Here2Care (Dartford)

Here2Care (Dartford) is a domiciliary care agency providing personal care and support to people in their own homes in Dartford, Gravesend and surrounding areas. Here2Care (Dartford) also provide support to people living in Extra Care Housing. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection there were 187 people using the service, of which, 175 people received support with personal care. This included twenty people living in an Extra Care Housing, including older people, people who live with dementia and people with a physical disability.

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

Feedback from people and relatives was positive. People told us they, “Felt safe and had good relationships with the staff that visit them.” One relative told us, “I have had no worries at all during the Covid-19 pandemic that my [relative] has not been safe.” And, “My [relative] is never rushed and the [staff] are all so kind to him.”

People were protected from the risk of abuse, with staff able to recognise the signs and different types and knew what actions to take to keep people safe. Concerns were raised when needed with guidance in place to manage this effectively. People were supported with their medicines as prescribed and staff competency was checked to ensure they knew how to complete this safely. There were adequate numbers of staff to ensure people’s needs were met and the provider had safe recruitment procedures in place. There was clear oversight of accident and incidents, when these had occurred, action was taken to reduce any risk of reoccurrence. Staff ensured risks of infection to people were minimised.

Feedback from staff and people was actively sought and analysed. There was a clear and open culture of learning from past mistakes and concerns.

Quality monitoring systems had improved and where issues were identified they were acted upon. The service is using a new electronic call monitoring system to reduce the risk of any missed or severely delayed care visits. The service worked in partnership with other agencies to provide good outcomes for people.

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 Requires Improvement (published 7 February 2020) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced inspection of this service on 5 November 2020. At last inspection there were three breaches of regulation in relation to Safe care and treatment (Regulation 12) Staffing (Regulation 18) and Good Governance (Regulation 17) The provider completed an action plan after the last inspection to show what they would do and by when they would improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Here2Care (Dartford) on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Here2care (Dartford) is a domiciliary care agency providing personal care and support to people in their own homes in Dartford, Gravesend and surrounding areas. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. Where they do we also consider any wider social care provided. At the time of the inspection the service was providing care for 201 people. This included older people, people living with dementia and people with a learning or physical disability.

People's experience of using this service

Medicines were not safely managed. Medicine administration record (MAR) charts were not completed in full, they included gaps without any explanations. Risks were not always identified and assessed. Risk management plans did not always guide staff on how risks should be minimised. Staff did not always attend calls at scheduled times to provide timely care. Care plans were not always updated to show a change in people needs. The provider did not have effective processes in place to monitor the quality of the service as they had not identified the issues we found at this inspection.

People said they felt safe and that their needs were met. There were appropriate safeguarding systems in place to protect people from the risk of abuse. People were protected against the risk of infection. There were systems in place to manage accidents and incidents. The provider carried out robust recruitment checks prior to employing staff.

Staff were supported through regular training and supervisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to eat a healthy and well-balanced diet if required. People had access to healthcare services when required to maintain good health and their independence was promoted.

People and their relatives where appropriate, had been consulted about their care and support needs. There was an effective complaints system to manage people concerns in a timely manner. The provider worked in partnership with the local authority to ensure people's individual needs were planned.

Rating at last inspection and update

The last rating for this service was Good (published 28 June 2017).

Why we inspected

This was a planned inspection based on the previous rating

Enforcement

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to risk management, staffing and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

At the last inspection on 12 and 13 March 2015, the service was rated Good.

At this inspection on 10th May 2017, the service remained Good.

The service was run by a registered manager who was present on the day of our visit. 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 trusted staff and therefore felt safe whilst being supported by them. Staff continued to receive training in how to safeguard people. They knew what signs to look out for which would cause concern and how to report them so the appropriate action could be taken to help keep them safe.

Comprehensive employment checks were carried out on all potential staff at the service, to ensure that they were suitable for their role. There was on-going recruitment to ensure staff were available in sufficient numbers.

Assessments of potential risks had been undertaken in relation to the environment that people lived and worked in and in relation to people’s personal care needs. This included potential risks involved in moving and handling people, supporting people with their personal care needs and with managing medicines. Guidance was in place for staff to follow to make sure that any risks were minimised.

A medicines policy was in place to guide staff. Staff received training in the administration and storage of medicines and a system was in place to regularly check they had the knowledge and competence to manage people’s medicines safely.

New staff received an induction which ensured that they had the skills they required, before they started to support people in their own homes. Staff continued to undertake face to face training in essential areas, their practice was observed and they shadowed senior staff to ensure they were competent. People said that staff had the skills and knowledge they needed to support them.

People said staff asked for their consent before supporting them with their care. Staff had undertaken training in The Mental Capacity Act (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.

People’s health care and nutrition needs had been assessed and clear guidance was in place for staff to follow, to ensure that their specific health care needs were met. Staff continued to liaise with health professionals when appropriate.

Staff were consistently kind and patient and treated people with dignity and respect. Staff had developed relationships with people and involved them in decisions about their care and support.

People’s care, treatment and support needs were assessed and a plan of care was developed jointly with the person, which included their likes and dislikes. Individual guidance was in place for staff to follow to meet people’s needs.

People were informed of their right to raise any concerns about the service and action was taken to investigate and endeavour to resolve them to people’s satisfaction.

There continued to be robust systems in place to assess and monitor the quality of the service, which included asking people about their experiences. The registered manager had sustained an open and positive culture and staff knew how to put the aims and values of the service into practice so people received personalised care. Feedback from people was that most people were satisfied or more than satisfied with the service they received.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us, 'My carer is excellent, they listen to me', the support and care I receive means I can stay in my own home' and 'my care workers have a good understanding of my disability, I have always felt valued & safe'.

We saw that care plans were person centred and detailed support needs. We spoke to eight members of staff who confirmed that there was a care plan for each person they visited. These staff also confirmed that a brief overview of the support required was given on each person's rota.

Other people who used the service told us 'I am a very nervous person due to having had several falls in the past and I can only walk with a frame but the carers are understanding and helpful, patient in giving me time to move around.' Others said 'Here2Care were very good in the hot weather, with regular phone calls to ensure my mum was drinking and was well' and 'The care workers treat my wife with respect and always make her laugh and talk to her as soon as they walk in, the care agency staff are always so polite if they phone me, or if they visit."

We found that there were effective recruitment and selection processes in place. The provider kept satisfactory documentation for all staff to evidence relevant qualifications and a full employment history with satisfactory written explanation of any gaps in employment.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

People told us that they were very happy with the care and support that they or their relatives received, staff were reliable, supportive and flexible. People who used the service were treated with respect and dignity. One person said "The carers are excellent, very caring and professional."

Another person said 'I am very happy with the carers and I am very involved in the care planning process on behalf of my relative who receives the service."

We observed telephone conversations within the office where staff answered the phone promptly and spoke to the caller in a polite and courteous way. One carer told us that the staff in the office were very approachable, polite and helpful.

We spoke to a relative of a person who uses the service and they told us that they had been made aware of the complaints policy and how to make a complaint. They stated that they have raised concerns in the past and they were always dealt with swiftly and to their satisfaction.

Staff we spoke to told us that they received regular supervision and that the senior team are available for advice and support. One person said "The senior staff are approachable and very supportive. We saw that staff received regular training appropriate to the needs of the people they support.