Archived: Help for Carers

South Thames Crossroads, which is a registered charity, provides support to approximately 500 carers living in the London Boroughs of Merton, Wandsworth, Sutton, Lambeth and Croydon. Staff employed by the organisation provide short respite breaks for carers by taking over the care and support tasks for people or children they care for. The breaks can be anywhere between a few hours a week or over a number of days. Approximately 80 adults and 60 children, with a wide range of health care needs and conditions, receive help with personal care and support from this service. The majority of people receiving this support were funded by their local authority but some people also pay privately for support from the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a 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 found significant improvements had been made in the way medicines were managed and in the way important information about people, and other records relating to the service, were maintained. People received their medicines as prescribed. Improvements had been made in the way staff maintained records each time they supported people with their medicines. There was appropriate guidance for staff to follow to ensure people received their ‘as required’ (PRN) medicines when they needed this. We also found other records maintained by the service were accurate and contained up to date information. Measures were in place to ensure these were consistently maintained to a good standard.

People and their carers told us they felt safe with the support provided by the service. Staff had been provided with the information and support they needed to take appropriate action to ensure people were protected if they suspected they were at risk of abuse and not harmed by discriminatory behaviour or practices. Risks to people’s health, safety and wellbeing had been assessed by senior staff. Plans were put in place which instructed staff on how to minimise any identified risks to keep people safe from harm or injury.

The provider ensured people were supported by staff that were suitable and fit to work for the service. They carried out employment and criminal records checks on all staff. The majority of people told us they had no concerns about staff turning up late or missing a scheduled visit. This indicated there were sufficient numbers of staff available to support people. Staffing levels were monitored by senior staff to ensure people’s needs could be met at all times.

Staff received relevant training to meet people’s needs. Senior staff monitored training to ensure staff skills and knowledge were kept up to date. Staff received supervision so that they were appropriately supported in their roles to care for people. Staff were provided opportunities to share their views about the quality of support people experienced and for their suggestions about how the service could be improved.

People and their carers told us their views were taken into account when staff assessed their care and support needs. Each person had a care plan which was reflective of their specific needs and preferences for how they wished to be cared for and supported. People and their carers said staff were able to meet their needs. Senior staff reviewed people’s care plans regularly to ensure staff had up to date information about people’s current care and support needs.

Where the service was responsible for this, people were encouraged to eat and drink sufficient amounts to support them to stay healthy and well. Staff monitored people’s general health and wellbeing. Where they had any issues or concerns about this they took appropriate action so that medical care and attention could be sought promptly from the relevant healthcare professionals.

The provider had clear goals and objectives about what people and their carers should expect from staff and the service in terms of service standards and conduct. The majority of people and carers we spoke with were satisfied with the care and support they received. People and their carers knew how to make a complaint if needed. People and their carers told us staff looked after them in a way which was kind, caring and respectful. People’s right to privacy and dignity was respected and maintained by staff, particularly when receiving personal care. People were encouraged to do as much as they could and wanted to do for themselves to retain control and independence.

They provider had arrangements in place to ensure all people, including hard to reach communities, could access information, advice and support for carers and their family members. The views of people and staff were regularly sought about the service. Senior staff used this information along with other checks to assess and review the quality of service people experienced. There was regular communication from the senior staff team to people and their carers keeping them updated and informed about the service.

People, staff and others such as local authority commissioning teams had been consulted and engaged with, in deciding the changes the service needed to make in order to continuously improve. The provider was proactive in making improvements where these were needed. This included investment in new technology and resources which will provide staff with improved tools to support them in their roles.

Senior staff carried out checks of the service to assess the quality of care and support people experienced. Where there were any shortfalls or gaps identified the registered manager took responsibility for ensuring these were addressed promptly. Progress against these actions was discussed and reviewed weekly by the senior staff team. Information about current service standards and progress against action and improvement plans was shared with Trustees so that there was oversight and scrutiny at board level.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. Staff received training in the MCA so they were aware of their roles and responsibilities in relation to the Act. Records showed people’s capacity to make decisions about aspects of their care was considered when planning their support. Where people lacked capacity to make specific decisions there was involvement of their relatives or representatives and relevant care professionals to make these decisions in people’s best interests.

The provider sent us an action plan on 13 January 2014 setting out the actions they would take to achieve compliance with these regulations. During this visit we checked these actions had been completed.

We saw evidence there were appropriate measures in place to ensure that the care and support needs of people using the service were reviewed and assessed in a timely manner. We looked at people's records and saw people's care and support needs were reviewed by senior staff to identify any changes. We also noted risks to people's health, safety and welfare had also been assessed in a timely manner. There was current information on people's records that detailed the care and support provided to them by carers.

A small number of people told us about their experiences when staff had been late or not turned up for scheduled visits. We discussed this with senior staff who were already aware of these issues and had taken steps to address these.

People told us they and/or their relative had been involved in making decisions and consenting to the care and support that was planned. Where people were unable to make decisions, relatives had been involved in making these on their behalf.

The service had carried out assessments with people, and where appropriate their representatives, to identify the specific care and support that was required from staff. People had been able to state their choices and preferences for how they or their relative were looked after. The service had used this information to develop care plans to provide the care and support people needed. We saw from care plans we looked at there was information for staff about how to meet people's care and support needs.

However during the inspection we identified some people had not had a reassessment of their care and support needs for over a year. This meant any changes to people's needs had not been appropriately identified and put people at risk of receiving unsafe or inappropriate care. We also found daily records completed by staff detailing the care and support provided, were not current on people's individual files. This meant senior staff could not be assured staff had delivered the care and support that had been planned.

There were effective procedures in place to recruit and appoint staff and appropriate checks were made about staff's suitability to work for the service. The competency of new staff was assessed to ensure they had the appropriate skills and knowledge to care for and support people using the service.

People were provided with information about how they could make a complaint about the service. People were also asked for their views and given opportunities to make suggestions for improvements. We saw the service acted on these suggestions and made changes and improvements that people wanted.

We looked at the plans in place to provide care and support to people using the service. We found there were instructions and guidance for staff about how to meet people's care and support needs. We also saw that risks to their health, safety and wellbeing had been identified with a plan in place for staff to manage these.

Staff employed by the service had access to suitable training and development opportunities. There was a system in place for senior staff to assess and monitor the quality of service being provided. However not all of the records kept by the service were up to date and accurately maintained.