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Inspection carried out on 19 July 2017

During a routine inspection

This inspection took place on 26 July 2017 and was announced. The provider was given notice because the location provides domiciliary care services and we needed to be sure that someone would be available to answer any questions. We contacted people who used the service and staff via telephone on 19 July 2017 prior to the inspection office visit.

Eldercare registered with CQC in January 2011 and is registered to provide personal care. Eldercare is based in Pickering and provides support to people in the community within the Ryedale area. At the time of this inspection there was 90 people using the service, most of whom were older people. The registered manager, who was also the company director and nominated individual was present throughout the inspection. A nominated individual is a person who is responsible for supervising the management of the regulated activity – personal care.

At the last comprehensive inspection in May 2015 we rated the service Good overall with the well-led domain requiring improvement. This was because there was not a registered manager in post.

At this inspection, we found that some improvements were required in the safe, effective and well-led domains. Quality assurance processes were not in place to monitor and improve the service. Some records had not been appropriately completed by staff and staff had not always received the required training.

We judged this to be a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

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

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. The registered manager was supported by two office managers who took responsibility for the day to day running of the service.

People told us they felt safe. Staff understood and could describe action they would take if they suspected abuse was taking place. However, appropriate training had not always been provided.

Recruitment procedures were in place to ensure staff were safe to work and did not pose a potential risk to people who used the service. However, dates when such documentation had been received was not always recorded to evidence these checks had been completed prior to employment commencing.

Procedures were in place to guide staff on the safe administration of medicines and staff had received medicines training. The records we checked showed that people had received their medicines as prescribed. We found that the use of topical medicines was not appropriately recorded. We have made a recommendation about the management of this.

When risks had been identified appropriate plans were in place to support people safely. Although these provided only basic information, all identified risks had been addressed and provided appropriate advice for staff to follow.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005. Staff were aware of the procedure to follow if they suspected a person lacked capacity to make decisions, although relevant training had not been completed by all staff.

There was a process for completing and recording staff supervisions. New staff completed an induction before employment commenced and shadowed more experienced staff until they had built relationships with people. Appraisals had taken place for some staff but this was not consistent.

Training had not been completed for all staff in areas such as safeguarding and the Mental Capacity Act and some training had expired. A training plan was in place to ensure all training was up to date by the end of September 2017.

Some people who used the service were supported by staff with meal preparation and where possible people’s independence was promoted in this area. Records and people confirmed that they were given choice and were able to make independent decisions about what they had to eat and drink.

People were supported by a regular team of staff who knew their likes, dislikes and preferences. Staff had the knowledge of people’s personal histories and medical conditions and had been involved in implementing and developing support plans to meet people’s needs.

Care records contained evidence of close working relationships with other professionals to maintain and promote people’s health. People were clear about how they could get access to their own GP and other professionals and staff at the service arranged this for them where needed. People and relatives told us they were always treated with dignity and respect.

People usually consented to their care and support from staff by verbally agreeing to it. People we spoke with confirmed they had input into the planning of their support and had access to their care records. Information on advocacy services was available.

The provider had an effective system in place for responding to people’s concerns and complaints. People said they would talk to the manager or staff if they were unhappy or had any concerns and were confident any concerns would be appropriately addressed.

Satisfaction surveys had not yet been distributed to people who used the service to gain their views.

We found examples where the provider's quality assurance systems had not been effective in recognising and rectifying issues.

The manager and office managers were not fully aware of when notifications should be submitted to CQC. We directed them to guidance.

The provider had been requested to complete a Provider Information Return. This had not been returned within the required timescales.

Staff told us they felt supported by the management. They said the management team were approachable and felt confident that they would deal with any issues raised. Staff were kept informed about the operation of the service through regular staff meetings. They were given the opportunity to suggest areas for improvement.

Inspection carried out on 15 May 2015

During a routine inspection

We undertook an announced inspection of Eldercare on 15 May 2015. We told the provider two days before our visit that we would be coming.

At our last inspection on 4 July 2013 the provider was meeting the regulations that were assessed.

Eldercare provides care and support to people who need help to remain at home. At the time of our visit 70 people were receiving a personal care service.

Although there was an established management team in place the service did not have a registered manager, which is a requirement of their 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.

We saw that information which would be available to prospective and existing people using the service and their relatives was out of date. This included information on the provider’s website, the complaints procedure, the Statement of Purpose and the Service User Guide. However, during our visit the provider showed us the new policies and procedures manual that they were going to introduce.

Although information in the complaints procedure needed updating we found that people knew who to speak to if they had any worries or concerns. People were satisfied that any complaints they had raised had been dealt with to their satisfaction. They told us they were always treated with dignity and respect.

We found that effective arrangements were in place to safeguard people and to promote their wellbeing. People were supported by care workers who had the right mix of skills to make sure that practice was safe and they could respond to unforeseen events. People spoke positively about their care workers and said that they received a consistent, reliable service.

Care workers had received appropriate training including training in safeguarding adults and on the safe administration of medicines. Care workers were knowledgeable about their roles and responsibilities and had the skills, knowledge and experience required to support people with their care and support needs.

Improvements were required to the regularity and documentation around care worker’s supervision sessions. However, there were regular team meetings where care workers could meet together and discuss new ways of working, changes to legislation and share good practice.

Safe recruitment practice was followed, which minimised the risk of appointing someone unsuitable for the job. We found that people’s care was designed to meet people’s care needs in a responsive, personalised way.

There were examples of good partnership working that enhanced people’s care and wellbeing. This included informal training arrangements with a nearby care home and joint working with the hospice, Marie Curie and Macmillan Nurses, end of life charities and the Malton (Ryedale) Community Response team. These arrangements were used to support people’s care preferences and to make sure that they received good, consistent care.

People were supported to attend healthcare appointments and care workers liaised with other healthcare professionals as required to meet people’s needs. People were supported to eat and drink according to their plan of care.

Care workers were aware of the requirements of the Mental Capacity Act 2005 and understood how they should this in their work to make sure that people’s rights and freedoms were upheld.

People’s feedback was gained and people using the service and care workers confirmed that their comments were acted upon. Care workers confirmed that they felt well supported and the care manager was singled out for special mention as a person who was knowledgeable and approachable and provided clear leadership. Care workers and people who used the service told us that they felt able to provide feedback on the service and were confident that appropriate action would be taken in response.

Inspection carried out on 4 July 2013

During a routine inspection

We spoke with several people who used the service. They told us that staff always asked what help they wanted and took their time when assisting them. One person said "I like to be independent and the girls help with that". Another person said "The girls are very good- they do what I want"

We saw that the support offered was reflected in the person’s care plan. We saw that quality monitoring visits were carried out to ensure people received the support they needed.

People’s medication was managed appropriately and staff had received training in the safe handling of medicines. We saw that the medication records were in the person's file that was kept in their accommodation. We saw the medication records in five houses and staff had completed them properly and the records matched the number of tablets in the container.

We checked four staff files and these were found to contain appropriate information. Staff had undergone checks with the Disclosure and Barring Service (BDS) to determine that they were suitable to work with vulnerable people.

We saw that the manager had implemented a quality assurance system to ensure that people received a safe service and that staff received appropriate training.

Inspection carried out on 31 July 2012

During a routine inspection

People we spoke with during the visit told us the staff delivered support that met their needs. One person said the “The staff are wonderful especially …..she does all that I need her to do” Another person said “The staff are marvellous” and “They do all the tasks I need them to do and any small jobs I might also have”

Someone else said “Everyone is very nice and look after me well” and “……calls to see me regularly to make sure everything is alright” Another person said “If I was not happy with the service I would ring the office and tell them”

Staff told us that their rotas were organised in a sensible fashion, which meant that they carried out their work in a calm and unhurried manner. They also said that the timings on their rota were flexible. This meant if they found someone was unwell they could spend more time with that person without feeling pressure to complete their rota. Staff also told us they received good support from the management team and if they needed assistance whilst they were working all they needed to do was ring the office.

A health care professional told us that the staff were very good at informing them when situations changed or if they were worried about anything. They also told us that the monthly meeting was beneficial as it allowed all the staff to receive the same information about people who use the service.