Archived: Synergy Homecare - Kirklees

We previously inspected the service on 14, 20 and 21 March 2017 and the service was rated as ‘Requires Improvement’ in four of the five key questions and overall, and as ‘Good’ in the key question of caring. We identified breaches of the regulations relating to need for consent and good governance. As a result, we served the registered provider with two warning notices.

Following the last inspection, we met with the provider to discuss improvements required. They provided an action plan to show what they would do and by when to improve all the key questions to at least good. On this visit, we checked to see if improvements had been made.

Synergy Homecare – Kirklees is a domiciliary care agency that operates in the Kirklees area. The agency provides a range of support for individuals in their own home which includes personal care, social care and domestic assistance. At the time of our inspection 56 people were receiving support from this provider.

The service had 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.

People told us they felt safe with the staff that supported them. Staff had undertaken safeguarding training which was kept up to date. Staff understood their role and responsibilities to keep people safe from harm.

There were robust risk assessments in place which also covered the environment in which people were supported. There were risk specific assessments which identified risks and the measures which were put in place to minimise the risks to people.

There were sufficient staff to meet people’s needs. There was a high level of consistency in the staff who attended each person. People told us they knew the staff who were supporting them.

Staff recruitment pre-employment checks had been carried out. Internal audits had not identified gaps in candidates’ employment history had not always been explored.

People were supported with medication and medicine administration records were audited monthly. However, some minor issues were not always picked up by the registered provider’s heads office audit process.

We have made a recommendation about effective audit processes.

Staff had undertaken training on the Mental Capacity Act (2005) and deprivation of Liberty Safeguards. Care records evidenced people had consented to care and treatment. Staff told us how they would always ask for verbal consent to care before assisting people.

New staff were supported in their role, which included training and shadowing a more experienced staff member. We saw evidence staff had received regular ongoing training in a variety of subjects. Staff received regular supervision and field based observational spot check assessments of their performance.

Staff knew how to access relevant healthcare professionals if their input was required.

People we spoke with told us staff were kind and caring. Staff treated them with respect and took steps to maintain their dignity and privacy. People’s private information was kept confidential.

People had a care plan in place which was person centred and provided sufficient detail to enable staff to provide the care and support required by each individual. Staff made a record of the care they provided at each call.

There was a complaints process in place; however there had been very few complaints received and none during 2018. People told us they knew what to do if they had any concerns or complaints about the service.

People supported told us the service was well led. They told us they were asked for their input and feedback regularly, during verbal contact and more formally in reviews and an annual satisfaction survey.

Feedback regarding the registered manager was positive. People spoke highly about the management of the service.

The service worked in partnership with other organisations and healthcare professionals.

Sevacare Kirklees is a domiciliary care agency that operates in the Kirklees area including Batley, Dewsbury, Huddersfield and the Valleys. The agency provides personal care support to people in their own home. There were 169 people using the service during the time we inspected which included people with a learning disability receiving support with personal care.

The service had a registered manager at the time of the inspection. 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, and their relatives, told us they felt safe receiving support from care workers at Sevacare Kirklees. We looked at safeguarding records and found evidence of appropriate reporting and thorough investigations where concerns had been raised. All staff had recently undergone refresher training in relation to safeguarding and were confident in recognising signs of abuse or neglect, and in taking action.

During the previous inspection we had highlighted significant concerns around the timing, duration and location of calls for care workers to manage. At this inspection we found signs of significant improvement. The service had implemented a system of electronic call monitoring which provided key data for the care co-ordinators and registered manager to analyse. This had only been in place for three weeks at the start of the inspection but we saw evidence of issues being addressed as a result.

We still saw some people were receiving less care than they had been allocated and the registered manager had liaised with the local authority in regards to this. People’s views, and staff comments, were much more positive and the general view was rotas were more consistent and tasks were completed as required. People were pleased to receive their rotas in advance so they knew who was coming.

Further work was required on the risk assessments in relation to people who were experiencing some form of memory loss as the impact of this was not always clear. We recommend that the registered manager urgently review all risk assessments to reflect people’s level of capacity to assess risk and consent to support, providing guidance for staff on how to best to support where there were concerns. We found some very good examples of person-centred moving and handling assessments and stressed to the registered manager the importance of following these records.

We had no concerns around the administration of medication during this inspection and felt confident all staff understood their role in relation to this part of the care delivery. We saw all staff had received refresher training in this area and records were being audited in depth. By the end of our inspection the registered manager had secured agreement for further home visits to take place to ensure practice was sound.

All staff had been re-trained in relation to medication, safeguarding, and moving and handling. They had also received training on the Mental Capacity Act (MCA) 2005. Supervisions had been completed, and where due had been scheduled with the staff member.

The service had not progressed since the last inspection with meeting the requirements of the MCA as there was no evidence of any capacity assessments or best interest decisions. People told us their consent was obtained before care tasks were undertaken but some records we read did not indicate everyone had the capacity to make this decision. This meant the service was not meeting the requirements of the MCA.

No issues were raised in relation to nutrition or hydration and people said all care tasks were completed as expected. People were supported to access health and social care agencies as required.

People and relatives were very complimentary about care staff, saying how much they valued their involvement. Evidence was shared of positive relationships with interested and engaged staff who respected people’s dignity.

Care records had remained person-centred in their style but not all had been reviewed by the time of the inspection due to the need for the service to focus on other key areas and needed further clarity around people’s needs.

Complaints were handled in more depth although the service needed to ensure follow up checks were completed to evidence situations had improved for people.

We found evidence of sound leadership which provided guidance and direction for staff. Audits were thorough and reflected what was required to determine if the service was performing well.

The registered manager was aware not all the planned changes had been fully implemented but had a detailed timetable of action to follow and the service needed to sustain areas where it had made progress.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We found continued breaches of Regulations 11 and 17 at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Sevacare Kirklees is a domiciliary care agency that operates in the Kirklees area including Batley, Dewsbury, Huddersfield and the Valleys. The agency provides personal care support to people in their own home. There were 133 people using the service during the time we inspected. There were a further 30 people with a learning disability receiving support to access the community. The registered manager had informed us these 30 people did not require personal care support and therefore did not come under our regulated activity regulations. However, upon sampling some of the care records of these people we found they were receiving support with personal care.

There was a registered manager in post during the time of the inspection. 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 serious issues with the allocation of care tasks that left people with late and shortened calls, staff had no time to carry out their duties effectively and there was a high risk of the likelihood of errors as staff were tired and under pressure to complete tasks in unrealistic timeframes. The service had no effective monitoring procedures in place to evaluate the provision of the calls and relied on staff or people using the service to report any concerns in relation to missed or late calls. This meant some people who were not in a position to request help were potentially left vulnerable as they had not received appropriate care.

Staffing numbers were inadequate to meet the demands of the service and some staff were working particularly long shifts, with no allocated travel time between calls and in most cases, having to pick up shifts for colleagues who were off sick. Some staff told us, and we saw written evidence, that working hours could not be altered due to pressures in the service.

Not all people receiving the service said they felt safe with the care workers and we reported two serious concerns which were investigated by the local authority. One of these had been partially addressed by the service but the other was not recorded despite the person saying they had reported it. Staff showed they had an understanding of how to report safeguarding concerns.

We found risk assessments did not always reflect individual need which meant staff did not always have effective guidance to follow if a person’s needs were more complex.

Medication records were completed in full by care workers at the start of each month with no extra time in place to fulfil this task or ensure these were double checked by another staff member, which increased the likelihood of error. We observed poor medication practice on one occasion which we reported to the registered manager who agreed to address the concerns promptly.

Staff had received an induction and supervision although only at six monthly intervals. Training records also indicated all staff had up to date training, although this was not reflected in conversations with staff.

People felt they had appropriate access to external support agencies as needed and care workers contacted these as required.

Where people lacked mental capacity to make decisions such as administering medication we found no evidence of capacity assessments or best interest decision-making. The registered manager told us they relied on information from the local authority.

People said most staff were pleasant and caring but there was evidence of a lack of dignity and respect for others. This was mostly attributed to staff rushing their tasks due to a pressured rota and not completing tasks in line with requirements. People’s preferences, such as for gender of carer, were not always respected.

Care records were written in a person-centred manner and outlined all key tasks that should be undertaken. However, there were serious issues with the records held in the office where we found conflicting lists of people using the service, paper files and electronic records. We found little assurance the registered manager had a full knowledge, understanding or oversight of the service.

Quality assurance measures were ineffective and did little to identify the concerns we found. There was little evidence of reviews of care provision involving the people using the service; these were limited to basic telephone questions. Although complaints were logged, investigations were not always completed thoroughly and low level concerns were not recorded effectively. There was a lack of effective leadership, scrutiny and ownership of the service which meant people did not always receive the care they were entitled to.

We found breaches in the following regulations; 9, person-centred care, 10 dignity and respect, 11 consent to care, 12 safe care and treatment, 17 good governance and 18 staffing.

Full information about CQC's regulatory response to any concerns found during inspections is

added to reports after any representations and appeals have been concluded. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We looked at 15 care records. The care records showed people were involved with their care planning and were consulted about services they required. The support plans were centred on the outcomes, aspirations and wishes that people would like to experience.

Sevacare Kirklees followed the Sevacare (UK) Ltd corporate safeguarding vulnerable adults and whistle blowing policies. This provided guidance for staff on how to detect different types of abuse and how to report abuse.

The staff we spoke with said they had received induction training which was followed by a period of shadowing. We reviewed nine staff files that demonstrated evidence of the induction and mandatory training. Records showed that all staff had completed up to date mandatory training and all senior staff had completed NVQ Level 3 in Health and Social Care.

The provider had systems in place to identify, analyse and review risks and incidents. Information about quality and safety was gathered and monitored to identify risks and areas for improvement. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented.