Archived: Carol Spinks Homecare

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 visits on time. People said they were always supported by staff they had been introduced to. Everyone said they felt the care workers were totally reliable. Everyone said they felt their care workers knew them/their relative well and they completely trusted the carers. People said they felt completely safe with the care workers and there were many compliments on their professionalism. People felt the care workers had the skills to do their jobs properly. The friendliness, compassion and kindness of the care workers were also frequently mentioned, and everyone felt they and their relatives were treated as individuals.

People’s care records had all been reviewed since the last inspection and held comprehensive information about how people wished to be supported. Records were regularly updated to reflect people’s needs. Risk assessments had been developed with the local safeguarding team and reflected people’s risks with clear information for staff about how to ensure these were identified and minimised.

The service training matrix showed all staff had received relevant and sufficient training to enable them to carry out their role effectively. A specialist external trainer in medicines administration and management in the community had ensured all staff who administered medication had received training. An updated medication policy was in place. Staff had received training in manual handling and there was an updated lifting and handling policy.

Recruitment records were robust and ensured that staff had received the relevant checks before commencing employment to ensure that people were safe.

There were effective systems in place to monitor the quality and safety of the service and drive on-going improvement in relation to the warning notices as the service had reviewed these. Where people raised concerns these were taken seriously and acted upon in a timely way.

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 complete care tasks. This meant people may not have consistently received their care in the way they preferred. A senior staff member told us they were reviewing all care plans with people, to help ensure they contained this detail.

Staff told us they respected people’s wishes regarding food and drinks and tried to encourage them to maintain a healthy diet. People’s care plans did not always contain people’s dietary requirements such as allergies. This meant there was a risk staff may have provided food that was not suitable for people’s needs.

People and their relatives spoke positively of the staff and the support provided. Comments included, “The staff are all very nice, very caring and very helpful. They are not bossy. If you ask for anything, they will help.” People told us staff treated them with dignity and respect and protected their privacy. Comments included, “Yes they are very respectful and treat me very well.” Staff members described how they respected people’s homes and belongings and people confirmed this to be the case.

Staff told us they would be able to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

Complaints were taken seriously and responded to. A new system had recently been introduced to record and monitor complaints.

We found breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report.

We are considering our actions in line with CQC’s enforcement policy. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

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.

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.

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.