Archived: Penwith Care

People’s experience of using this service:

The service had safeguarding systems in place, and staff had received suitable training about recognising abuse. People said they felt safe.

Appropriate risk assessment procedures where in place so any risks to people and staff were minimised.

Staff were recruited appropriately. Staffing levels were satisfactory, and people received timely support from staff when this was required.

People received suitable assistance with their medicines. Staff received training in medicines management.

The service had appropriate procedures to ensure any infection control risks were minimised.

The registered manager was able to demonstrate the service learned from mistakes to minimise them happening again.

The service had suitable assessment and care planning systems to assist in ensuring people received effective and responsive care.

Staff received suitable induction, training and supervision to assist them to carry out their work.

People received suitable assistance, when necessary with their shopping , meal preparation and help to eat and drink.

People received suitable support from external health professionals, and were encouraged to live healthier lives.

Staff encouraged people to have choices about how they lived in line with legal guidance.

People said they received support from staff which was caring and respectful. Care promoted people’s dignity and independence. People were involved in decisions about their care.

People felt confident raising any concerns or complaints. Records showed these had been responded to appropriately.

The service was managed effectively. People and staff had confidence in the registered manager.

The service had suitable systems to monitor service delivery and bring about improvement when necessary.

The team worked well together and had the shared goal of providing a good service to people who used the service.

The service worked well with external professionals, and other organisations to provide good quality care.

Rating at last inspection: Rating at last inspection: ‘Requires improvement.’ (published on 25 May 2018.)

The service was last rated ‘Good’ in the report dated 13 April 2017.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to make improvements to the service.

Why we inspected: We completed this inspection to check whether suitable action had been taken following the last inspection. The evidence found showed the service had met the breaches of regulation and at this inspection the service was rated Good.

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

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

Penwith Care provides people with personal care in their own homes. At the time of the inspection the service provided support for approximately 40 people. The service provided support for people in the Newlyn, Penzance, Hayle, Carbis Bay and St Ives area. The service works with mostly elderly people.

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 service had satisfactory safeguarding policies and procedures. Staff were trained to recognise abuse, and what to do if they suspected abuse was occurring. Suitable risk assessment procedures were in place, and risk assessments were regularly reviewed.

Recruitment checks for new staff were not satisfactory. We were concerned about checks completed by the registered persons such as Disclosure and Barring Service checks and reference checks. We were also concerned, due to the lack of records kept, about whether staff induction was thorough. Staff also were not provided with any first aid training. Records of staff supervision were also sometimes limited.

Medicines procedures were satisfactory, and we were told the support people received in this area was good. Staff were trained in procedures to minimise the risk of infection. People and their relatives said staff were always clean and well dressed. Staff said they were provided with disposable gloves and aprons.

There were satisfactory procedures to assess people to check they were suitable to receive support from the service. Subsequently staff developed comprehensive care plans for people and these were regularly reviewed.

Where people received support to prepare meals, and monitor food eaten and fluid intake, procedures were satisfactory.

Where people lacked capacity to make decisions for themselves, suitable systems were in place to meet legal requirements and ensure people’s rights were protected.

We received positive support about staff attitudes. Comments included; “It is fantastic, amazing, I am full of praise,” “They are totally wonderful,” “Lots of banter but at the same time gentle and sympathetic,” and “I am happy with everything.” Staff worked with people to maximise people’s independence.

The service had a complaints procedure. People said they would approach staff or management if they had a concern.

The registered manager was viewed positively by the people who used the service, staff and professionals who we contacted.

The staff team said they worked well together. People and their relatives viewed staff positively and staff were viewed as caring.

Quality assurance processes were not sufficient to adequately pick up and address shortfalls in service provision.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

The service was led by a registered manger. 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 told us they were happy with the care and support provided by Penwith Care. Their comments included, “I am well looked after”, “[The staff] are very obliging, very willing”, “Marvellous, every one of them is marvellous” and “Absolutely brilliant.” People’s relatives also reported that staff were, “Extremely keen and take pride in the care they provide.”

There were sufficient staff available to provide all of the service’s planed care visits. The registered manager had chosen to limit the growth of the service and during both days of our inspection we overheard staff declining to accept additional care packages. Office staff told us, “We have the right balance at the moment of staff and clients.” The service rotas were well organised and staff had been allocated for all planned care visits during the week of our inspection. The Registered manager told us, “Rotas are done weekly and we are always a week ahead.” While staff commented, “Rota wise it does seem to be going really well”, “We have the app on our work phones, It works well” and “The rota is on the app, so you know exactly what visits you have.”

The service operated a call monitoring system to ensure all planned care visits were provided. This system was monitored in real time by the office staff team and where necessary action was taken to avoid care visits being missed. People told us they had not experienced recent missed care visits. An incident had occurred on New Year’s day as a staff member had failed to attend work. This incident had been managed appropriately and the person’s care needs had been met.

We compared staff rotas with daily care records and information from the service’s call monitoring system. These records showed that people normally received their visits on time and for the correct duration. People told us they normally received their visits on time and for the correct duration. People told us, “They are very good for time” and “Yes they are normally on time, the time on the rota is when they come.”

Staff were provided with an appropriate induction and training to ensure they were sufficiently skilled to meet people’s care needs. Staff told us, “I feel confident, I know what to do” and “The training is absolutely fine, they tell us when it is due.” In addition, staff were actively encouraged to continue their professional development. On the day of our inspection five staff attended the office to sign up for diploma level training. Staff told us, “I’ve done my induction, moving and handling and loads of on line training, 20 odd sections I think,” “I’ve done a lot of training” and “I feel confident, I know what to do.”

Staff told us they were well supported by the office staff team and staff had received regular supervision and spot checks. One staff member told us “[The compliance officer] did a supervision with me the other day, she came along behind me and checked the book (care plan) and spoke to the clients to check they were happy with me”.

Most people’s care plans were accurate and detailed. They provided staff with clear guidance on how to meet people’s care and support needs. One person’s care plan was missing some detailed information. This was raised with office staff and the person’s care plan was reviewed ad updated during the inspection process. Staff told the care plans were up to date and accurately reflected people’s needs. Staff comments included, “All the care plans are up to date” and “The care plans are fine, they have enough information. If you read them you know what you need to do.”

People understood how to raise complaints about the service’s performance and complaints received had been investigated and resolved appropriately.

The service was well led by the registered manager and office staff team. The operational management team had remained stable since our previous inspection. The roles and responsibilities of each member of office staff were clearly defined and systems had been introduced to document the action office had taken in response to information provided by members of care staff.

Records were well organised and the service had successfully introduced a mobile phone based application to improve information sharing between carers and office based staff. Using the application staff were able to view their individual rotas and directly report any information of concern to office based staff. Staff told us, “We have the app on our work phones, It works well”, and “The app is fantastic, you know what you are supposed to do each shift.”

The service’s quantity assurance systems were appropriate and a survey to gather additional feedback form people who used the service was in development.

This report only covers our findings in relation to topics of concern identified during our previous inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Penwith Care on our website at www.cqc.org.uk.

Penwith Care is a domiciliary care agency which provides support to people in their own homes in and around St Ives Bay and Penzance. The service supported 65 people at the time of this inspection. The service normally provides short visits to support people to get up in the morning, to go to bed in the evening and to prepare meals during the day. However shortly before this inspection the service had begun to provide a 24 hour care package for one person.

Penwith care was led by a registered manager who owns the business. 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 and associated Regulations about how the service is run.

At our previous inspection we found that staff had miss-recorded information about the length of care visits they had provided. At this inspection we found managers had taken action in order to prevent staff miss-recording information about the timing of care visits they had provided. Staff were no longer allowed to record information about visit times when not at the person’s home. In addition the service had trialled the use of a mobile phone app to allow staff to report information about visit times and their current location to office staff in real time. These changes once fully introduced will prevent staff from miss-reporting visit time information.

In May 2016 people told us they were not receiving care visits on time or for the correct duration. Some people told us they felt rushed while receiving support and staff told us they had shortened the length of peoples’ planned visits.

People now normally received their care visits on time and we found no evidence of planned visits having been missed. Non-one told us they felt rushed during their care visits and people’s comments included, “I am definitely safe”, “Visits times are consistent” and “Sometimes they are a bit late but only once have they been very late.” While staff said they had sufficient time to travel between care visits. Since our previous inspection a new system had been introduced to allow staff to record and explain why a care visit had been shorter than planned.

In May 2016 the service had not made necessary safeguarding alerts or appropriately investigated accidents and incidents. At this inspection we found that all accidents and incidents had been fully investigated by the service’s management team. Records showed staff had received additional training on how to safeguard people from abuse and the service had recently made appropriate referrals to the local authority to ensure a person was protected from possible abuse.

In May 2016 we identified an ongoing failure to provide staff with training, which the service had identified as necessary. At this inspection staff had been provided with significant additional training to ensure they were sufficiently skilled to meet people’s needs. Staff told us, “I have done all the online training and moving and handling as well” and “They send out online training for you to do and check that you have done it.” In addition,13 staff were in the process of completing diploma level qualifications in care. Recently recruited staff were in the process of completing the care certificate. People told us their care staff had sufficient skills to meet there needs and commented, “They all seem very very nice and very very helpful” and “The carers are fantastic, they really are first class. ”

The services management structures experienced significant changes during our previous inspection. At this inspection we found there had been no changes to the service’s management structure and that the roles and responsibilities of each manager were clear and well understood. During this inspection office staff took an open and honest approach to the inspection process.

In May 2016 the service’s visit planning systems were disorganised and staff had not received weekly visit schedules. At this inspection the service’s office systems were more organised and visit schedules had been provided to staff a week in advance. Staff said, “We know seven days in advance what to do” and “It is much much better, they have looked at the routes and they all make sense now.”

A new information management system had been trialled since our last inspection and staff were now able to access details of people’s care plans, their visit schedules and share information with office staff using a secure mobile phone application. This trial had been successful and staff told us, “The app is quite helpful” and “It is relatively straight forward and you can write a note to the office on it.” Managers told us they intended to provide all staff with dedicated mobile phones to enable this system to be used in future to record and share information about all of the service’s care visits.

We found improvements had been made to the service’s quality assurance system and that available information about visit times was now sampled my managers. Where any discrepancies were identified these were investigated.

The commission recognises that the service has made significant improvements since our previous inspection. We will return in the future to ensure these improvements are sustained and further progress is made to ensure the care provided consistently meets people’s needs.

The service had previously been inspected in June 2015 when it was found to require improvement overall. Issues were identified within the Safe, Effective and Well Led domains. Two breaches of the regulations were identified in relation to staffing levels and staff induction, training and supervision. We found at this inspection that while some improvements had been made more needed to be done to improve the quality of the service provided.

Penwith Care is a domiciliary care agency which provides support to people in their own homes in and around St Ives Bay and Penzance. The service had doubled in size since our previous inspection and now supports approximately 60 predominantly older people in their own homes. Since our previous inspection the service had changed address.

The service generally provides short visits to support people to get up in the morning, to go to bed in the evening and to prepare meals during the day.

The organisation was led by a registered manager who also owns the business. 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 and associated Regulations about how the service is run.

At our previous inspection we found staff had not received an appropriate induction, staff training needs had not been met and staff had not received regular supervision. During this inspection we identified similar issues. The service had failed to follow its own induction training policy with respect to the Care Certificate and assessments of staff skills.

The training needs of the staff team had not been appropriately managed. The service used on line training materials to enable staff to access these materials when they wished. However, the service had failed to ensure all staff had completed the training the service policies had identified as necessary. In relation to moving and handling training one person told us, “They haven’t had any personal training, it’s all done on the internet, a lot of them don’t know how to lift.” While staff said, “I’ve had no training on how to handle people, how to roll people or things like that” and, “I have had no training and I do the hoist every day.” Training records showed that of the 26 current staff; five had received no formal training, only eight staff had received manual handling training and 14 staff had received Health and safety training.

Staff did not understand local safeguarding procedures and only 14 staff had completed safeguarding training. Where significant incidents involving vulnerable adults had occurred the service had failed to make timely referrals to the local authority

People told us, “They always come” and, “They have never missed a visit.” During our review of call monitoring data and daily care records we found no evidence of planned care visits being missed. However peoples’ feedback in relation to the length of care visits provided by staff was mixed; most people reported they did not feel rushed. However, one person told us they felt rushed and said their visits had been cut short. Staff comments about visit times revealed significant differences in approach dependent on the number of hours staff worked and the way in which they were deployed.

The service used a telephone based call monitoring system to ensure people received all of their planned care visits. People told us staff did not always use the call monitoring system and one member of staff said, “They all know how to scam it.” We investigated this and found evidence that indicated staff had miss-recorded information via the call monitoring system. We discussed the time required to travel between these locations with the registered manager who agreed it was not possible to make this journey in the time recorded on the call monitoring system.

Accidents and incidents had not been appropriately documented. Where investigations had been completed they had not been sufficiently robust to establish what had actually happened.

People’s care plans were up to date and provided staff with sufficient detailed guidance to enable them to meet people’s care needs. People told us they got on well with their care staff and that their decision and choices were respected.

We found 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 the report.