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Archived: Care Rangers Limited Requires improvement

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Inspection report

Date of Inspection: 22, 23 April 2014
Date of Publication: 14 May 2014
Inspection Report published 14 May 2014 PDF


Inspection carried out on 22, 23 April 2014

During a routine inspection

As part of our inspection we followed up on compliance actions we had made during our previous inspection on 13 and 14 December 2013. Following that inspection the provider responded to us on 22 January 2014 and advised us of the actions they would take to ensure that those regulations would be met.

We considered our inspection findings to answer questions we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

Our inspection took place over two days. On the first day we visited the agency�s office. We looked at documentation such as care plans, visit schedules, policies and procedures, training records, staff records, surveys and audit material. We spoke with the registered manager and manager. We visited and spoke with four people who used the service in their homes and two relatives.

On the second day we spoke with four people who used the service in telephone interviews and two relatives. As part of our inspection process we also spoke with four care workers. This is a summary of what we found -

Is the service safe?

In December 2013 we found that the service failed to meet some people�s individual needs because care plans did not always contain relevant risk assessments. The provider did not have appropriate arrangements for the safe administration and recording of medicines used for the purpose of the regulated activity. The provider did not keep accurate and up to date records and documents in respect of risk assessments which would protect people who used the service from receiving unsafe care.

At this inspection we found that there was a system in place for planning people�s care and support. The people we spoke with said they had an individual plan which set out the care that had been agreed. We looked at four people�s care records when we visited the agency�s office. The records set out the actions taken by care workers to effectively assist each person with their range of care needs.

People's medicines support was assessed to support the way in which it was delivered. People's care plans stated that people should only be prompted to take their medicines. The provider had carried out assessments of people's medicines arrangements in all cases.

We saw evidence to support that care workers had received refresher training in safeguarding of vulnerable adults and moving and handling during January and February 2014. Medication update training was ongoing through a local college. There was a training plan in place to ensure that all care workers received ongoing training for their professional development.

We found that people�s care records were up to date, accurate and included the necessary risk assessments. We saw that people�s care plans contained the information staff needed to care for people safely and was easy to read.

Is the service effective?

During our previous inspection we found that the provider did not have suitable arrangements in place to obtain best interest decisions in respect people who lacked mental capacity. The provider failed to ensure that care workers were given appropriate development training in respect of safeguarding of vulnerable adults.

At this inspection we found that when there had been some concerns about capacity a Mental Capacity Act (MCA) assessment had taken place. One person did not have capacity to make some decisions. We saw that a mental capacity assessment had been undertaken by the provider and best interest decisions made around the persons care and support and followed the five principles of the MCA. This was documented in the persons care plan and involved the person receiving care, the person�s relatives, and health care professional, for example, occupational therapist.

Six people told us care workers were punctual and they saw the same care workers on a regular basis. Four care workers we spoke with told us that having regular people to care for helped them have a greater understanding of their care needs.

There were records of practical assessments to demonstrate that care workers were competent following training. This meant that there was a system in place to ensure that care workers were able to deliver care to a safe appropriate standard.

Is the service caring?

During our inspection in December 2013 we found that the provider had failed to identify how risks should be managed to ensure the welfare and safety of people who use the service.

We read that advice had been sought from a healthcare professional to ensure the care plan reflected best practice in relation to the person�s health condition.

People told us that the care workers treated them with dignity and respect. One person said: �The carers are nice to me they put a towel around me and dry me quite well�. Another person said: �The carers are lovely. I really don�t know what I would do without them�

Is the service responsive?

We saw, for example, that one person with complex health needs had a care plan in place that explained how staff assisted them with their personal care and nutritional needs.

Care plans detailed peoples preferences for example, how they liked their tea and by what name they preferred to be called. Care plans also had detailed risk assessments on how people should be mobilised and how risks to tissue viability concerns should be managed.

Is the service well led?

There was a system in place for planning people�s care and support. The people we spoke with said they had an individual plan which set out the care that had been agreed.

The deputy manager told us that quality assurance systems were in place to review and monitor care records. We looked at 31 customer survey questionnaires that had been completed during January, February and March 2014. Comments from people who used the service were generally very positive, for example: �The care and support is excellent. Lovely group of carers. Always willing to do that little bit extra� and: �My carer always arrives on time. I can set my watch by her.

One person who used the service had requested an earlier call in the mornings to enable them to attend hospital appointments. The provider had changed the timings of the calls for those days to accommodate the person�s needs.