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Archived: Carol Spinks Homecare Requires improvement

The provider of this service changed - see new profile

Reports


Inspection carried out on 6 July 2017

During an inspection looking at part of the service

We carried out an announced comprehensive inspection of this service in January 2017. During that inspection we found the service was failing to comply with Regulation 12 Safe care and treatment and Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In relation to Regulation 12 Safe care and treatment, we found people’s risk assessments did not identify and ensure risks were minimised. Staff administering medication and assisting people with their mobility had not always been trained to do so. Not all staff had been recruited robustly before commencing employment and some people did not receive visits at times they needed them. In relation to Regulation 17 Good governance we identified that some systems or processes in place to assess, monitor and improve the quality and safety of the service were not always effective. For example, recognising the above issues and ensuring actions were taken. Staff call times were not audited to ensure staff visited at the required times and care records were not audited. Following this inspection in January 2017 we issued two warning notices relating to Regulation 12 and 17 requiring the service to become compliant with the relevant requirements by 21 April 2017. We received a satisfactory action plan from the provider detailing the actions they had taken to meet the regulations.

We then carried out this focussed inspection on 6 July 2017 to check Regulations 12 and 17 had been met. The evidence in this report only relates to the compliance of the warning notice and not the remaining key lines of enquiry for safe. We are unable to change the rating on this key question until the next comprehensive inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Carol Spinks Homecare on our website at www.cqc.org.uk. We found that all areas referred to in the warning notices had been addressed and Regulations 12 and 17 had been met.

Carol Spinks Homecare is a domiciliary care service that provides care and support to adults of all ages in their own homes. The service provides help with people’s personal care needs in Saltash, Liskeard and Callington and the surrounding areas. At the time of this inspection 80 people were receiving support with their care needs.

The service had a registered manager in post who was also the provider. 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.

All the people and relatives we spoke with told us they were very happy with the service. They felt safe and were very complimentary about their care workers and expressed confidence in the way the service was managed. Three people who had been out when we telephoned, phoned back because they wanted to record their appreciation. One person said, “I really hope they do well in the inspection. They certainly deserve top marks as far as I’m concerned!” Other people commented, “They [staff] chat away to him when they shower him – and it takes his mind off it. I’ve been amazed at how well he has accepted having carers in. He was dead set against it at first but he recognises that they have made life so much better for both of us”, “‘They [staff] are like gold-dust. They are all so good – I do have my favourites though. They are so well trained, so consistent” and “They [staff] treat me wonderfully. I was apprehensive at first of course. But they are so discreet, so understanding. They don’t get embarrassed, so I don’t get embarrassed.”

Staff rotas showed that there were enough staff to meet people’s needs. No-one had experienced a missed visit in the last 12 months and visits were monitored to ensure people received vis

Inspection carried out on 25 January 2017

During a routine inspection

Carol Spinks Homecare is a domiciliary care service that provides care and support to adults of all ages in their own homes. The service provides help with people’s personal care needs in Saltash, Liskeard, Callington and surrounding areas. The service supports some people who require support with personal care needs at specific times of the day and/or night. At the time of the inspection 43 people were receiving support with personal care needs.

At the previous inspection in December 2015 we found breaches of regulation. The Mental Capacity Act 2005 (MCA) was not always being followed and risk assessments were not always in place and reviewed to ensure people were kept safe. Care plans were not effectively reviewed and reflective of the care being delivered and where people were supported with medicines, records did not detail their medicines and the support they required. Staff were not always trained to administer medicines to help ensure people received them safely. Staff did not always receive training appropriate to their role to enable them to carry out their duties. The provider’s quality monitoring systems were not always effective to help ensure the service being delivered to people was of a good quality and met their needs.

Prior to our inspection we had received information of concern from the local authority. These included people not being supported safely with their finances or medicines and staff not receiving sufficient training, particularly regarding moving people. Concerns were also raised about calls to people being late.

A registered manager was employed to manage the service locally. 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 this inspection we found assessments were carried out to identify risks to people relating to their health and social care needs. However they did not always identify all risks to people and were not always supported with information to guide staff how to help mitigate the risks.

Recruitment processes were undertaken but these were not always thorough or reflective of current regulations. For example, staff were at times, required to visit people’s homes before relevant checks, such as references and disclosure and barring service (DBS) checks had been received by the service.

Staff training was not always up to date or sufficient for the tasks staff were supporting people with. For example, staff who were supporting people to move or take their medicines had not always received training to do this. Staff and senior managers had received training regarding the Mental Capacity Act 2005 but did not reflect the requirements of the act in their knowledge or practice. This meant people’s rights may not have been protected.

Records did not always give a clear overview of what care had been provided and when care had been refused. Incident forms were not always completed in a timely way or monitored for emerging themes. This meant changes to people’s needs may not have been identified as quickly as possible.

The quality of the service was not monitored effectively to identify areas for improvement. Where concerns had been raised through feedback requested by the service, it was not clear action had been taken. People had previously raised concerns about the times of their calls. The provider told us they now monitored calls more closely but people we spoke with told us they still had concerns in this area. One person commented, “They arrive quite late sometimes. It should be 7am and can be up to 9.30am.”

Care plans contained information about what care people required, their background and their daily routines but did not always contain guidance for staff about how people liked staff to c

Inspection carried out on 15 & 21 December 2015 3 & 29 January 2016

During a routine inspection

The inspection took place on 15 and 21 December 2015 and 3 and 29 January 2016, and was announced.

Carol Spinks Homecare provides domiciliary care services to older and younger people within East Cornwall. On the days of the inspection the service was providing personal care to 90 people, including those with physical disabilities, sensory impairments, mental health needs, and people living with dementia. The service also provided palliative care to people who were at the end of life.

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.

People felt safe when care staff entered their homes. The staff and the provider had a good understanding of how to report any safeguarding concerns. People described staff to be kind and caring. Staff had a good understanding of how to respect and promote people’s privacy and dignity.

People felt they could complain and that their complaints would be investigated and resolved. People’s main complaint had been in respect of late visits and about not being informed when staff were running late. The provider acknowledged people had experienced this, and was in the process of making improvements. People were asked for their feedback about the service they received, and it was valued and used to facilitate improvements. There was an on call and out of hours facility in place for people to access.

People’s changing care needs were referred to relevant health services when concerns were identified. People were supported and assisted with their meals to help maintain a balanced diet. People’s had care plans and risk assessments in place, however, they were not always detailed and reflective of people’s needs and how they wished to be supported. This meant staff did not always have sufficient information about how to support people. At the time of our inspection, the provider was taking action to make improvements.

Staff obtained people’s consent before providing personal care. Staff had a limited understanding of the Mental Capacity Act 2005 (MCA), which meant decisions being made by staff may not have been in the person’s best interests.

People were supported with their medicine; however people’s care plans relating to medicines to give guidance to staff were not always in place. Staff administering medicines had not always received training which meant staff may not be safely administering people’s medicines.

People were supported by staff who had been recruited safely and were suitable to work with vulnerable people. Staff confirmed they received training, however records showed staff did not always complete training applicable to their role, which meant they may not always have the correct knowledge and skills to meet people’s needs. There were enough staff to meet people’s needs but people told us they were not always informed when staff were running late.

Staff enjoyed working for the organisation and told us the provider was supportive. There were quality assurance systems in place to help drive improvements and raise standards. However, the systems were not always effective in helping to ensure the service being delivered was of a good quality and met people’s needs.

We found 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.

Inspection carried out on 14 August 2014

During an inspection looking at part of the service

We gathered evidence against the outcomes we inspected to help answer two key questions: Is the service safe? Is the service well led? We gathered information from people who used the service by talking with them.

Is the service safe?

At the time of our inspection we found the service to be safe.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. Since our previous inspection the provider had taken action to improve the management and completion of care documents. A programme of continuous and ongoing improvement was in place.

Is the service well-led?

At the time of our inspection we found the service to be well-led.

We spoke with some people who used the service they told us, �I�m very pleased with them. If I�m not happy I tell [the office]�. Another person told us, �very nice, very good no complaints�.75% out of 100%�.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

The provider was aware of their responsibilities to notify the commission of important events that affected a person�s welfare.

Inspection carried out on 30 April and 7 May 2014

During an inspection in response to concerns

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

This is a summary of what we found-

Is the service safe?

We spoke with some people who used the care agency. They told us they felt safe when staff entered their home.

People were confident that if they were concerned they would speak with the manager or office staff. One person told us, �I�m quite happy, if I wasn�t I would complain�.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DOLs). We saw from the providers training records that staff had competed training of the Mental Capacity Act (MCA) which incorporated training relating DOLs. However, we found that people�s care plans did not always have written consent of the person.

We found that people�s care plans did not always identify or document risks associated with their care. Risk assessments support staff to reduce and prevent a risk to the person or to themselves.

Is the service effective?

The care agency provided care and support to people in their own home, to enable a person to remain as independent as possible. People who used the care agency were complementary of the care provided by staff. People told us, �I am completely helpless, they do everything for me� and �very good indeed, I couldn�t do without them�.

Although people were complementary of the staff that supported them, we found staff had not always received training and support applicable to their role.

Is the service caring?

We spoke with people who used the care agency and asked them if they felt staff were caring. People told us, �[staff] very respectful�, �very good indeed, I couldn�t do without them� and �I think they�re very good�.

We spoke with staff who appeared to enjoy their job, and explained to us how they supported people and how they knew what people�s care needs were.

Is the service responsive?

Prior to our inspection the Commission had received information of concern regarding the administration of medication. As part of our inspection, we looked at the concerns which had been raised and found the provider had been responsive to the incident which had taken place.

People who used the care agency told us, �they remind me of things to do� and �when I ask them they�re quite happy to do it, they do anything I ask them to do�.

We found care records and risk assessments were not always reflective of people�s care needs. This meant the manager and provider could not demonstrate the care being delivered was in line with people�s choice, wishes and expectations.

We found policies and procedures were not always up to date or reflective of current practice.

Is the service well-led?

The service had a manager who was registered with the Care Quality Commission.

People who used the care agency were complementary of the manager. One person told us that they wished the manager would come out and visit.

Staff we spoke with told us they felt the managers were supportive and that they could speak with them at any time.

We found the manager and provider did not have effective systems in place to monitor the quality of the service being provided. We found the monitoring and auditing of care records required improvement.

Inspection carried out on 16 January 2014

During a routine inspection

Most people that we spoke with told us that they were very satisfied with the care and support provided by Carol Spinks Homecare. One or two expressed some minor niggles and concerns. We saw that the office had a system for logging such complaints however there was little evidence to show how these were dealt with.

We spoke with staff who told us how they ensured that they, and the people that they worked with, were protected from infection. We saw that staff were properly recruited and that the agency took all reasonable precautions to ensure that they only employed people who were suitable for the work that they did.

Inspection carried out on 7 March 2013

During a routine inspection

We spoke with eight people who used Carol Spinks Homecare or their relatives. They said they were happy with the service provided. One relative told us �The carers are brilliant with X� she added �they [care workers] are very attentive and very caring�.

We looked at some care records. They included a care plan, daily evaluation records and risk assessments. There was evidence of care plan and risk assessment reviews. The supervisor told us she was able to update care plans regularly so they reflected the most up to date care and support required.

All of the people we spoke to, who used the agency, told us they felt safe when staff entered their own homes.

The agency had polices in place for safeguarding of vulnerable adults. The policy included local contact details of where staff should report concerns and made reference to Cornwall County Council�s safeguarding �alerters guide�.

We saw the staff were up to date with all their mandatory training such as safeguarding, food hygiene and manual handling. We saw there were support systems in place to ensure the care workers could carry out their role effectively.

We were told one of the supervisors regularly asked people who used the service and their relatives about the quality of the care and support they received. The provider had systems in place to review policies and procedures and audit completed documentation for example to ensure the service was working within best practice guidance.