Archived: Express Healthcare UK Limited Domiciliary Care Agency

Express Healthcare provides personal care to people living in their own homes in the community, to assist and support them in maintaining or improving their independence.

The service had a registered manager. 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 told us not everyone who received a service had the capacity to make decisions about their care and support. They said people did not have mental capacity assessments in their care plans. We found the management team needed to obtain a better understanding of what was required to help the service work within the principles of the MCA and further training needed to be sought.

People and relatives told us they were very happy with the service they received and staff were kind and caring, treated them with dignity and respected their choices. People told us they felt safe and we found there were appropriate systems in place to protect people from risk of harm.

People’s care and support needs were assessed and care plans identified how care and support should be delivered. Staff members told us care plans contained sufficient information to enable them to carry out their role effectively. We saw the care plans were reviewed on a regular basis to make sure they provided accurate and up to date information. People received assistance with meals and healthcare when required. We found there were appropriate arrangements for the safe handling of medicines.

We found people were cared for, or supported by, appropriately trained staff. Robust recruitment procedures were in place. Staff had opportunities for on-going development and the registered manager ensured they received induction, supervision, annual appraisals and training relevant to their role. People who used the service said staff always stayed the agreed length of time and were more or less always on time.

People who used the service, relatives and staff all told us the management of the service was very good. They said the registered manager was approachable and responsive. We found there were appropriate systems in place for the management of complaints and systems to monitor and improve the quality of the service provided.

We found a breach 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.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service caring?

We found people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The agency send out questionnaires and complete telephone monitoring calls every six weeks.

Some of the comments from the questionnaires seen were:

'All care workers are good and caring'

'I am very happy with the service'

Is the service responsive?

We found evidence people were involved in planning their care and support, where possible. If a person had difficulty in making a decision about their care then the views of people's relatives were sought in order to gain an insight into what the person may have chosen. We saw that care plans were easy to follow with personalised individual support plans outlining how people preferred their care to be delivered.

One person receiving care from the agency said 'I would recommend them. We are asked how things are going and if we are happy with the carers.'

The relatives we spoke with told us they would raise any issues of concern with staff or with the manager. They were confident the agency would attend to any areas of concern.

Is the service safe?

Assessments of any potential risks were completed before any support or care was given so that the person receiving support can have their care delivered safely. The areas covered included: moving and handling, safe prompting of medication, and health and safety. One person had a ceiling tracking hoist in place and there were clear assessments to enable staff to support the person safely.

We noted that one person was supported into the community in their wheelchair. Yet it was not clear if staff had been trained in the correct way to support the person or if any assessments of potential risk had been carried out. The agency created competency forms for the use of wheelchairs outside the service user's homes and an assessment form to highlight any potential risks with an action plan on how to minimise them. The agency confirmed after the inspection that an assessment had been made.

The staff we spoke with all confirmed they all received training to enable them to support people safely. Staff gave details of their training and how it informs their work. This included moving and handling, medication and safeguarding. We saw evidence of training certificates and qualifications in staff files.

Is the service effective?

People spoken with said the carers often prompted or assisted them with medication.

Everyone spoken with said carers always documented their actions in the medication

sheets which were kept in their care plans. The medication sheets seen in people's care plans confirmed this.

We spoke with four care staff who all had a good knowledge of the people they cared for. They told us peoples' care plans and risk assessments were kept in people's homes. Staff told us the care records had guidance on how people's needs should be met.

Is the service well led?

We saw evidence of a system to ensure that people's care was reviewed regularly, daily notes, financial sheets and medication charts were also regularly reviewed. There was system to record any complaints and the action taken. There had been one complaint with a note of the action taken to respond.

The manager told us staff received regular supervisions which were held every 8 weeks. Supervisions were carried out by the senior and deputy manager. We spoke with four care staff who confirmed they received regular supervision. Staff explained they had shadowed a more experienced member of staff during their induction and probationary period. This helped to support staff to deliver safe and appropriate care.