Archived: Barnfield Care Agency

Barnfield Care Agency is registered to provide personal care to people living in their own homes, including older people who have a physical disability or people living with dementia.

At the time of our visit the agency supported 69 people, of which 56 people received personal care. CQC only inspects where people receive personal care. This is to help with tasks related to personal hygiene and eating. Where they do provide personal care, staff also consider any wider social care provided. Care calls ranged from 30-minute duration and at the time of our visit, 13 people received care, 24 hours a day, seven days a week.

People’s experience of using this service and what we found

The registered manager worked closely with staff and provided direct care to people themselves which gave them oversight of the service. However, there were limited systems in place to monitor and improve the delivery of the service. The registered manager said they checked daily records and medicine records, yet they failed to identify the issues we found. Furthermore, there were no records to show what actions had been taken when improvements were identified.

Care staff had not been recruited safely because the registered manager had not ensured all the required employment checks had been undertaken before staff commenced work at the service. These checks are required to ensure staff were suitable for their role.

Care plans and risk assessments reviewed were incomplete and did not provide staff with information to give consistent support. In some cases, certain health conditions although known by staff, were not recorded to form people’s plans of care.

Overall, people were happy and satisfied with the quality of care they received from a consistent care staff team. No one raised any complaints to us during this inspection visit although some relatives felt the management of the service could be improved. People were happy with the care provided and felt safe when being supported by staff. Staff knowledge of people helped to keep them safe from potential risk of harm or unsafe practice. Staff wore gloves and aprons to ensure they protected people from cross infection.

People and their relatives made decisions about their care and were supported by staff who understood and followed the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider was embracing new technologies such as electronic call monitoring. This was being set up and trialled before its eventual rollout. Other communication systems were used to inform and update care staff. However, we recommended that the registered manager seek guidance to ensure that confidentiality and security was not compromised through their use of some electronic communication systems.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Good (published 12 May 2017).

Why we inspected

This was a planned and announced inspection based on the rating at the last inspection.

Enforcement

We have identified two breaches in relation to safe care and treatment and the lack of effective monitoring of the quality of the service. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to tell us what they will do to improve the standards of quality monitoring and safety. We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

Barnfield Care Agency is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the agency supported approximately 70 people with personal care.

People who used the service had a variety of care needs. Some had 24 hour live in care staff, some had very complex needs with several care calls a day and others required one call a day.

The service has a registered manager who was also the provider. 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 our last inspection in September 2015 we found there was a breach of the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. The breach was because although the registered manager was investigating concerns of alleged abuse, they were not always reporting these through the appropriate channels. At this inspection we found the registered manager had taken the action they said they would take, and had reported any safeguarding concerns to the local authority and to us.

People were supported by a consistent group of care workers who arrived at the times that were agreed. People who used the service said they felt safe with their care workers and relatives were confident their family members received safe care. Care workers demonstrated a good understanding of how to manage individual risks to people’s health and wellbeing and checked equipment was safe before they used it. Care workers understood their responsibilities to report any concerns about people’s health or safety to their managers. Checks were carried out prior to care workers starting work to ensure their suitability to work with people who used the service.

People and their relatives said that care workers had the skills and knowledge to meet their needs consistently and effectively. Care workers felt confident in their roles because they received appropriate training and support.

People told us care workers were exceptionally kind and thoughtful and relatives spoke overwhelmingly about their kindness and caring attitude. Care workers were allocated sufficient time to carry out their calls and had time to talk to people as they didn’t have to rush. Care workers understood the importance of maintaining people’s privacy and dignity when delivering care and encouraged and respected people’s independence.

The registered manager understood the principles of the Mental Capacity Act (MCA), and staff respected people’s decisions and gained people’s consent before they provided personal care.

Care workers had a good understanding of people’s individual needs and how to respond to them. Care workers were encouraged by the registered manager to be flexible and to respond if people wanted things to be done differently or at different times.

Care workers helped people manage their health and well-being if this was part of their care plan or they had any concerns. They accompanied people to healthcare appointments if required. Where care workers supported people with their medicines, people told us it was done safely and as prescribed.

The registered manager had a ‘hands-on’ approach and was clearly very well known to, and respected by people who used the service and their relatives. They described her as approachable and receptive. Care workers were universally positive about the registered manager, their leadership, their practice and how they supported people and staff.

The registered manager regularly checked people were happy with the care they received. However, some improvements were needed to record keeping to ensure the safety and quality of the service provided could be fully demonstrated.

Below is a summary of what we found.

Is the service safe?

We inspected this service previously on 14 August 2013 and identified improvements were required in the quality of the service's records. There were concerns that some people's care records were not accurate. We found the provider had made changes since our previous inspection and improvements had been made in this area of concern.

We saw people's care records accurately reflected their care needs. We found people had appropriate risk assessments in place that made sure any risks were managed. We found people's care records were regularly evaluated and reviewed by senior staff.

People we spoke with told us they felt safe using the service. One person told us, 'I feel completely safe in their care.' Staff understood how to safeguard the people they supported.

We found evidence that learning took place from incidents and investigations within the service and appropriate changes were implemented to improve the service.

Is the service effective?

People told us the care they received met their needs. People told us they had been involved in planning the care they received.

Staff we spoke with had a clear understanding of the needs of the people they supported and what they told us was reflected in people's care plans.

We spoke with staff and found they felt supported by their manager. They told us they felt their manager listened to them and they could raise any issues.

Is the service caring?

We spoke with 11 people who used the service and they were all positive about the staff who supported them. For example people told us; 'I feel quite relaxed. I feel I can depend on them', 'They were recommended to me', and 'I couldn't have a better care agency. I know I can ring and ask for extra help.'

Staff we spoke with were positive about their role as carer and enjoyed their job.

Is the service responsive?

We found people were asked for their views about their care and these were acted on. We saw the provider's latest customer quality survey results from March 2014.The results of the survey were good. We found that the any issues raised, were responded to by the manager.

People told us the service was flexible and they could contact the care office at short notice and request changes to their care. One person told us, 'I have two or three regular carers and they have all been really good. I can contact them (the service) and ask for changes, for example a longer call.'

People told us that care staff noticed when their needs changed and took action. People received help and support from other health professionals when required, such as GPs and district nurses.

Is the service well led?

We found the service had an effective quality assurance system in place and any identified actions had led to improvements in the service people received.

People who used the service and staff told us they were able to speak with the manager and felt able to raise any issues or concerns they had. We found evidence that improvements had been made to the service following investigation of any concerns.

People we spoke with were positive about the care they received. People told us that care staff had the right training and that their knowledge and skills were adequate. One person told us that they, 'Liked the carers we have, they are helpful.' They told us that, 'The manager is fantastic.' Another person told us that, 'They are very good.'

We found there was no policy concerning people giving their consent to care they received and there were no consent documents on people's care records. However people who used the service told us that they were treated with respect and given choices. One person told us, 'They are wonderful carers. They are very polite to me and always speak in a caring manner.'

We found that care staff were aware of safeguarding procedures and knew how to keep people safe. People who used the service and their relatives told us they felt safe.

We found that some people's care records including medical records were not accurate.

Although, we have found some information was still missing from the electronic 'client contact sheets' we noted that otherwise the records we reviewed were complete. We informed the manager of the information gaps we found and asked that people's contact sheets be audited and fully completed. This was confirmed by email as completed by the provider the day after our inspection.