Archived: Vera Care Limited

Vera Care provide personal care to one person in their own home. The Care Quality Commission (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

People told us they received the care and support they wanted in the way they preferred from the provider. The provider worked alone for most of the time and was supported on rare occasions by a member of care staff.

We found no evidence that people had been harmed however the provider was not operating systems and processes to ensure that people always received safe, effective, well led care which reflected their needs and preferences. This was important as the provider intended to employ more staff and expand the business.

The provider and staff member did not have the skills they needed to ensure people’s care was safe. For example, they had not completed training in medicines management, despite supporting people with their medicines. The provider prepared people’s meals and drinks but had not completed in depth food hygiene or infection control training.

Risks to people, including oral health care, had not been assessed. People told us they had planned their care with the provider and always received their care in the way they preferred. However, guidance about how to identify some risks had not been recorded. Assessments of people’s needs had not been completed to identify any changes in their needs.

Risks relating to people’s homes had not been fully assessed. Support to keep people safe in an emergency had not been planned. Systems were not in operation to learn from accidents and incidents and prevent them for happening again. People had not been given the opportunity to share their end of life wishes and preferences.

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; however, the policies and systems in the service did not support this practice. There was a risk that people would not always receive support to make decisions in ways which suited them best. Information about the service was not available in a variety of formats to ensure people always had the information they needed.

People told us they felt safe while the provider was in their home. The provider had not completed robust safeguarding training and there was a risk they may not identify when people were at risk of abuse.

A system was not in operation to ensure people received their care if the provider was not able to provide it at short notice. No new staff had been recruited since the last inspection.

The provider did not have systems in operation to invite feedback about the service from people, their relatives, staff and professionals. Other systems were not in place to check and evaluate the service and the provider was not aware of the shortfalls we found. The provider did not work with others to develop their skills or the service. Plans were not in place to continually improve the service, despite the providers plan to expand.

The provider did not fully understand their responsibilities to under the Health and Social Care Act 2008. We had not been informed about changes to the provider’s contact details.

People told us the provider prepared their meals and drinks in the ways they preferred. The provider identified changes in people’s health and supported them to contact health care professionals and follow their advice.

People said the provider was kind and caring and they got on well with them. They told us they were listened to and the provider delivered their care and support in the way they wanted. These were underpinned by the provider’s vision and values. People had shared their lifestyle choices with the provider and these were respected. People were supported to maintain their independence.

Any complaints or concerns people had raised had been addressed. The provider had a process in place to support this.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 17 October 2018). The service remains requires improvement. The service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staff skills and training, risk management, medicines management, planning end of life care, assessing people’s needs, accessible communication, obtaining consent to care, understanding people’s experiences of the service and the quality of the service, at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will 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 in the community. It provides a service to people living with dementia, older people, people with learning disabilities and autistic spectrum disorder, people with a mental illness and people who have a physical disability.

CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. There was one person receiving support with their personal care when we inspected.

At the last inspection on 26 July 2017 we rated the service Requires Improvement overall. We found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that medicines were suitably administered and recorded. The provider failed to establish and operate systems to assess, monitor and improve the quality and safety of the services provided. We also made recommendations. We recommended that the provider reviewed and amended recruitment records. We recommended that the provider reviewed systems and processes for recording and monitoring accidents and incidents. We recommended that the provider reviewed the systems they have in place in relation to reviewing and amending risk assessments. The provider submitted an action plan on 22 September 2017. This showed they had met Regulation 17 by 20 September 2017 and had met Regulation 12 by 15 September 2017.

There was no 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. The registered manager had deregistered on 22 August 2018, a manager was in post who planned to become the registered manager.

The person receiving care told us they received safe, effective, caring, responsive and well led care. They had nothing but positive feedback about the service they received.

The provider had followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles. The manager who was the only member of staff had attended training relevant to people's needs. The manager had received one to one supervision meetings and regular spot checks to ensure that they were putting their training into practice.

Individualised risk assessments were in place. However, the manager had not risk assessed catheter care. This meant risks in relation to infection control and monitoring the catheter had not been identified and mitigated. We spoke with the manager who provided the person their care and were confident that they knew how to work with the person effectively, who to contact and what to do if the catheter stopped working effectively. Managing risks to people's health was an area for improvement.

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

Systems were in place to enable the manager to assess, monitor and improve the quality and safety of the service. These systems were not fully robust as they had not identified the areas for improvement we found during the inspection.

People were supported and helped to maintain their health and to access health services. Timely action had been taken when people's health changed. There had been only one accidents and incident that had occurred. This had been handled effectively, there had been no lessons to learn from the incident.

Staff had received medicines training. Medicines had been recorded adequately. Medicines records were audited regularly. However, people were in receipt of as and when required (PRN) medicines had no PRN protocols in place to detail how they communicated pain, why they needed the medicine and what the maximum dosages were. This was an area for improvement.

People's care plans were clear for staff about how they should meet people’s care and support needs.

Essential information about people such as their life history, likes, dislikes and preferences were included. Care plans had been reviewed and amended regularly to ensure they reflected each person's current need or specific healthcare needs.

People knew who to complain to if they needed to. The complaints procedure was available in the office and in people had copies within their handbooks in their homes. People had opportunities to feedback about the service they received.

People were protected from abuse or the risk of abuse. The manager was aware of their roles and responsibilities in relation to safeguarding people.

People received effective support to prepare and cook meals and drinks to meet their nutritional and hydration needs.

There were suitable numbers of staff on shift to meet people's needs. People received consistent support from staff they knew well. People told us that staff were kind and caring. Staff treated people with dignity and respect.

People's information was treated confidentially. People's paper records were stored securely in locked filing cabinets.

Vera Care Limited is a small domiciliary care agency which provides personal care and support for adults in their own homes. The service provides care for people living in the Medway area. At the time of our inspection they were supporting two people who received support with personal care tasks.

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.

People were positive about the service they received. They told us they received a safe, effective, caring, responsive and well led service.

People’s medicines were not always well managed and recorded. There were gaps on the medicines records and codes to evidence why medicines had not been given as prescribed were not used consistently. Medicines records did not detail the times of day that people received their medicines, which meant there was a risk that people would receive their next dose too close together.

There were quality assurance systems in place. These were not yet fully embedded. Quality checks undertaken had not identified the issues in relation to medicines.

Risks to people’s safety had been assessed and recorded with measures put into place to manage any hazards identified. Risk assessments had not always been updated as people’s needs changed. We made a recommendation about this.

Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support. There were suitable numbers of staff on shift to meet people’s needs. Staffing files were missing photographs of staff. We made a recommendation about this.

Accident and incident recording systems were in place. There had been one accident that had not been appropriately recorded. Appropriate action had taken place to deal with the accident. We made a recommendation about this.

Staff and the management team had received training about protecting people from abuse, and they knew what action to take if they suspected abuse.

Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) were in place which included steps that staff should take to comply with legal requirements.

Policies and procedures were in place, which meant staff had access to up to date information and guidance.

Staff had received training relevant to their roles. Further training courses had been booked. Staff received regular support and supervision from their line manager.

People’s information was treated confidentially. People’s paper records were stored securely in locked filing cabinets.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner.

People’s needs had been assessed to identify the care and support they required. Care and support was planned with people and reviewed to make sure people continued to have the support they needed. People’s care plans detailed what staff needed to do for a person. The care plans included information about their life history and were person centred. People were supported to be as independent as possible.

People told us that staff were kind, caring and communicated well with them.

People and their relatives had been involved with planning their own care. Staff treated people with dignity and respect.

People were given information about how to complain and how to make compliments.

People’s views and experiences were sought through review meetings and through surveys.

People told us that the service was well run. Staff were positive about the support they received from the registered manager. They felt they could raise concerns and they would be listened to.

Communication between staff within the service was good. They were made aware of significant events and any changes in people’s behaviour.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.