We carried out a review of the data available to us about CCK Support Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about CCK Support Ltd, you can give feedback on this service.
CCK Support Ltd is a domiciliary care agency. It provides personal care to people living in their own houses
and flats. At the time of the inspection the service was providing care for 26 people including people with physical disabilities, mental health problems and people living with dementia. The service was provided in Canterbury, Whitstable, Herne Bay and surrounding areas.
Not everyone using CCK Support Ltd receives regulated activity; the Care Quality Commission (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.
People’s experience of using this service and what we found
People and relatives were positive and complimentary about the staff who supported them and the service they were provided with.
Audits undertaken by the registered managers had not identified there were some gaps in employment histories. We have asked the registered managers to improve this. People told us that they received their calls from regular staff who were on time and they had no missed calls. People received support from the registered managers and office staff when they needed it. They said there was always someone at the end of the phone.
People told us they felt safe and supported by staff in the way they preferred. Staff demonstrated good knowledge and received training on how to protect people from abuse. Staff could identify the forms of abuse and knew what they would do if the suspected or witnessed the different types. People spoke with staff about any potential risks to their health and welfare. These were assessed, monitored and regularly reviewed. Staff knew how to keep people safe from harm. People told us they received their medicines when they needed them. Staff administered people’s medicines safely
The registered managers made sure there was enough suitably trained staff to provide support to people. People said they were confident in the staff’s skills and abilities to look after them and keep them safe. Staff felt supported and valued. The registered managers checked that staff were undertaking their roles safely and effectively.
People's needs were assessed before they started using the service to make sure staff could deliver the care that they needed. People had been able to plan their visits with staff and how they wanted their care provided. Care plans were developed and reviewed regularly. People agreed to the support and care planned with them.
People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests. People were able to make decisions about their care and support and to maintain control of their lives. People's personal information was stored securely.
People said staff were kind, compassionate and caring and took their time to carry out their duties and did not rush. People said they were listened to and that they were treated respect.
People had access health care professionals when they needed them. The staff worked with other agencies to provide joined up care including specialist nurses when people were at the end of their lives. People were supported and cared for at the end of their life.
People were protected from the risks of developing infections. When staff prepared meals for people, they were supported to have a range of nutritious food and drink that they had chosen.
People knew what to do if they had any concerns or complaint. They said they would be listened to and their concerns would be taken seriously and acted on.
The registered managers were approachable and supportive and took an active role in the day to day running of the service. The culture within the agency was transparent, personalised and open. People and staff were positive about the registered managers. The registered managers and staff had ensured the delivery of high quality and safe care and understood their role and responsibilities
The registered managers worked closely with the staff team to monitor the care provided and any improvements needed were made. People had been asked for their views on their care and staff were happy working for the provider
Rating at last inspection and update:
At the last inspection on 5 and 7 November 2018, the overall rating of the service was 'Requires Improvement. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had continued to fail to ensure that the systems in place to quality assure the service were effective and staff had not received appropriate training to make sure they could carry out their roles safely.
We asked the provider to send us a plan setting out the actions that they would take to meet these legal requirements. The provider returned the action plan within the agreed timescale and told us they would meet all breaches of regulations by 17 January 2019.
At this inspection on 5 and 10 December 2019, we found that the provider had made improvements and was no longer in breach of the 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.
Not everyone using CCK Support Ltd receives regulated activity; 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.
The service was run by two registered managers, both of whom were present at the inspection visit to the office. 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 the last inspection on 20 and 22 September 2017, the overall rating of the service was ‘Requires Improvement. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Registration Regulations 2009. People could not be assured they would be protected from abuse; medicines were not well managed; care plans were not always personalised; some records were not accurate; and the quality of the service was not checked to make sure risks to people were minimised. Furthermore, the provider had not notified the Care Quality Commission of all events and incidents as required.
We asked the provider to send us a plan setting out the actions that they would take to meet these legal requirements. The provider returned the action plan within the agreed timescale and told us they would meet all breaches of regulations by 30 January 2018.
At this inspection on 5 and 7 November 2018, we found that the provider had made improvements in protecting people from abuse, medicines, care planning, managing risk, record keeping and informing us of important events. However, the provider continued to have ineffective systems in place to monitor the quality of the service. We also found an addition breach of regulation in that not all staff that supported people with equipment had received training in how to do so safely.
This is the second time the service has been rated as RI.
You can see what action we have asked the provider to take at the end of this report.
People and relatives told us they trusted staff and felt safe. Staff had received training in how to safeguard people and knew how to follow the service’s safeguarding protocols keep people safe.
Assessments of potential risks in the environment and with regards to people’s health and welfare had been carried out. Guidance and strategies had been developed which staff followed to protect people from avoidable harm. Accidents and incidents were monitored to see if there were any trends or if lessons could be learned.
Improvements had been made to the management of medicines. Staff had received training in how to give people their medicines and knew how to follow the service’s medicines policy. Medicines were audited and investigations took place to make sure people received their medicines as prescribed by their doctor.
Suitable recruitment checks were in place for new staff. People had their needs met by regular staff who were available in sufficient numbers.
Improvements had been made to the frequency that staff received formal supervision. Staff were supported by a management team that listened and responded to their views.
People’s health and nutritional needs were monitored. Referrals were made to health care professionals and their advice was acted on. People were encouraged to eat and drink to maintain good health.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were introduced to new staff members before they provided them with support. Staff knew people well and provided consistent care. People and relatives said staff were kind and caring and they provided them with physical and emotional support.
People's needs were assessed before they were provided with a service. Improvements had been made to care plans so that they were personalised and gave guidance to staff about how to care for each person's individual needs and routines.
People and relatives knew how to make a complaint. The provider monitored complaints to see if there were any patterns or trends that needed to be addressed.
People, relatives and health care professionals thought that the service was well run. They were asked for their views and these were taken into consideration in the running of the service. The registered managers led by example, supported people with their care and staff understood how to put the aims of the service into practice.
The service provided care and support to adults with a variety of needs living in their own homes. This included people living with dementia and physical disabilities. At the time of the inspection the agency provided personal care for ten people. They also provided support for other people with their shopping and activities but this type of support is not regulated by the Care Quality Commission (CQC).
The service is run by three registered managers. 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.
This was the first inspection of the service as they had moved locations and appointed two registered managers in April 2017. The registered managers had not identified the shortfalls found at this inspection. The audits in place had not ensured that the quality of the service was checked to assess the care being provided.
Policies and procedures had not been updated in line with current practice and legislation.
Although feedback about the service had been gathered from people and staff, other stakeholders such as health care professionals had not been sent a quality survey. The results of the surveys for people and staff had been analysed but this overview had not been distributed to ensure people were aware of the outcome.
Medicines were not being managed or administered safely. In some cases medicines could not be accounted for and some medicines were being left out for people to take after the staff had left their homes without full risk assessments in place to ensure this practice was safe. Medicine records were not clear to confirm that people were receiving their prescribed medicines. The medicine policy did not have full guidance for staff to follow.
Not all risks associated with people’s care had been identified, therefore guidance about how to manage risks and keep people safe were not in place. Staff were able to tell us how they moved people safely but this guidance was not in the care plans. Some people had medical conditions such as diabetes, and the care plans did not detail what signs and symptoms would indicate that their condition had become unstable. There was a risk that staff may not recognise the signs if a person was becoming unwell and when to seek medical advice.
People and relatives told us they felt safe whilst being supported by the staff, however the safeguarding policy was not up to date and although staff had received training on how to keep people safe, this had not been updated. Staff did not have a good understanding of how to report safeguarding concerns to the local authority safeguarding team.
Staff training was being provided but in some cases training had not been updated so that staff were aware of the latest guidelines and legislation. Staff had received medicines training however; senior staff had not observed staff practice to ensure they had the skills and competencies to administer medicines safely. Staff were not receiving regular supervision in line with the company policy.
Staff completed a full induction, which included shadowing experienced staff so they were aware of people’s needs and routines. Staff told us that they checked equipment such as hoists to ensure they had been serviced and were safe to use.
People said the staff asked for their consent when they supported them with their care. However people’s mental capacity had not been assessed to ensure that staff had an understanding of how this impacted on people’s daily lives.
People told us that the staff were reliable and they received their care from regular staff. They told us that each member of staff was introduced to them before providing their care. This gave them more confidence as they knew who was coming each day. There was sufficient staff on duty to cover the calls. Staffing levels were kept under review and there was ongoing recruitment to ensure there were sufficient staff to cover the calls. Staff recruitment required additional monitoring to ensure that all staff had two references including one from their previous employer.
Some care plans lacked detail to show that people received personalised care in line with their wishes. Although people were being supported to access health care professionals such as doctors or occupational therapists there was a lack of detail to guide staff how to support people with their catheter care or medical conditions such as diabetes. Staff reported any health concerns to the office staff who ensured appropriate action was taken so that people received the help they needed.
People told us there were supported with their meals and staff always gave them a choice. They talked about how staff left drinks and snacks out for them to eat later. People said the staff were kind and caring. Staff treated people with dignity and respect whilst encouraging them to remain as independent as possible. Staff told us how they supported people to access the community, such as dropping them off at social activities of their choice.
People told us that they would contact the office if they needed to raise any concerns. They told us that they did not have any complaints but were confident the office staff would sort things out if they raised any issues.
People and staff were aware of the out of hour’s telephone number and staff confirmed that staff on call always responded if they needed further guidance or support.
The registered managers both provided direct care at times and worked alongside care staff completing the calls. Although spot checks had not been completed since April this year, they told us how they observed staff practice during this time, however there were no formal records to confirm this.
People and staff told us the service was well organised and there was an open positive culture in the service. Staff understood the visions and values of the service, such as treating people as individuals with dignity and respect. .
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.