Wandle Healthcare Services

Wandle Healthcare Services is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection, 83 people were receiving personal care from this service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People's experience of using this service and what we found

Although people's care records required more information, people felt safe and well supported by the staff team. Systems were in place to ensure safe infection control practices and where necessary, the provider took action to improve their practice. People received their medicines as prescribed. Pre-employment checks took place before staff started working with people. Staff told us they were well supported and had appropriate training required for the job.

There was a strong management team in place with shared responsibilities to ensure effective care delivery. The service supported people's choices and well-being as necessary. People felt respected and had support to make decisions where they required it. Procedures were in place to address the concerns and complaints received as necessary. Staff contacted the healthcare professionals for guidance and support when people needed it.

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

Rating at last inspection

The last overall rating for this service was good (published 19/02/2020).

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wandle Healthcare Services on our website at www.cqc.org.uk.

Why we inspected

We carried out the inspection to check whether the provider had embedded and sustained improvements that we had noted at our previous inspection.

This was a focused inspection and the report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed and remains good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. At the time 27 older people, or those with dementia were using the service.

People’s experience of using this service

People and relatives raised some concerns were raised about the timeliness of call attendance. We have made a recommendation in relation to monitoring and improving lateness communications.

Risk assessments were clear in detailing people’s care needs and how staff needed to support people safely. Staff were safely recruited to ensure they were safe to work with people. Infection control measures were in place when supporting people. Medicines were safely managed and records were accurate.

People were supported with their nutritional needs and supported to access healthcare professionals when they needed to. Staff received regular training, supervision and appraisal to support them in their roles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff knew how to care for people well, and people appreciated the attendance of regular care staff. Steps were taken to ensure people’s privacy and dignity were respected.

Care records were personalised in detailing how people preferred to receive their care. People were supported to be independent where they were able to be. Complaints and concerns were appropriately responded to.

The management team took steps to support staff in their roles, and respond to client needs as they arose. Quality assurance systems had improved to ensure regular checks of care quality were carried out.

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

Rating at last inspection:

The last rating for this service was requires improvement (published 14 March 2019) and there were multiple breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, carried out on 6 February 2018, the service was rated Requires Improvement overall, with Requires Improvement in both the key questions, ‘Is the service effective?’ and ‘Is the service responsive?’. We found two breaches of the Regulations in relation to staffing and safe care and treatment.

This inspection took place on 4 and 5 February 2019 and was announced. We contacted the service 48 hours before the inspection to let them know that we will be coming to inspect them. We wanted to make sure that the management team would be available on the day of inspection.

This was a comprehensive inspection of the service and we rated the service Requires Improvement again. Their previous rating for the key question, Is the service effective? Has improved to Good. However, the rating for the key question, Is the service responsive remained Requires Improvement. The key questions, Is the service safe? and Is the service well-led? Has deteriorated from Good to requires improvement at this inspection.

The service had a registered manager in post. 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.

Risks to people's health and safety were not sufficiently assessed to ensure that appropriate guidance was provided for staff to mitigate the potential risks to people.

Care plans had not addressed the support people required to manage their health needs and to meet their individual care needs.

The provider did not have robust systems in place to monitor the quality of the services provided for people, including accuracy of care records and reviewing of incidents and accidents and complaints.

People felt well supported by staff and safe in their care. Staff had to undertake appropriate checks before they were employed by the service. Staff followed the service’s processes to provide immediate support to people if they noticed people being at risk to harm or when incidents and accidents took place. People had support to manage their medicines safely. However, some improvement was required to ensure that the medicine administration records were maintained appropriately.

Staff accessed appropriate training that gave them the knowledge and skills to support people effectively. Staff were confident that any concerns raised

would be acted upon by the registered manager appropriately. People told us that staff arrived for their shifts mostly on time and that they were contacted if staff were running late. Staff understood and followed the principles of the Mental Capacity Act (MCA) 2005. Healthcare professionals provided guidance to staff where people required support to meet their health needs and dietary requirements.

People’s views were listened to and staff had time to have conversations with people. Staff provided support that was respectful towards people’s privacy, culture and religion. People were treated with dignity and kindness. Staff enhanced people’s independence and encouraged people to take part in the activities of their choice.

People made choices about the support they wanted to receive and how they wanted to be cared for. Staff used people’s preferred communication strategies to involve them in conversations. People’s views were gathered and dealt with in a professional manner. Staff were guided on the support people required at the end stages of their life.

People felt that the service was well run and that the management team was responsive to their care needs. The registered manager was involved in day-to-day running of the service and knew what was required of them in their role. Staff had appropriate support which motivated their involvement in providing good support for people. Appropriate systems were in place to share information quickly as necessary.

This inspection was carried out on 6 February 2018 and was announced. We gave the registered manager 48 hours’ notice of the inspection because we needed to be sure that someone would be in when we come to inspect the service.

At the last inspection on 19 November 2015 the service was rated GOOD. At this inspection we rated the service Requires Improvement, with Requires Improvement in effective and responsive.

The service had a registered manager in post. 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 found that people’s care plans were not always accurately maintained. Information was missing on some of the needs identified and there were no records available on the support people required to meet these needs.

The training provided for staff was not always effective. Staff received a number of training courses in one day which made it difficult to retain information.

The management team had monitored safeguarding alerts raised and took actions to protect people as necessary. There were risk management plans in place to mitigate known risks to people. Recruitment checks were carried out to assess staff’s suitability for the role. The management team ensured that people had support to take their medicines in line with the service’s procedures. Measures were put in place to control infection and prevent accidents occurring.

Electronic systems were used to monitor the time staff spent with the people they were supporting. Staff also used their phones to share information as quickly as possible. Staff received one-to-one time with the managers to discuss their developmental needs and any concerns they had. People had the same staff members to support them which meant that staff knew people’s care and support needs well. Staff assisted people with their food shopping and cooking meals as necessary. There were processes in place for staff to follow to support people to make their own decisions if there were any concerns in relation to their capacity.

People and their relatives consistently told us that staff were caring, kind and respectful towards their privacy. Staff ensured that people had their dignity maintained and provided personal care in a way that felt comfortable. People had support to go out in the community and to maintain relationships that were important to them. People’s independence was enhanced and staff encouraged people to carry out tasks for themselves if they were able to. Staff knew what was important for people and ensured they provided people with the assistance they required.

People’s care and support needs were monitored and reviewed regularly so staff could provide the required level of care for people. People and their relatives approached the management team for information or if they were not happy about something so improvements could be made as necessary. Systems were in place to gather people’s feedback about the support they received and if they wanted to make any changed to the service delivery.

There was good leadership at the service and the staff team shared responsibilities to ensure effective care for people. Staff were provided with the service’s policies and procedures to follow and to provide consistent care for people. Quality assurance systems were in place and regular audits took place to review the quality of the care being delivered to people. The service worked in partnership with relevant agencies to share information about peoples changing needs.

We found two breaches of the regulations in relation to staffing and safe care and treatment. You can see what action we have told the provider to take at the back of the full version of this report.