Active Pathways Limited Central Support Office

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Burrowbeck Community Care provides a service to older adults, people living with dementia and people experiencing mental health conditions in Lancaster and Morecambe and surrounding areas.

At the last inspection carried out in March 2016, we rated the service good overall. At this inspection visit carried out in November 2018, the service remained good.

Since the last inspection visit the registered provider had worked to develop a person-centred culture. Staff told us the service had improved and staff were committed to providing person-centred care. People and relatives confirmed staff were empathetic and motivated to provide compassionate care. There was a continued emphasis on privacy, dignity and human rights.

People, relatives and health professionals told us the care provided was effective and people experienced positive outcomes. People received care which was regularly reviewed and support was based around good practice evidence.

We saw evidence that people were treated with dignity, care and compassion at the end of life. Emotional support to families extended after people had passed.

People praised the positive relationships they had developed with staff. Staff were repeatedly referred to as friends who had a made a difference in their lives. They told us staff often went above and beyond what was expected of them.

The registered provider understood the importance of addressing social isolation. They had worked hard since the last inspection visit to improve social activities for people at risk of loneliness and isolation.

The registered provider had continued to implement systems required to keep people safe. This included processes for managing medicines, safeguarding concerns and behaviours that are challenging to others.

Although risks were identified and staff were aware of individual risk, risks were not always clearly documented. We highlighted this to the registered manager who took swift action to rectify this.

When people required support with eating and drinking their dietary needs were considered and met by the registered provider.

People told us that on the whole staff were suitably deployed to meet their needs. Six of ten people told us they had experienced times when staff had been late or not turned up. We were told however, staff apologised or staff were deployed to ensure people did not go without a visit. Statistical data submitted to the local authority showed the provider was exceeding their responsibilities in ensuring staff were suitably deployed.

Training for staff was responsive and tailored to people’s individual care needs. Staff told us they were supported with continuous learning to ensure they had the correct skills to provide effective care.

The registered provider was responsive in seeking feedback from people and relatives to ensure people were happy with the service provided. People said they were happy with the ways in which complaints were managed and addressed.

Professionals told us the service was well managed. They praised the skills of the management team and their ability to provide an effective person-centred service. We were told Burrowbeck Community Care promoted independence to enable people to remain within their own homes.

The registered manager showed commitment and dedication to improving the services provided to people. Improvements within the service were based upon good practice guidance.

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. Consent to care and treatment was actively sought.

Staff told us they enjoyed working at Burrowbeck Community Care. They told us communication and team morale was good.

The registered manager had auditing systems so they could ensure safe and effective care was provided. When areas for improvement were identified action was taken to improve the service.

Burrowbeck Community Care is a domiciliary care agency which provides support to adults living in Lancaster, Morecambe and surrounding areas. We were informed there were approximately 61 people receiving a service from the organisation at the time of inspection.

There was not a registered manager in place. 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. The registered provider had recruited a manager who had been identified as becoming the registered manager. They were on duty on both days of the inspection and told us they were in the process of starting registration. We saw evidence the registration process with the Care Quality Commission had commenced.

People spoke positively about the quality of service provision on offer. People told us staffing levels were conducive to meet their needs. However, people told us staff punctuality was sometimes a concern. We discussed this with the manager who provided evidence to show they were taking action to improve on this.

Arrangements were in place to protect people from risk of abuse. People told us they felt safe and secure. Staff had a knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

Recruitment procedures were in place to ensure staff were correctly vetted before commencing employment. Staff retention was good and people said they benefited from staff who knew them well.

Suitable arrangements were in place for managing and administering medicines. People were encouraged to self-administer medicines where appropriate. Risks of self-administration were managed.

People’s healthcare needs were monitored. Care plans were in place for people who used the service. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Training was provided for staff to enable them to carry out their tasks proficiently. Staff training was monitored using a training matrix. The organisation responded to the needs of people using the service and tailored training to meet their needs.

People said they were supported at appropriate times to meet their nutritional needs. Strategies were in place to promote healthy eating where appropriate.

The manager had implemented a range of assurance systems to monitor quality and effectiveness of the service provided.

Systems were in place to monitor and manage risk. Information regarding accidents and incidents was monitored so trends and themes could be identified and processes put in place to minimise risk. External consultants were commissioned to monitor and promote health and safety.

The registered provider encouraged people to live active lives within their community.

Staff were positive about ways in which the service was managed. Staff spoke highly about levels of training on offer and support from management. Staff described the working culture as positive.

At our last inspection in October 2013, we found that the provider was not compliant with the requirement to operate effective recruitment procedures for staff. We asked the provider for an action plan, which we received on 18th November 2013.

This action plan undertook to implement a new check list for all new employees. This checklist would help ensure that people were not employed until satisfactory checks were completed.

At this follow up inspection on 26th February 2014 we asked to see this check list and records of staff recruitment. We looked at three files for staff recruited since our last inspection. We also reviewed those staff files we saw in October 2013, where people had been recruited without satisfactory references.

We saw that effective procedures were now in place and operating for staff recruited since our last inspection. We saw that the check lists were in place and being used. We judged that the provider had improved their procedures to make them more robust. We also reviewed the files from the previous inspection, and judged that the provider had taken reasonable steps to rectify the omissions identified at that time..

We looked at how the management ensured a good quality service. We found Optima Care had systems in place for quality monitoring, which included talking with clients. We checked whether an effective complaints procedure was in place. We found that people were given good information about how to complain. The provider had responded appropriately to complaints received.

We also checked recruitment of staff and found that the provider was not compliant with that outcome. The provider had employed staff without obtaining satisfactory references. This may put people at risk of being cared for by staff who are not of good character.

People who use the service told us they were happy with the support they received. One person said, "The staff turn up on time, are very polite and there have been no problems at all.'

People told us they had received a visit from a representative from the agency before the service commenced. They told us their needs had been discussed and they had agreed to the support to be provided. They told us their carers provided sensitive and flexible personal care support and they felt well cared for.

We found that there was enough skilled and experienced staff so that people had their care delivered by the same people, in ways they wanted. One person said, "I always have the same people unless the normal carers are on holiday."

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe with the care staff and said they would report any concerns to a manager.