Sahara Community Care Services

Sahara Community Care Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger adults, people living with dementia, children, people with a learning disability, people with mental health needs, physical disabilities and sensory impairments. It provides personal care to people from all cultural and ethnic backgrounds. It also specialises in providing services to black and minority ethnic groups in Peterborough.

Not everyone using Sahara Community Care Services receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection staff were providing personal care to 56 people.

Peoples experience of using this service:

• Risks to people were identified and managed well. Appropriate steps had been taken to safeguard people. Sufficient numbers of staff with the required skills had been recruited safely and deployed to keep people safe. One person said, "[Staff] are very good at making sure I use my walking frame, every time."

• People were supported to take their medicines as prescribed by trained and competent staff. Lessons were learned when things did not go quite so well. Infection control systems promoted good hygiene standards.

• Skilled staff were provided with the necessary support including coaching, shadowing experienced staff and regular supervision, staff maintained their skills.

• People's needs were met. One relative told us that it was purely due to staff that their family member was alive and doing well. People's independence was upheld and promoted with enough to eat and drink. Staff enabled people to access healthcare support by working well with others involved in people’s care.

• 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 cared for by staff with compassion, kindness and dignity. Staff knew people well and they promoted people’s privacy, culture needs and independence.

• People had a say and choice in who and how their care was provided. One person told us, "Staff are very kind and compassionate. I have got to know them as a friend."

• People’s care was person centred and based on what was important to them. People's concerns were dealt with and acted on before they became a complaint and to the person’s satisfaction. Systems were in place to meet people’s end of life care needs and help ensure a dignified and pain free death.

• One compliment from a relative stated, "Thank you for making our [family member's] final days so special. We couldn't have managed without you."

• The registered manager promoted and supported an open and honest staff team culture. Staff upheld the provider's values by helping people live a meaningful life.

• Governance and oversight of the quality of the service was effective and helped drive improvements. People had a say in how the service was run and developed. The service and its management team worked well with other organisations including community nursing teams and GPs, People received care that was coordinated.

• Many people complimented the service for the quality of care provided. One relative told us, "I would not hesitate to recommend the service to anyone, whatever their culture or background."

Rating at last inspection: Good (report published 5 September 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence 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

We carried out an announced comprehensive inspection on 9, 10, and 11 November 2015. A breach of a legal requirement was found. This was because the provider did not take reasonable steps to make sure that they maintained an accurate record of people’s care and treatment needs. This included the accurate completion of people’s medication administration records. After the comprehensive inspection, the provider wrote and told us to say what they would do to meet the legal requirements in relation to the breach.

We undertook this announced inspection on 11 August 2016 to check that they had followed their plan and to confirm that they now met legal requirements. We found that the provider had made some of the necessary improvements.

During this inspection we saw that the provider had not displayed their previous inspection rating on the communal notice board within their office nor on their website. We discussed this with the registered manager during the inspection.

There was a registered manager in place during this inspection. 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 Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager had an understanding that people being supported by the service who lacked the mental capacity to make day-to-day decisions should have an application to the Court of Protection made on their behalf. Staff were able to demonstrate a basic understanding of the MCA. This meant that any decisions made on people's behalf by staff would be in their best interest and as least restrictive as possible. However, records did not document where care was to be given in people’s best interests.

People had care records in place which included information on how they wished to be supported, and what was important to them. These care records also documented people’s care and support requirements and any assessed risks. Where appropriate, staff made sure that care and support was delivered in line with people’s religious and cultural requirements.

People’s health, nutritional and hydration needs were met. Detailed information around people’s specific dietary needs were not always recorded clearly. People were assisted where required, to contact and access a range of external healthcare professionals to maintain their health and well-being.

People and their relatives said that staff respected their choices about how they/their family member would like to be supported. People were supported by staff in a caring and respectful way. Staff promoted people’s privacy and dignity.

Plans were in place to minimise people’s identified risks and to prompt staff on how to assist them safely whilst maintaining their independence. These records and reviews of these records, documented that people and/or their appropriate relatives had been involved in and agreed their plan of care.

Arrangements were in place to ensure that people’s medicines were administered safely. Records regarding the administration of people’s prescribed medicines were kept.

There was a sufficient number of staff to provide people with safe support and care. Staff were trained to provide care and support which met people’s individual needs. The standard of staff members’ work performance was reviewed during supervisions and appraisals to make sure that staff were confident and competent to provide the agreed care and support.

Staff understood their responsibility to report any suspicions of harm or poor care practice. There were pre-employment essential checks in place to ensure that all new staff were deemed safe and suitable to work with the people they supported.

People’s complaints were listened to and resolved where possible. The registered manager sought feedback about the quality of the service provided from people who used the service and their relatives. Staff meetings took place and staff were encouraged to raise any suggestions or concerns that they may have had.

Quality monitoring processes to identify areas of improvement required within the service were in place. Improvements identified as required were either completed or were on-going.

Is the service caring?

People and relatives of people using the service had positive comments to make about the care and support they received. They told us that the support helped them maintain their independence. People we spoke with had comments that ranged from, 'Satisfactory at the moment,' to 'Very good.'

Care records we looked at showed us that people were supported to live as independent a life as possible with the assistance of staff members. We noted that people's individual equality and diversity needs were recorded. Staff we spoke with demonstrated to us their knowledge of the people they supported and cared for.

Is the service responsive?

We looked at the care records held in the provider's office for four nine out of the 66 people who used the service. We saw that the provider had made the necessary improvements since our previous inspection in July 2013. This was because eight out of nine people's care records we examined showed that people's individual needs had been reviewed regularly since July 2013 to ensure that the care and support and support provided was accurate and up-to-date.

People we spoke with told us that their care and support had been provided in accordance with their wishes. One person told us, 'They (staff) always ask me what I want and they do it, they are brilliant.'

Is the service safe?

In the care records we looked at we saw that risk assessments regarding people's individual needs were carried out and measures were in place to minimise these risks. However, in three out of nine care records we looked at we found that risk assessments for people with specific health and support needs were not always documented.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider told us that they currently do not support any people with care 24 hours a day, seven days a week. However, we were not able to find evidence that people had been either assessed or legal advice sought by the provider to ensure that they were not at risk of their liberty being deprived.

A random sample of staff rotas we looked at for two weeks in April 2014 indicated to us that the provider took into account people's care and support needs. The sample we looked at also indicated to us that there were enough staff to cover the care and support work planned. Eight out of nine people we spoke with told us that they had consistent carers and that this was their preference.

Is the service effective?

People we spoke with told us how staff assisted them with the care and support that they had agreed to.

People's care and support needs were effectively met. People had positive comments to make about how the support they had been given enabled them to stay living in their own home.

Is the service well led?

Improvements had been made since out previous inspection, which we carried out on 22 July 2013. This was regarding the on-going monitoring of the quality of the service provided.

Quality monitoring systems were in place so that people were listened to and were safe from the risk of unsafe and inappropriate support and care.

People and relatives of people who used the service were asked for their feedback on the service provided. Where improvements had been noted, the provider could demonstrate that they working to address these concerns.

We reviewed four people's care records and found that they did not always contain up to date information to reflect the current care and support being delivered. Risk assessments had not been reviewed regularly, with one being dated from 2009, with no documented evidence of it being reviewed since. This meant that the care records did not have the most up to date information to guide staff in how people's care and support needs were to be met.

During our inspection on 25 February 2013 we found that the Medication Administration Records (MARS) we saw did not evidence accurate documentation to ensure that people were protected against the misuse of medication. During this inspection on 22 July 2013, we found that the provider had made the required improvements to the recording of medication administration.

Staff training was in place to make sure that people who used the service received safe support and care from suitable, skilled, and knowledgeable staff.

We did not see an effective quality assurance system in place. This was because the provider had not undertaken any audits to continually monitor the quality of the service provided therefore ensuring the safe care and support people received.

At the time of our inspection there was no registered manager in post.

We reviewed five current care records and found that they provided members of staff with guidance in how people's individual support and care needs were to be met in a safe and appropriate way. One person who used the service told us they experienced, "Excellent care."

People were protected from the risk of abuse because the provider had put appropriate measures in place.

When reviewing Medication Administration Records (MAR) we did not see evidence of accurate documentation to ensure that people were protected against the misuse of medication.

Effective staff recruitment and training was in place to make sure that people who used the service received safe support and care from suitable members of staff.

There was an effective system in place for people to make a complaint if they wished to do so.