Kalcrest Care (Northern) Limited

Kalcrest Care (Northern) Limited 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 mainly older adults. At the time of the inspection, care and support was being delivered to 94 people

At the last inspection in May 2017 we rated the service requires improvement and found three breaches of regulation relating to safe care and treatment, person-centred care and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe well led to at least good. At this inspection we found further improvements had been made and the service was no longer in breach of any regulations.

A registered manager was 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.

Overall people provided positive feedback about the service and said it had continued to improve. People said they felt safe and secure in the company of staff. Systems were in place to protect people from abuse. Risks to people’s health and safety were assessed and clear and detailed risk assessments put in place for staff to follow.

We found there were enough staff deployed to ensure people received a reliable service although people and staff said there were some issues with continuity of staff on one of the rounds. Staff were recruited safely to help ensure they were of suitable character to work with vulnerable people. Staff received a range of training and support to enable them to do their role effectively. Overall, staff said they felt well supported by the management team.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity to make decisions, best interest decisions were made. People were involved in care planning to the maximum extent possible.

People’s care needs were assessed and clear and detailed plans of care put in place for staff to follow. These covered meeting people’s nutritional needs. The service worked with external health professionals to ensure people’s healthcare needs were met. People said care needs were met by the service.

Whilst most people were happy with the times that staff visited, we found some improvements were needed to ensure other people received care at a consistent time each day. We made a recommendation in relation to this.

People said staff were kind and caring and treated them well. Most people received consistent care workers which helped the development of positive relationships. People’s independence was promoted by the service.

Where people raised complaints these were logged, investigated and responded to within a timely manner. People’s feedback on the quality of the service was regularly sought and any negative comments or issues acted on.

People and relatives spoke positively about the overall quality of the service. Staff said they enjoyed working for the service and felt well supported.

Systems were in place to assess, monitor and improve the service. Audits and checks were used to make positive improvements to the service.

The inspection took place between 21 and 28 April 2017. We gave the provider a short amount of notice of our visit to ensure management staff were available to assist us with the inspection. At the time of the inspection there were 158 people using the service.

A registered manager was not in place although a manager had been appointed and had put in an application with the Commission to become registered. 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 undertook the inspection to check whether improvements had been made to the service following our previous inspection in October 2015. During that inspection we identified five breaches of regulation and rated the provider ‘Inadequate’ overall and in four of the five inspection domains.

We found improvements had been made to the service and we rated the service ‘Requires Improvement’ overall and in each of the five domains. Although some concerns still remained, the number of breaches of regulation had reduced from five to three and the severity of these breaches had been reduced meaning risks to people had been reduced.

Most people and relatives we spoke to told us they were now happy with the service provided. A number of people remarked how improvements had been made and they now received a more consistent and reliable service.

At previous inspections we had serious concerns over the lack of staff employed, staff rushing and being unable to stay with people long enough to ensure all care and support tasks were completed. At this inspection we found improvements had been made. Most people now reported staff did not rush and that the timeliness of the service was now acceptable. We saw additional staff had been recruited and rotas were now realistic and attainable and contained travel time between calls. However some people still raised concerns that staff did not always arrive on time, which demonstrated work was required to further improve the reliability of the service.

Staff were recruited in a safe and proper way to help ensure they were suitable to work with vulnerable people.

Medicines were not consistently managed in a safe way. Although a new system was being introduced which would reduce errors, documentation did not demonstrate people always received their medicines as prescribed.

People said they felt safe in the company of staff. Action had been taken to investigate and learn from safeguarding incidents. People said equipment was used safely and competently by staff. Risk assessments were in place; however some of these required bringing up-to-date.

People and relatives said the consistency and familiarity of care workers had increased and most people praised the skill and knowledge of staff. Staff received a range of training and support relevant to their role.

People said they were supported appropriately to eat and drink by staff.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which meant people’s rights and freedoms were protected.

Overall, people said staff were kind and caring and treated them well. We saw action had been taken to address reports of uncaring or undignified care, showing the management team recognised the importance of dignity and respect.

Some people reported that staff did not always let them know if they were going to be late or if new care workers were being introduced.

Most people and relatives said care was appropriate and met their individual needs. Whilst some people had a complete assessment of their needs in place, a number of care records were not up-to-date. We saw a plan was in place to address this.

People, relatives and staff reported a more organised service which was now more responsive in dealing with concerns and issues. Staff said morale had improved and they felt more able to provide high quality care and support.

Systems to assess, monitor and improve the service were in place but they were not sufficiently robust. For example in terms of ensuring medicines were managed in a safe and appropriate way.

People’s feedback was obtained and the service logged, investigated and responded to most complaints. However where negative comments were received through questionnaires, these were not always responded to as complaints.

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

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

The inspection took place between 24 and 28 October. We gave the provider a short amount of notice of our visit to ensure management staff were available to assist us with the inspection. At the time of the inspection there were 183 people using the service.

A registered manager was not 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. Following the inspection the provider told us they had appointed a manager who would shortly begin the registered manager application process.

People and relatives provided mixed feedback about the quality of the service. Most people said they felt safe in the company of staff. They said staff were kind and compassionate and treated them in a respectful and kind manner. However most people told us timekeeping was poor and care needs were not met since staff didn’t arrive on time or did not stay for the correct amount of time.

Medicines were not managed in a safe way. Medicines records were poorly completed which meant we could not confirm whether people had received their medicines as prescribed. There was insufficient information recorded on the medicines people were taking.

We found some people did not have complete care plans or risk assessments in place, which meant the risks to their health and safety had not been properly assessed. Some incidents and accidents were not properly recorded and preventative actions were not always noted to enable staff to learn from incidents.

There were insufficient staff deployed to ensure people received a reliable and consistent service at the times they needed care and support. Safe recruitment procedures were in place to make sure staff were of suitable character to work with vulnerable people.

Most people told us regular staff understood their needs and had the right skills and knowledge to care for them. However they said when staff had to cover shifts at short notice these staff did not know what to do. People said staff rushed and this was at the detriment to effective care, particularly for those living with dementia.

Overall we concluded, the service was compliant with the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards.

People’s needs were not fully assessed and appropriate plans of care were not always in place. Some people were without complete care plans. There was a lack of information recorded on how staff should manage people’s emotional and psychological needs and manage refusal of care and support.

Care was not appropriate, as staff were not consistently arriving on time or staying for the correct amount of time.

The service had received a large amount of complaints about the quality of the service. We saw many of these had yet to be properly processed. Complaint records showed themes first raised in early 2016 had yet to be fully resolved.

The provider and management were open and honest with us about the current challenges facing the organisation. They recognised the service required improving and were in the process of recruiting further staff to help enable improvements to the service.

We found a lack of systems and processes to adequately assess and monitor various aspects of the service. Some audits and checks were undertaken. However these were not sufficiently robust in resolving issues and were not always undertaken in a timely way.

We found care staff were not completing an accurate record in respect to each service user, with inaccurate visit times recorded on timesheets and people’s daily records.

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.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes the records we looked at and what people who used the service and the staff told us.

Is the service safe?

At the time of our visit there was approximately 150 people who used the service. We spoke with four people who all told us they felt safe when staff visited them. We also spoke with four relatives who told us they felt staff provided people with safe and effective support.

Each person's care file had risk assessments which covered areas of potential risk. When people were identified as being at risk, their plans showed the actions required to manage these risks.

There were enough skilled and experienced staff to ensure people received a consistent and safe level of support.

We found there were appropriate arrangements in place to ensure that medicines were managed safely.

Is the service effective?

People had individual care records which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their health and care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

People told us they received the care and support they required at the times they needed it. One person told us 'Staff fit into my routine, they come when it's convenient for me." Another person said 'They even move the times they come if we ask them to because we have an appointment to attend; they are always very accommodating." A relative told us 'They never let us down, staff arrive every day like clockwork. If they do run late they have always called to let me know. The staff are like our family."

Is the service caring?

People told us the service provided a good standard of care to people. One relative told us 'I am more than happy, it's a marvellous service. I could not cope without them. The difference it has made to our lives is immeasurable." Another relative told us 'They provide an excellent standard of care. I now don't have to worry about anything.'

Our discussions with people and the records we looked at also told us that individual wishes for care and support were taken into account and respected.

We found the care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered.

Is the service responsive?

Care records were reviewed and any changes made either when people's needs changed or as part of the annual review process. We saw evidence of this within the care records we reviewed. The staff we spoke with told us they would immediately alert the manager if they noticed a change in people's needs.

We found people knew how to make a complaint if they were unhappy. We saw evidence that the service took any concerns people raised seriously and looked into them quickly. From our review of records and from speaking with people we saw that people who used the service were asked for their views about their care and treatment and they were acted on.

Is the service well-led?

We saw there was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service.

People who used the service told us if there were any problems they felt able to raise these with staff and were confident they would be listened to.