Health and Social Care Act 2008. However, further improvement was needed.

The service had a registered manager. This is a requirement of the provider’s registration. 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 provider had developed systems to gather feedback from people, relatives and others so they could use the information to improve the quality of the service provided. Audits and checks to monitor the quality and safety of the service were being regularly completed. However, further improvement was required because some issues we found during our inspection had not been identified during the auditing process. Complaints were managed in line with the provider’s policy and procedure.

Some known risks related to the delivery of care and support for people who used the service had not been assessed. Some risk assessments did not reflect people’s current needs. This meant staff did not always have the information they needed to support people safely and effectively. The registered manager took action to address this. People who used the service told us they felt safe with care workers. Staff understood how to protect people from abuse.

The registered manager had an understanding of the principles of the Mental Capacity Act 2005 and their responsibilities under the act. However, some people’s capacity to make decisions had not been assessed. Care workers did not have the information they needed to understand which decisions people could make and those they needed support with. Care workers sought people’s consent before care was provided.

People’s care plans were personalised and contained information about how people preferred their care and support to be provided. People were involved in planning and reviewing their care.

There were enough care workers to provide planned care and support to people. The provider conducted employment checks prior to staff starting work, to ensure their suitability to support people in their own homes. Staff completed an induction when they joined the service and had their practice regularly checked by a member of the management team. Care workers received training the provider considered essential to meet people’s needs safely and effectively. Most people told us care workers had the right skills and knowledge to provide the care and support required.

Some people did not always receive care and support at the agreed time. This was being addressed by the management team. People told us regular care workers stayed the agreed length of time at care calls and knew how they liked to receive their care.

People told us their regular care workers were kind and respectful and understood how people wanted their care and support to be provided. Care workers respected and promoted people’s privacy and dignity. People were encouraged to maintain their independence, where possible.

People were supported with their medicines by care workers who were trained and assessed as competent to give medicines safely. People who required support had enough to eat and drink and were assisted to manage their health needs.

Sevacare-Coventry is a domiciliary care agency which is registered to provide personal care support to people in their own homes. At the time of our visit the agency supported approximately 172 people with personal care and employed 92 care workers.

A requirement of the provider’s registration is that they have 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. At the time of our inspection there was a registered manager at the service. We refer to the registered manager as the manager in the body of this report.

Systems to monitor and review the quality of some areas of the service people received were not in place. Quality monitoring systems that were in place were not always effective. People and relatives were able to share their views of the service they received. The provider did not always use this feedback to make improvements to the service. People and relatives knew how to complain but were not always satisfied with the way their concerns and complaints were managed.

People’s care plans were not personalised and did not always reflect people’s current needs. Care workers understood how to protect people from harm or abuse. However, care records did not give care workers the information needed to ensure care and support was provided, safely and in the way people preferred.

People who used the service told us they felt safe with care workers. There were enough care workers to provide planned care to people.

Staff had been recruited safely and completed an induction when they joined the service. Care workers felt supported by the management team during core office hours. Care workers received training the provider considered essential to meet people’s needs safely and effectively.

People told us their regular care workers were kind and caring and had the right skills and experience to provide the care and support required. People were supported with dignity and respect.

People did not always received care and support at their pace, or at the agreed time. People told us regular care workers stayed the agreed length of time at care calls and knew how they liked to receive their care.

Staff understood the risks associated with people‘s care. However, processes to minimise risks to people’s safety were not consistently followed. This meant staff did not always have the information they needed to support people safely and effectively.

The managers had a basic understanding of the principles of the Mental Capacity Act (MCA) and their responsibilities under the act. Care workers encouraged people to be independent where possible and sought consent before care was provided to them. However, some people’s capacity to make their own decisions was not always fully assessed.

People who required support had enough to eat and drink and were assisted to manage their health needs. Care workers referred people to other professionals if they had any concerns. Systems were in place to manage people’s medicines and staff had received training to do this.

People and relatives were not always involved in planning and reviewing their care.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found the care services manager - Midlands (previous manager of the service) was providing management cover for the agency until a replacement manager was recruited. We spoke with them as well as care workers, five people who used the service and two relatives. This was to find out what their experiences of using Sevacare were like.

We looked to answer five key questions: is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We saw people's care had been arranged according to their personal needs. There was a process in place for managing risks associated with people's care. Records clearly showed how care workers should manage these risks.

We asked people or their relatives if they felt safe when the care workers were with them. They told us,

'Oh definitely yes, I get on smashing with them.'

'They meet our needs at the moment and that is good. At the moment it suits us well.'

We saw records that showed people were assisted to take medicines. Care workers were able to tell us how they checked records to make sure they gave the medicines in a safe way and as prescribed.

We found care workers had completed the training required to work with people in a safe way. We were told care workers were not able to complete calls to people's homes until all the necessary recruitment checks and training had been completed.

We found people who used the service felt confident any concerns or complaints would be investigated by the service.

Is the service effective?

People told us they had been involved in planning their care. We saw records which showed people received varying levels of support depending on their needs. Some people had multiple visits during the day. The support provided included help with personal hygiene, continence care, mobility, nutritional care, meal preparation and administration or prompting of medicines. People were positive about the care workers supporting them and told us they always completed the tasks they expected of them. They told us: 'We have a good routine going now and that's helpful if you know who's coming and when.'

People told us the care workers arrived around the time they were expected and usually let them know if they were going to be late.

Staff we spoke with had a good understanding of people's needs and how to support them safely.

Is the service caring?

We saw that care plans were person centred to make sure care workers delivered care and support in a way that people preferred.

People who used the service told us,

'They are ok, I am pleased they are coming. They are always very kind and they help X and they fit in with our arrangements.'

'The carers are very friendly, they seem quite nice. No problems at all.'

People we spoke with told us the care workers were respectful and maintained their dignity when delivering care.

Is the service responsive?

People knew how to make a complaint if they were unhappy. People told us if they raised a concern with the agency, it was dealt with. For example one person told us,

'At odd times when they are late, they are very helpful about it.'

We saw positive responses had been received following reviews of people's care.

People we spoke with told us all the tasks they expected care workers to complete were carried out. One person told us,

'Anything I can't do, they do.'

We saw where complaints had been received, these had been managed in a timely manner and had been responded to.

Is the service well led?

At the time of our visit the care service manager for the Midlands (the previous registered manager) was providing a supportive role to the agency. They were working at the agency for two days per week until a new manager was appointed.

We saw systems were in place to regularly assess whether people were happy with the service they were receiving. This included the completion of a 'client' satisfaction survey which showed a high level of satisfaction with the service.

We saw that people were asked on a regular basis for their views about the service through the completion of 'service monitoring and review forms'. We saw positive responses to the questions asked about the service they received.

People we spoke with were positive about the agency responding to their needs. They told us,

'They are pretty good, if you phone them to pop in, they will.'

'They always ask me first what I would like, or would say you only have this or that and what would you like.'

'I can't find any fault with them they seem to be ok with me. If they are going to be late they let me know. I can't ask any more than that.'

'The care company are very good I have no problems.'

Care workers received regular supervisions that included work based observations to make sure they worked in line with Sevacare's policies and procedures.

The service had auditing procedures in place to make sure care workers provided care to people as required.

We saw there were appropriate arrangements in place to ensure people consented to their care.

We saw people received varying levels of support depending on their needs. Some people had multiple visits during the day. The support provided included help with personal hygiene, continence care, mobility, nutritional care, meal preparation and administration or prompting of medicines.

People were positive about the staff supporting them and told us the care staff did not rush them. They told us: 'They are lovely.' 'I can't complain about any one of them (staff) they were marvellous.'

We saw that when people had made complaints, these had been recorded and responded to appropriately. People told us there was nothing they would change about the service they were receiving.

We saw systems were in place to regularly assess whether people were happy with the service they were receiving. This included the completion of a satisfaction survey which showed a high level of satisfaction with the service.

We found that some records were not sufficiently detailed to support staff when delivering care. The provider gave a commitment to rectify this.

We saw that people received varying levels of support depending on their needs. Some people had visits to deliver care throughout the day and some had care workers supporting them at night. The support provided included help with personal hygiene, continence care, mobility, nutritional care, meal preparation and administration or prompting of medicines.

People were positive about the staff supporting them. They told us: 'I am pleased with the carers they are very good.' 'They always turn up on time unless something has come up, they do let you know.'

We saw that where concerns had been raised these had been effectively managed and responded to. People told us there was nothing they would change about the service.

Staff told us they enjoyed their work and confirmed they had completed all of the required training so they could support people safely. We saw systems were in place to regularly assess whether people were happy with the service they were receiving.