Eldercare

At our last inspection the provider was found to be in breach of Regulation 17 Good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of: Is the service Safe? Is the service Effective? and Is the service Well-led? to at least good.

At this inspection we found that sufficient improvement had been made to show that the provider was no longer in breach of regulation.

Eldercare is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, some of whom may be living with dementia. At the time of inspection 86 older people used the service. One of the directors, who was also the registered manager, was present throughout the inspection.

There was a manager in post who had registered with CQC. 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.’

Since the last inspection, quality assurance processes had been introduced to monitor and improve the service. These had checks been conducted on a regular basis but had not always been effective in identifying when documentation had not been returned to the office for monitoring. We have made a recommendation about this.

Safe recruitment processes continued to be followed although references did not always record dates to evidence when they had been received. The registered manager took action to correct this during the inspection.

Risk assessments were in place where required. There was a safeguarding policy and procedure in place and staff had been provided with safeguarding training. The management team were fully aware of the process to follow if any concerns were raised.

There were enough staff available to meet people’s needs and attend planned care visits. People were supported by a consistent team of staff and pre-admission assessments had been completed to ensure the service could meet people’s needs before a package of care was accepted.

Since the last inspection staff had been provided with additional training to ensure they had the skills and knowledge to carry out their roles. A training plan was in place to ensure all training was delivered and refreshed within required timescales. Supervisions had begun to take place although this was not yet in line with the frequency outlined in the provider’s supervision policy.

Improvements had been made to the management of medicines. Medicines had been administered and recorded appropriately. An auditing system was now in place to highlight and respond to any shortfalls.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had signed their care plans to consent to the support they were receiving.

People were encouraged to remain as independent as possible and their choices were respected by staff. Support with meals was provided where required.

Care was delivered in accordance with people’s wishes and needs and care plans contained person-centred information. Relatives told us they were kept informed if any changes occurred.

People knew how to make a complaint and were confident any issues would be promptly addressed. The provider had a complaints policy and procedure in place and this was included in the service user guide.

The registered manager requested feedback from people who used the service and relatives. The results of these surveys had been analysed and action taken when shortfalls were identified. People, relatives and staff spoke positively about the management team and their approach.

Regular staff and management meetings took place to ensure all employees were kept up to date with changes and developments within the service.

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.

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.