Archived: Crest Care Services Ltd

Updated 22 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 19 September 2018 and was carried out by one inspector. The provider was given 48 hours’ notice of our visit because we wanted to ensure the registered manager was available to support the inspection process.

Before the inspection we reviewed records held by CQC which included notifications, complaints and any safeguarding concerns. A notification is information about important events which the registered person is required to send us by law. This enabled us to ensure we were addressing potential areas of concern at the inspection. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During our inspection we visited the agency’s office and spoke with the registered manager and the care co-ordinator. We checked care records for three people, including their assessments, care plans and risk assessments. We looked at four staff files and records of staff training and supervision. We also checked records related to the management of the service, including satisfaction surveys, complaints, quality monitoring checks and audits.

After the inspection, we spoke with two people who used the service and two relatives to hear their views about the care and support provided. We also spoke with two members of staff to hear their views about the training and support they received.

Updated 22 December 2018

The inspection took place on 19 September 2018 and was announced.

This service is a domiciliary care agency. It provides personal care to older people living in their own homes. The agency provided personal care to 23 people at the time of our inspection.

There was a registered manager in place. 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 our last inspection we identified concerns in relation to the agency’s recruitment procedures. We also found medicines were not managed safely and that people’s care plans were not reviewed regularly enough to ensure they reflected their needs. Staff had no travelling time between their scheduled care visits, which meant people’s visits were often delayed. Staff did not have opportunities to discuss their performance or their training and development needs with their managers. Spot checks had not been carried out on some staff, which meant the registered manager could not be sure they were providing consistent and effective care. Some people were dissatisfied with the agency’s communication with them.

At this inspection we found improvements had been made. Staff had been recruited safely and people’s medicines were being audited to ensure they were being administered correctly. People’s care plans had been reviewed and updated where necessary. Staff had travelling time built into their rotas. Staff had received one-to-one supervision, which provided them with opportunities to discuss their professional development and training needs. Spot checks had been carried out to check that staff were providing care safely and in the way people preferred. A care co-ordinator had been recruited, who had contacted all the people using the agency to hear their views about the service they received.

Although improvements had been made in these areas, we identified further improvements that the registered manager needed to make to ensure the service was well-led. Most people reported that communication from the agency’s office had improved since our last inspection and that, as a result, they could access the information they wanted when they needed it. However, some people told us that they could not always contact the office when they needed to and had to leave messages, which were not always responded to. We have made a recommendation about this.

Staff attended safeguarding training and understood their responsibilities in terms of recognising and reporting abuse. Staff understood any risks involved in people’s care and managed these well. The provider had developed a contingency plan, which prioritised the delivery of care to people most at risk in the event of an emergency. Staff helped people keep their homes clean and maintained appropriate standards of infection control.

Staff had access to the training they needed to carry out their roles. People’s care was provided in accordance with the Mental Capacity Act 2005 (MCA). Staff had received training on the MCA and understood its principles. People’s nutritional needs were assessed during their initial assessment and any dietary needs recorded in their care plans. Staff understood people’s healthcare needs and supported them to maintain good health.

Staff were kind and caring. People had developed positive relationships with their care workers and enjoyed their company. Relatives said staff treated their family members with respect and maintained their dignity when providing care. Staff supported people to maintain their independence wherever possible.

Care plans provided guidance for staff about people’s needs and the way they preferred their care to be provided. The agency was not providing end-of-life care at the time of our inspection, although people were able to express their wishes about this aspect of care to ensure this information was recorded. Team meetings had been introduced since our last inspection, which staff told us had improved the information they received from the agency’s management team. Where necessary, staff worked in partnership with healthcare professionals, such as community nurses, to provide people’s care.

People had opportunities to contribute their views about the service they received. The agency’s care co-ordinator had contacted all the people who used the service for feedback since our last inspection. People knew how to complain if they were dissatisfied. People who had complained told us action had been taken as a result of the concerns they raised.