Castle Care Teesdale Limited

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults and younger disabled adults. On the day of our inspection there were 47 people receiving the regulated activity of personal care.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 in June 2017 we rated the service as ‘Requires Improvement’ as we wanted to see sustained evidence of improvement following an inspection in February 2017 where we found the service in multiple breach of regulations and rated it as ‘Inadequate’. We saw at this inspection considerable improvements had been sustained and we now rated the service as 'Good'.

People told us they felt safe with the staff from Castle Care Teesdale Limited. The registered manager and team leaders understood their responsibilities with regard to safeguarding and staff and managers had received updated training in the protection of vulnerable adults.

The provider had an effective recruitment and selection procedure in place. People who used the service and their family members said staff usually arrived on time and stayed for the agreed length of time.

Accidents and incidents had been appropriately recorded and risk assessments were in place for people who used the service and staff. The service demonstrated it learnt from accidents, incidents and safeguarding issues and shared this learning with the staff team to drive improvements.

There was a safe system in place for the management of medicines and medicines administration records were completed accurately.

Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. We saw that the management team and staff were committed to supporting people to remain in their own homes with support and worked with district nurses, G.P’s, occupational therapy, physiotherapists and other specialist services as and when needed.

People who used the service and family members we spoke with were complimentary about the standard of care provided by the staff at Castle Care Teesdale Limited. People said their privacy and dignity were respected and they enjoyed positive relationships with the care staff.

Care records showed that people’s needs had been assessed before they started using the service and care plans were written in a person centred way. This meant that their preferences and wishes were respected.

People who used the service and family members were aware of how to make a complaint and people told us issues raised had been addressed by the management team.

Staff told us they were supported by the registered manager, assistant manager and care co-ordinator and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. People and family members told us the management and office staff were approachable. We saw some recent concerns from people and relatives regarding communication with the office had been addressed by the management team.

At the last inspection in February and March 2017 we rated the service as ‘Inadequate’ and the service was placed into ‘Special Measures’. The service has not been compliant with regulations since our inspection in 23 and 28 July 2015 and October 2016. People who use adult social care services have the right to expect high-quality, safe, effective and compassionate care. Where care falls below this standard and is judged to be inadequate it is essential that the service improves quickly for the benefit of people who use it. Special measures will give people who use the service the reassurance that the care they get should improve .

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 they are no longer rated as inadequate overall or in any of the key questions. Therefore, this service has now been taken out of Special Measures.

The provider has worked on improvements with the Care Quality Commission, Durham local authority and through their own consultants brought in to assist them since our last visit. At this inspection we found the provider had worked hard to meet all required regulations but needs to complete the improvement work they have started and to sustain the improvements long term.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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 our last inspection in February 2017 we saw that not all people had a list of medicines in their dosette boxes so staff knew what they were supporting people to take. Not all staff had been trained in the safe administration of medicines. This put people at risk of not receiving their medicines safely. On this visit we saw all policies and procedures had been revised and shared with staff in relation to medicines and all staff had been trained in the safe handling of medicines. Robust checks were now in place to ensure medicine records were safe and we saw actions taken by the service in response to issues found by audits. The service was carrying out competency checks with staff which observed staff carrying out medicine administration as well as recording their response to scenarios that may occur. We did find some gaps in the medicine administration records (MARs) we looked at. We could see that some staff had recorded their administration in the daily notes of the person rather than on the MAR and this did not contain the detail of the exact medicines that had been given. We asked the provider to explore the gaps we saw and they carried out an investigation and returned the findings to us including actions they were taking to ensure staff improved in this area.

At our last inspection in February 2017 risk assessments were not in place to ensure people were kept safe. People who required restrictive equipment such as bedrails did not have specific risk assessments in place. This meant staff did not always have the guidance in place to help them mitigate the risks to people using the service. On this visit we saw in the four files we viewed that risk assessments were in place and had been reviewed. We saw a variety of risk assessments were in place including for moving and handling, falls, bathing, bed rails and equipment and these had been reviewed with the person or their named representative.

At our last inspection in February 2017 there was not a systematic method of recording incidents. We found incidents had not been reviewed in sufficient detail to ensure people who used the service were kept safe. At this visit we saw two incidents had been recorded, investigated and appropriately actioned by the registered manager, this included the submission of a statutory notification to the CQC.

At our last inspection in February 2017 no required notifications had been made to CQC since the service registered with us in 2010. At this visit we saw that the provider had submitted appropriate notifications to CQC in a timely manner.

At our last inspection in February 2017, the provider had not carried out comprehensive pre-employment checks to ensure staff were safe to work with vulnerable people. Although the service had not employed any new staff by this visit, we saw that all outstanding references had been sought and new Disclosure and Barring Service checks had been carried out by the provider for those staff without the correct level of check.

At our last inspection in February 2017, staff were not supported to carry out their role through regular supervisions and appraisals. We found staff were caring for people without having training to meet people’s needs. On this visit we saw the registered manager had begun a programme of one to one supervision with care staff and had recorded these meetings. Staff also told us they had received supervision and had found it helpful. Since our last visit staff had undertaken training in mandatory subjects such as moving and handling, food hygiene, infection control as well as training to meet the specific needs of people such as diabetes and pressure care.

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. The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

At our last inspection in February 2017, two people did not have assessments or care plans in place. This meant that people were at risk of receiving unsafe care. We saw all people now had care plans in place and these had been reviewed with the person or their named representative. Whilst care plans had improved we discussed with the provider that further improvements still needed to be made to ensure care plans were person centred and reflected the preferences and wishes of people who used the service.

There had been no complaints received since our last inspection and we saw that the service’s management team had met with people and their representatives as they reviewed people’s care. People were asked about their satisfaction with the service or if they had any concerns.

At our last inspection in February 2017, there was a lack of established quality audits carried out at the service by the registered manager and provider. The service had implemented spot audits to visit people at home and observe staff, but this had not commenced until January 2017 so this required sustained improvement. We saw new audits in relation to service user records had been undertaken and these had addressed and actioned areas for improvement. The provider had also reviewed and re-drafted its quality assurance policy to self-monitor and evaluate the service with the assistance of an external consultant. Management changes had also taken place to ensure the registered manager had the appropriate time and support to make the improvements required from the last inspection.

Feedback from people who used the service and their relatives at Castle Care Teesdale Limited was positive about the care and support received from staff. People we spoke with told us staff turned up on time and were caring and diligent. Relatives we spoke with told us the service had improved in relation to the administration of medicines and that staff were responsive to any changes in people’s needs.

At the last inspection on 16 and 19 September 2016 we rated the service as “Requires Improvement.” The service has not been compliant with regulations since our inspection in 23 and 28 July 2015. We had issued a warning notice to Castle Care Teesdale Limited on 13 October 2016 where the service was required to be compliant with regulations by 31 January 2017.

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.

The service had 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.

We checked to see if people were given their medicines in a safe manner and found there were gaps in the Medicine Administration Records (MAR). We saw that not all people had a list of medicines in their dosette boxes so staff knew what they were supporting people to take. Not all staff had training in the safe administration of medicines. This put people at risk of not receiving their medicines safely.

Risk assessments were not in place to ensure people were kept safe. People who required restrictive equipment such as bedrails did not have specific risk assessments in place. This meant staff did not always have the guidance in place to help them mitigate the risks to people using the service. We saw one person had a serious incident with a bedrail that was not followed up or reported to the relevant authorities by the registered provider.

There was not a systematic method of recording incidents. We found incidents had not been reviewed in sufficient detail to ensure people who used the service were kept safe. CQC requires registered services as a part of their registration to notify the Commission when there are incidents of a safeguarding nature, people receive injuries or there is a death of someone using the service. We found no notifications had been made to CQC since the service registered with us in 2010.

The registered provider did not carry out comprehensive pre-employment checks to ensure staff were safe to work with vulnerable people.

Staff were not supported to carry out their role through regular supervision and appraisal. We found staff were caring for people without having had training to meet people’s needs. For example we found no staff had received training in diabetes or catheterisation. Some staff members had not received training in mandatory areas such as safe handling and administration of medicines, food hygiene, safeguarding and health and safety. Induction training could not also be fully verified for new staff which meant people were at risk of receiving care from staff who were not trained.

We saw the service had now sought the written consent of people using the service.

Assessments were not always carried out with people prior to them receiving the service. We found two people without assessments and care plans in place. This meant that people were at risk of receiving unsafe care.

We found people with specific needs such as diabetes or were at risk of choking did not always have care plans in place to ensure staff were given guidance on how to care for people. This meant people could be at risk of receiving unsafe care.

There was a lack of established quality audits carried out at the service by the registered manager and director. The service had implemented some spot audits to visit people at home and observe staff but this had not commenced until January 2017. There were still no mechanisms for reviewing medicine administration records which meant gaps we found had not been picked up and addressed.

Management systems such as policies and procedures were not shared with staff, and although staff told us they felt supported by the registered provider and registered manager, there were not systems in place to share service updates via staff meetings as these did not take place.

We did see that the registered manager had begun to carry out care plan reviews. These had not taken place systematically previously.

Care plans were not person centred and did not reflect the views and preferences of people who used the service. We found care plans were a list of tasks to be carried out by care staff.

The service did not have an established complaints process in place and we saw complaints had not been dealt with according to the registered provider's own policy on receiving and responding to complaints.

Feedback from people who used the service at Castle Care was positive about the care and support they received from staff.

During our inspection we found a number of continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Details of any enforcement action taken by CQC will be detailed once appeals and representation processes have been completed

The service is registered to provide personal care to people in their own homes. At the time of our inspection the provider gave us a list of 100 people who used their service, 60 of whom were in receipt of personal care.

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 time of our inspection there was a registered manager in post.

We found new medicine administration records had been implemented but we saw gaps in recording which had not been identified through a robust audit process which meant people may be at risk of not receiving their medicines in a safe way.

There was a recruitment procedure in place to protect people from care being delivered by unsuitable staff but the service had not ensured appropriate references were sought in the case of one recently recruited staff member.

The registered provider had in place clear guidance to staff regarding gifts and gratuities which helped prevent people from being placed at risk of financial abuse.

People’s written consent had not been obtained by the provider to deliver care. During the course of our visit the assistant manager devised a new format to implement in people’s care plans to record their consent.

The service had considered people’s food and fluid intake and put in place specific plans to meet individual people’s needs.

We found staff did not receive recorded support through supervision and appraisal meetings although staff told us they felt supported and could raise issues at any time with the service’s management team.

People, their relatives and other professionals told us the service was caring.

The service supported people to attend local groups and day centres to help prevent social isolation.

The registered provider had in place a statement of confidentiality and staff we spoke to understood the statement.

The registered provider had in place arrangements to gather information about people before they visited to assess their needs before delivering care.

We found care plans had not been formally reviewed but feedback and discussion took place between staff and people to confirm care was still appropriate. This meant there was a risk that people’s needs had changed but staff did not have up-to –date written information to guide their practice.

We found training records were not up to date but saw a new programme of training was scheduled with a new training provider. Staff told us they had received training in moving and handling, dementia, administering medicines and first aid.

Staff who were new to the service underwent an induction period although this was not always well recorded. This included staff shadowing other more experienced staff members to learn about people’s needs and how they liked their care to be delivered.

The service had sought people’s views on the quality of the service they received but needed to ensure this linked to an improvement / action plan so that the service could demonstrate it had followed up any suggestions, comments or feedback.

The service worked in partnership with key organisations to support care provision and to ensure people's healthcare needs were met.

During our inspection we found a number of breaches 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.

We spoke with four people who used the service. All said they were very satisfied with the support they received. One person told us, "The service is first class, I am never rushed and they always have time for a chat." Another described the service as,"Excellent."

We saw evidence how the provider co-operated with other health care professionals to protect the health, welfare and safety of people who used the service.

The relationships people had with the staff who supported them were good. All personal support they received protected their privacy and dignity. This was confirmed when we spoke with people who used the service.

The recruitment records demonstrated all appropriate checks were in place before an employee commenced work at the agency.

We found suitable arrangement were in place for handling concerns and complaints.

We found Castle Care had 42 staff who provided care to around 110 people in their own homes in the Barnard Castle area and its surrounding villages.

We spoke with 4 people who used the service. All were highly complimentary of the care, treatment and support they received. One person said 'They're wonderful! They are so very good and they know exactly what they are doing.' Other comments included 'Very professional. I couldn't fault them in any way' and 'I'm well looked after. My son says I couldn't be in better hands.'

We spoke with 3 care workers. They all said they felt very well supported by the provider and thought they gave a good quality of service to people. One staff member said 'It's about engaging with the clients; being a little ray of sunshine in their lives.' Another said 'You become part of your client's family.'