Caring Moments Limited

At our last inspection on 5 and 11 July 2017, we found a breach of Regulation 19 of the Health and Social Care Act 20018 (Regulated Activities) Regulations 2014. Improvements were needed to establish safe and robust recruitment systems. We rated the service overall requires improvement. The key questions safe, responsive and well-led were rated requires improvement. The key questions effective and caring were rated good. Following the inspection, the provider sent us an action plan detailing how the shortfalls would be addressed.

At this announced, comprehensive inspection 28 September 2018, we found that improvements had been made in most areas and therefore, the provider was no longer in breach of any regulations. The overall rating for the service has now changed from requires improvement to good.

At the time of this inspection, there were 33 people who used the service and received ‘personal care’. The provider was given 48 hours’ notice because we wanted to be certain the registered manager and key staff would be available on the day of our inspection. We also wanted to give them sufficient time to seek agreements with people so that we could visit them in their homes to find out about their experience of using the service.

At this inspection, we found that improvements had been made and were ongoing. A registered manager was now in post. 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 registered manager had implemented systems to monitor the quality and safety of the service provided. Recording, auditing and documentation in these areas had recently been improved. However, these were not yet fully embedded into practice and at the time of the inspection we were unable to assess their effectiveness. 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 question of safe, caring, responsive and well led to at least good. At this inspection we found that improvements had been made in most areas and therefore, the provider was no longer in breach of any regulations. The overall rating for the service has now changed from requires improvement to good.

People and their relatives had developed good relationships with the care workers and management team. People received care that was personalised and responsive to their needs. They expressed their views and care staff listened to what they said and ensured their opinions were acted on.

People’s care records were accurate and reflected the support provided. Care workers consistently protected people’s privacy and dignity.

People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Systems were in place to minimise the risks to people, including from abuse, and in relation to mobility, nutrition and with accessing the community. Care workers understood their roles and responsibilities in keeping people safe.

Recruitment checks were carried out with sufficient numbers of care workers employed. They had the knowledge and skills through regular supervision and training to meet people’s needs.

Where people required assistance with their medicines, safe systems were followed. Care workers were provided with training in infection control and food hygiene and understood their responsibilities relating to these areas. Systems were in place to reduce the risks of cross infection.

The service worked in partnership with other agencies. Where care workers had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment. Where required, people were safely supported with their dietary needs.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. People’s feedback was valued and acted on. As a result, the quality of the service continued to progress.

A registered manager was not in post. 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. A general manager had recently been appointed at the service and their application to register with CQC had been submitted.

At our comprehensive inspection of 20 October 2016, we rated this service as inadequate and placed it in ‘Special Measures’. We found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were needed regarding safe management of medicines, safe care and treatment, person centred care and good governance. A warning notice was served to the provider for failing to provide people with safe care and treatment. In addition a positive condition was placed on the provider’s registration to submit to CQC a monthly report of the actions taken to improve the quality of the service.

The provider submitted an action plan to us about the measures they were taking to address the concerns found at the last inspection. This included medicines errors, continuity of care, recording shortfalls, ineffective oversight and governance arrangements, not responding appropriately to people’s concerns and poor quality of care provided. We received monthly progress reports which showed the provider was making the improvements needed.

During this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to fit and proper persons employed. Robust recruitment procedures were not in place. You can see what action we told the provider to take at the back of the full version of this report.

Since our last inspection there had been several managerial changes. This had impacted on the quality of service provision and progress on implementing the provider’s action plan. During this inspection we found a new manager had been appointed and worked closely with the provider and this had led to the overall quality of the service improving. The provider’s action plan for the service was being further developed to ensure that progress was continued, sustained and drove improvement. This included a number of measures to improve the overall quality and stability of the service. For example the recording and auditing within safe management of medicines and people’s care records and the coordination of people’s visits. However at the time of our inspection not all of these measures were in place for us to assess their impact. These measures need to be fully embedded and sustained within the service to drive continued improvement.

Progress had been made regarding the safe management of medicines with new documentation in place and further training provided for staff. Records seen showed no unexplained gaps but it was too early to assess the impact and effectiveness of the medicine audits as these were being implemented.

People and their relatives were complimentary about the care provided; stating communication in the office had improved. They praised the current manager for addressing the previous concerns around continuity of care and were confident in their ability to address any issues.

There was a more positive culture in the service which meant that care workers were aware of the values of the service and understood their roles and responsibilities.

Improvements were ongoing to ensure people’s care records reflected personalised care which was regularly reviewed and amended to meet changing needs. People and/or their representatives, where appropriate, were involved in making decisions about their care and support arrangements.

A complaints procedure was in place and the majority of people knew how to raise their concerns if they were unhappy with the care they received. There was mixed feedback from people about their experience of the complaints process; not everyone felt their concerns had been properly addressed by the previous managers, but were positive about the impact of the new manager and their ability to deal with any issues. Improvements were needed to ensure people could report their concerns, with their feedback valued and used to improve the service.

Systems were in place which provided guidance for care workers on how to safeguard the people who used the service from the potential risk of abuse. Care workers understood their roles and responsibilities in keeping people safe and actions were taken when they were concerned about people’s safety. They were confident in how to report concerns internally but not all care workers could describe how to escalate issues externally. Improvements were needed to ensure all employees understood the whistle blowing process and how to report concerns to external agencies.

Procedures and processes provided guidance to care workers on how to ensure the safety of the people who used the service. Risks to people were assessed and managed appropriately to ensure that people's health and well-being were promoted.

There were sufficient numbers of care workers to meet people’s needs. They had received supervision and training to support them to perform their role.

Care workers understood the need to obtain consent when providing care. They had completed training in relation to the Mental Capacity Act 2005 (MCA). Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) were followed which included steps that the provider should take to comply with legal requirements.

Where care workers had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment. Where required people were safely supported with their dietary needs

This service had 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.

There was not a registered manager in post. 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 deputy manager had made an application to become the registered manager and this had not yet been confirmed.

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

During this inspection, we found that the registered provider was in breach of six regulations 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.

The provider was failing to protect people using the service against the risks associated with the management of medicines. Medicine Administration Records [MAR] were not always completed or accurately recorded by care workers. This meant that we could not be confident people were receiving their medicines as prescribed. Refusal of medicines had not been reported to relevant health professionals.

The provider had not ensured that people were protected from the risks of unsafe care because people's needs had not been routinely reviewed, and checks on documentation had not been carried out. We found risk assessments that did not reflect current needs, and this meant that care workers did not always have up-to date and clear guidance to help them support people safely. Some people's care plans were not accurate in all areas and needed to reflect more fully people’s individual preferences. Where risks were documented, some people's care plans did not state actions to reduce risk.

Care workers asked for consent prior to carrying out any care or treatment, however, people's capacity to make decisions was not properly assessed, and there were no MCA assessments or best interest decisions in place.

Care workers understood their role in protecting people from abuse, types of abuse they may come across in their work, and who to report concerns to. However, a recent incident had not been reported by the management team, and therefore we could not be sure that all levels of staff understood when to raise concerns.

People who used the service told us that generally care workers were kind and caring. Care workers took steps to maintain people’s privacy and dignity, such as closing doors and curtains.

People’s feedback was not routinely sought to enable the service to understand people’s experiences of the care they were receiving. Complaints were logged, but actions taken were not always recorded. It was therefore ineffective at identifying themes and was not being used to drive improvement or make changes in the care people received.

Robust quality assurance systems and audits were not in place to monitor the service provided to people, and so the provider was unable to identify shortfalls in the safety and quality of the service. The provider did not undertake regular checks to ensure the quality of care or to use this to drive improvement. Observations to assess care workers competence had not been carried out. The provision of on-going supervision and performance management for care workers was not consistent. This resulted in poor practice in areas such as the management of medicines.