Archived: CRG Homecare Milton Keynes

CRG Homecare Milton Keynes provides personal care to people who live in their own homes, in order for them to maintain their independence. At the time of our inspection they were providing approximately 51 care packages, 45 of which were adult packages and the remaining six were children's.

There was not a registered manager in post when we carried out the inspection; however the provider was in the process of recruiting one. 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 service had not taken steps to robustly identify and assess risks to people's health or well-being. Actions to reduce risk levels were not clearly recorded therefore were not available for staff to follow.

People's consent to their care and support had been sought however; the service had not implemented systems to ensure that the principles of the Mental Capacity Act 2005 (MCA) were always adhered to if people lacked mental capacity. Appointments and visits from healthcare professionals had not been recorded effectively; therefore this information was not available to staff to ensure they gave appropriate care and support.

People's care was person-centred and sensitive to their specific needs and wishes however; care plans were not always reflective of this and did not always provide staff with person-centred information. People were able to make complaints about the care that they received and were happy to do so if necessary. There were systems in place to ensure complaints were looked into and dealt with appropriately.

There was a lack of clear leadership at the service. Staff had worked hard to minimise the impact of this on people and their care, however; some areas, such as quality assurance processes, had not been fully completed as a result. In addition, there had not been an effective handover when the registered manager had left and interim arrangements for management at the service had not been implemented. There was however a positive and open culture at the service and staff had worked hard to ensure people continued to receive their care, treatment and support.

Staff had knowledge and understanding of abuse and worked to keep people safe from avoidable harm. If abuse or harm was suspected, appropriate procedures were followed to record and report it. Staffing levels were sufficient to ensure people's needs were met and staff had been recruited following safe and robust practices with appropriate checks being carried out. Staff were also able to provide people with their medication safely, where necessary.

Staff members were provided with regular training and support to ensure they had the skills and knowledge to perform their roles and meet people's needs. They also provided people with support to ensure they had a healthy and sufficient diet, if this was required.

There were positive and meaningful relationships between people and members of staff. Staff treated people with kindness and compassion and spent time getting to know them and build up a professional relationship. People had been involved in planning their care and were consulted about how they wanted to be looked after. They were also provided with information about the service and the care that they could expect from them. Staff treated people with dignity and respect.

The manager had started the process with the Care Quality Commission (CQC) to become the registered manager of the service. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register. This was because they had failed to inform us they were no longer managing the service. Our records show that the previous registered manager made contact with us just prior to this inspection and the de-registration process has now started but is not yet completed.

We gathered evidence against the outcomes we inspected to help answer our five key questions:-

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive to people's needs?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

Since our last inspection better processes had been put in place to ensure the people who use the service and the staff providing care knew when a visit was expected. This meant that calls were monitored more closely and any late calls identified earlier. One person said, 'I know when to expect them.'

In addition people's care files had been reviewed and re-written in more detail in order to give staff clearer guidance about how care was to be delivered and promote consistency.

We saw evidence that all care staff were subjected to a safe recruitment process before being offered a position with the service and starting their induction period. This meant the provider had taken the appropriate steps to ensure they recruited staff considered to be safe to work with vulnerable adults.

Is the service effective?

In order to review peoples care needs and ensure they were current, the manager, or a care coordinator, had visited each person in their home to discuss the service provided. This meant people were involved in planning and agreeing their care and their plans of care were current.

Many new care staff had been employed over the last three months and the manager told us that consideration was given to where care staff were asked to work, in order to avoid as much unnecessary travel as possible.

Is the service caring?

We visited two people in their own homes. It was clear from our discussions with them and the care documentation we saw that the care staff provided met their assessed needs. We also saw evidence of staff providing additional support. For example, we saw that one person had received an extra visit when they were distressed. Another person told us that the care staff had acted appropriately when their medical condition had become unstable and stayed with them longer than planned.

Is the service responsive to people's needs?

The manager told us that people who use the service told them they wanted the same members of care staff to provide their care. In order to achieve this the service had been split into teams under the leadership of a care coordinator and a team leader. This meant that a team of staff worked with and knew the needs of a smaller group of people who use the service. This meant the provider had taken the appropriate action to ensure people who use the service would be likely to know a member of staff who would visit when their regular care worker was off duty.

Is the service well-led?

The provider had introduced systems to assess and monitor the quality of the service they provided in order to identify concerns with the service in a timely fashion. However, at this inspection we were not able to confirm these systems were effective as they were new.

We have asked the provider to tell us how they will continue to meet the requirements of the law in relation to monitoring the quality of the service provided.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive to people's needs?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

All of the eight people we spoke with told us the care staff treated them well and did what was expected of them. One person said, 'I don't know where I would be without them.' However, three of the eight told us about times when their calls had been very late or missed.

In some of the files we looked at, we saw that more detail was needed to ensure that risk assessments were effective and staff understood how they could minimise risk while ensuring people's independence was maintained. We saw that the new manager, who had yet to apply to be registered, and the quality team from the head office were working to make the necessary improvements.

The staff we spoke with were knowledgeable about people's care and support needs. At times they said,they felt frustrated as they did not have the time to deliver the care as they wanted to because they were not given time to travel from one house to the next. At times travelling between episodes of care involved a long journey because of the geographical area the service covered.

Recruitment practices required strengthening to ensure that at least one reference was obtained from the potential member of staff's last or current employer.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was limited evidence that people had been involved in planning and agreeing their care, and the care plans lacked the detail to ensure care could be delivered in a consistent manner and met people's assessed needs.

We have asked the provider to tell how they will make the improvements and meet the requirements of the law in relation to providing sufficient detail in care plans and risk assessment to ensure care and support was delivered safely.

Is the service caring?

We spoke to eight people who used the service, or a relative who spoke with us on their behalf. They told us most of the staff were kind and provided a good standard of care. However some people said they had difficulty understanding a care worker when English was not their first language.

Some of the people who used the service told us, that if a care worker was going to be late to their call they would phone them or send a text message. However not everyone had the same experience and some people were kept waiting for care staff to arrive which caused then unnecessary stress.

Is the service responsive to people's needs?

People told us that if they needed the staff to do anything different or arrive at a different time the service were responsive to their request.

People told us they could not always guarantee the staff would arrive when expected. However they did tell us they had seen an improvement in the times staff arrived to provide care recently

Is the service well-led?

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register. This was because they had failed to inform us they were no longer managing the service.

The provider had started to seek the views of people using the service and their representatives, and planned to take account of these to make improvements.

The provider did not have effective systems to assess and monitor the quality of the service they provided and as a result they had not identified concerns with the service in a timely fashion.

We have asked the provider to tell how they will make the improvements and meet the requirements of the law in relation to monitoring the quality of the service provided.