Cera - Old Stratford

Cera – Old Stratford is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection 40 people were receiving support with personal care. 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 the service and what we found:

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support

Staff supported people to have the maximum possible choice, control, and independence over their own lives. Staff supported people with their medicines.

Right Care

People received kind and compassionate care. Staff treated people with dignity and respect and understood and responded to their individual needs. Staff had training on how to recognise and report abuse. Staff understood how to protect people from poor care and abuse. The service had enough staff to meet people's needs and keep them safe. People's support plans reflected their needs and the risks posed.

Right Culture

People received good quality care and support. Staff knew and understood people well and were responsive to their care and support needs. Management and staff put people's needs and wishes at the heart of everything they did.

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 08 March 2023).

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

When we last inspected Cera Old Stratford on 6 October 2022 breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cera – Old Stratford is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection 77 people were receiving support with personal care. 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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. We considered this guidance as there were a small number of people using the service who have a learning disability.

Right Care:

Risks to people were not always identified or managed safely, as people’s care plans and risk assessments did not always reflect people’s current needs. People’s care records did not reflect they had been provided with all the care they required. For example, where people required regular support to reposition to prevent skin damage.

Care was person-centred and promoted people's dignity, privacy and human rights. Staff had received training on supporting people with a learning disability, and autistic people. Staff understood how to protect people from poor care and abuse.

Medicines were safely managed, and people received their medicines as prescribed.

People were protected from the risks associated with infection because the service had processes in place to reduce the risk of infection and cross contamination and these were followed by staff.

Right Support:

Some people received their care visits outside of the time that had been agreed and the provider had not always ensured people were kept informed of which staff would be attending their care visits and at what time.

People were supported to have maximum control, choice and independence through the care provided in their own homes. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Culture:

There were insufficient systems in place to assess, monitor and improve the service. Where the provider had identified issues with the quality of the service, they had failed to implement the changes required.

There was a positive and inclusive culture at management level, the management team worked well with partnership agencies.

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 10 December 2021) and there were 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 the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was carried out to check whether the Warning Notice we previously served in relation to Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The overall rating for the service has not changed following this focussed inspection and remains requires improvement.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cera – Old Stratford on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of people’s risks, management of care calls and the oversight of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

At the time of inspection, it appeared that we had not received statutory notifications for notifiable incidents. We are currently looking into this matter.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Cera- Old Stratford is a domiciliary care agency providing personal care to people living in their own homes. 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. At the time of inspection 113 people were receiving personal care.

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

Risks to people had not always been recorded and assessed. Care plans and risk assessment had missing information. Records of care tasks to mitigate risks were not always completed.

Systems required to ensure effective oversight of the service was not always in place or effective. For example, the systems in place to ensure medicines were recorded and administered appropriately had not identified some of the concerns found on inspection.

Medicine management required improvement. Records were always completed fully. However, people told us they received their medicines as prescribed.

People did not always know what staff were coming or what time staff would arrive. Call times varied dependant on the person’s priority based on risk. Staffing levels were low, and the provider was in the process of recruiting new staff.

People were supported by staff who received appropriate training, understood safeguarding, had been safety recruited and wore personal protective equipment (PPE) to reduce the spread of COVID-19.

People, relatives and staff were asked to feedback on the service. However, not all staff felt involved in the service. For example, not all staff were able to attend staff meetings to understand what changes or improvements were being made or to share information between the staff team.

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 9 April 2021) and there were two 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 not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to people not receiving care calls. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cera- Old Stratford on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risks and management oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Cera- Old Stratford is a domiciliary care agency. They provide personal care to people living in their own homes. 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. At the time of the inspection 96 people were receiving personal care.

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

Medicine administration required improvement. Records of the administration of medicines had gaps and incorrect codes used. We found missing information regarding application of creams and start/end dates of medicines.

Not all risks to people had been recorded as assessed or had mitigating strategies identified to lower the known risks. Care plans were not always person centred or up to date.

Staff did not always turn up on time or stay the allocated amount of time for each support call. The Registered manager was reviewing these.

Not all staff had up to date training, however the registered manager had booked all relevant staff onto to refresher training courses.

The oversight of the service did not consistently assess, monitor and improve the quality of the service. Audits completed had not identified all of the concerns we found on inspection. When the audits had identified issues, we did not see evidence of the actions taken to reduce the risk of reoccurrence.

People were mostly supported by staff who knew them well and had been safely recruited. Staff understood how to recognise and report any concerns of abuse.

Relatives were kept up to date about any changes and were able to send messages directly to staff and the registered manager as required.

Staff felt supported by the manager and received one to one meetings to discuss any concerns they may have.

Staff were being regularly tested for COVID-19 to protect people from the spread of infections.

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 good (published 31 July 2018).

Why we inspected

We received concerns in relation to missed care calls, infection control and medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cera- Old Stratford on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to risk assessments, medicine management and oversight 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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

At our last inspection in June 2016 we rated the service. At this inspection we found the evidence continued to support the rating of good, and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff received safeguarding training so they knew how to recognise the signs and symptoms of abuse and how to report any concerns of abuse. Risk management plans were in place to protect and promote people’s safety. The staffing arrangements were suitable to keep people safe. The staff recruitment practices ensured staff were suitable to work with people. Staff followed infection control procedures to reduce the risks of spreading infection or illness.

The provider understood their responsibility to comply with the Accessible Information Standard (AIS), which came into force in August 2016.

Staff received induction training when they first started work at the service. On-going refresher training ensured staff were able to provide care and support for people following current practice.

Where the provider took on the responsibility, staff supported people to eat and drink sufficient amounts to maintain a varied and balanced diet. The staff supported people to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

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 support this practice.

People had their diverse needs assessed, they had positive relationships with staff and received care in line best practice meeting people’s personal preferences. Staff consistently provided people with respectful and compassionate care.

The service had a positive ethos and an open culture. The registered manager was a visible role model in the service. People, their relatives and other professionals told us that they had confidence in the manager’s ability to provide consistently high quality managerial oversight and leadership.

Mears Care - Old Stratford provides people with personal care in their own homes in Milton Keynes and Northamptonshire. They provide care to older people, as well as people with physical or learning disabilities. When we inspected they were providing care to 90 people.

The service did not have a registered manager in post, as they had recently left the service and de-registered. A new manager had been appointed and was in the process of registering. 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 felt safe when they received care from the service and staff worked to protect them from harm or abuse. There were systems to identify potential risks to people, and to put steps in place to help staff manage those risks effectively. Staffing levels were consistent and sufficient to meet people's needs without the need for agency staff. Background checks and references were completed for all staff members to ensure they were of good character and suitable for their roles.

Staff were given the training and support they needed to equip them with the skills and knowledge required to meet people's needs. Staff received regular supervision and were able to discuss any concerns they had. People's consent to their care and support was sought and there were systems in place to help make best interests' decisions if people lacked mental capacity. Staff supported people to maintain a health and balanced diet and helped them to see healthcare professionals if necessary.

People were treated with kindness and compassion by staff members. Staff worked to build strong relationships with people and their family members, which helped them to deliver people's care in the way they wanted. Information about people's care and the service was available to them and their family members and they were involved in planning their own care. Staff members treated people with respect and made sure their privacy and dignity was upheld.

Person-centred care was given, which ensured people received care and support which took their specific needs and preferences into account. Initial assessments were carried out to identify people's needs and care plans were updated on a regular basis to ensure they were accurate. Feedback from people was encouraged, as were compliments and complaints, to help the provider develop the service.

There was a positive and open culture at the service. People were happy with the care they received from members of staff and felt that there had been positive developments at the service. Staff were aware of their roles and responsibilities and were motivated to work with people and meet their needs. The manager had been newly appointed and was positive about the service and the direction they wanted to take it in. They were aware of their statutory requirements and had systems in place to oversee the service and identify areas for development.

During our inspection of Mears Care ' Old Stratford we set out to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found.

Is the service safe?

People we spoke with told us they felt safe being cared for by staff from the service and felt confident to raise concerns with staff. Staff had received training in safeguarding and were clear about how to identify, prevent and report abuse.

There was one occasion when seven people did not receive a care visit on the same day, when a member of staff went off sick and the visits had not been reallocated. We were informed that as soon as the service had identified the missed calls, they called each individual and offered to provide them with a care worker. We saw records that demonstrated the service had notified the local safeguarding team and the Care Quality Commission. This meant that the service was transparent by ensuring that local safeguarding protocols were being followed.

The service followed safe recruitment practices. This meant only staff who were suitable to work with vulnerable people were employed by the service.

Is the service effective?

People told us that they sometimes experienced late care visits and three people added that they were not advised of the delays. However, eight of the ten people we spoke with stated that they received all their care, felt their needs were met and were happy with their regular care workers.

Records we looked at were varying and inconsistent. People's medication needs were not detailed in care plans and people's Medication Administration Records (MAR) contained numerous omissions. Electronic records of staff providing care did not correspond with hand written records. This meant that people using the service were not protected from the risk of unsafe care and treatment because records were not accurate or fit for purpose.

Is the service caring?

Three people said they did not always receive care from a consistent group of care workers who knew and understood their needs. However they confirmed that they were happy with their regular care workers and said their care needs were always met.

Care workers we spoke with were aware of people's care needs and spoke kindly about the people they cared for. We also heard office staff talking about people fondly and knowledgably.

Is the service responsive?

We saw four examples of individual complaints in relation to inappropriate timings of peoples care visits. Although these had been responded to individually, we received feedback from people that their care visits were sometimes late.

People were encouraged to make their views known about the care and support they received. We observed 26 feedback forms recently completed by people using the service. These were overall positive and 14 people rated the service as 'very good' and five as 'excellent'.

Is the service well-led?

We were made aware that there had been changes to the management of the service. A new manager had been appointed and was receiving additional support from the organisations operation manager.

Staff spoken with said that the new manager had brought in lots of changes to improve on the care provided. A staff member said, 'The manager and trainer work hands on to ensure that care is provided to an appropriate standard.'

Is the service safe?

In the first six months since Mears Care managed their domiciliary service from their new office in Old Stratford there had been concerns about the number of missed or late calls being reported. This meant that some people had not always received safe care. This was because some people had their needs neglected because staff had not always managed to provide the agreed number of visits some people required throughout the day. We found that, for example, although assessed as necessary, some people had not always received two staff to support them with their personal care needs. This was due to a combination of factors including, for example, problems with staff recruitment which meant staffing levels were sometimes inadequate to ensure people consistently received the care they needed. We also saw that previously the day-to-day scheduling of staff had not always been effectively coordinated and communicated to staff. This had meant some people had not always received their care at the time or interval agreed with them.

We found that although there had been improvements made to increase the reliability of the service so that people received safe care, some further improvements were still needed to ensure this was consistently sustained. The improvements already implemented when we inspected included the recruitment of more staff, the appointment of a new manager, and better communication between the office staff, the staff scheduled to provide people's care, and the people who received that care. We saw, for example, that the provider had introduced a new telephone system that required staff to 'log' in and out of their scheduled visit. This had reduced the risk of a call being missed and provided the manager with information about times of arrival and departure from people's home.

Is the service effective?

The issues already highlighted above had meant that in the months previous to this first inspection of the service located at Old Stratford the service had not always been effective.

We saw from the eight care files that we looked at that individualised care plans and risk assessments were in place that gave staff the information they needed to provide effective support. It was clear from speaking with staff that they had a good understanding of the individual care and support needs that people required.

We saw that communication between staff had improved which has had a positive impact upon the day-to-day effectiveness of the service. The six people we visited at home all said they had received the agreed service they needed. One person said, 'The carers are not as bad at time keeping as they once were. There has been a lot of improvement. I have no complaints at all about the carers.' Another person said, 'The carers have always had to rush to get things done although I am not unhappy with what they do for me. I get the help I need, but I still think the staff are under a lot of pressure to get things done in the time they have.'

Is the service caring?

The six people we visited at home all said the staff that visited them were friendly, caring, and treated them respectfully. This was the experience of the additional ten people we telephoned and was also reflected in previous surveys carried out by the provider. One person said, 'I have no worries about the way the carers treat me. I think they are marvellous. A few times though when I have had to phone the office they did not ring me back even after saying they would. I think that could be better. It gives the wrong impression.'

Is the service responsive?

We found that in the eight care files we looked at the assessments had included identifying any risks to people and detailing how staff should care for people to support their safety and wellbeing. Previously some people had not always experienced a responsive service. This was because the provider had not always been aware that scheduled calls had been missed or that staff had arrived late at people's homes. We saw that improvements had been made to the scheduling of day-to-day visits to people's homes. This meant that the risk of people not receiving the care they needed, when they needed it, had been reduced.

New office staff had been appointed to co-ordinate the service more efficiently. This meant that staff were in a position to respond appropriately and in a timely way to unforeseen problems that had an effect on the reliability of the service, such as traffic delays causing staff to run late, or staff sickness requiring last minute changes to the visit schedules. This meant that people were better informed about unavoidable delays to their service.

Prior to our inspection people were unhappy that they rarely knew who had been allocated to visit them at home. Although people had been sent a weekly schedule it was often sent incomplete. We saw that this had improved, with complete weekly schedules posted out to people so that they were not left wondering if anyone had been scheduled to visit them.

Is the service well led?

We saw that a new manager had been appointed and recently registered with the Care Quality Commission (CQC) in July 2014. The five staff we spoke with individually confirmed that the manager is approachable, supportive, and committed to sustaining the improvements already implemented prior to our inspection. This meant that people were assured of receiving a service from staff that were enabled to do their job with the managerial support and guidance they needed.