Vista Home Care Services Ltd

Vista Home Care Services Ltd is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection the service was providing personal care to nine people.

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.

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

People and relatives were complimentary about the staff and the service. However, we continue to have some concerns about the systems and processes used to manage the service, which although have improved since the last inspection, remain not sufficiently robust. Our telephone calls made to the office were not always answered and telephone messages were not returned in a timely manner. We found a recording discrepancy between a person’s medicine administration record and daily notes which had not been audited.

Staff did not always receive medicine competency checks to check practices were safe prior to administering medicines. Governance and performance management systems were not always effective.

Recruitment processes were of good quality. New staff received an induction. The service received the input of other healthcare professionals where needed.

Staff were caring. People and their relatives told us they very happy with the service, although there were some concerns regarding late and missed calls. People were treated with dignity and respect. Support plans were accurate.

The provider had a complaints procedure in place. People and their relatives were aware of how to make a complaint. People and relatives were consulted and asked for feedback about the quality of the service. People's views were sought and action taken to improve the service from these.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The provider was working within the principles of the MCA. Some staff understanding of the MCA was limited.

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

Rating at last inspection

The last rating for this service was requires improvement (published 9 July 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

This service has been in Special Measures since 8 July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continuing breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service: Vista Home Care Services Ltd is a domiciliary care agency based in Batley, West Yorkshire. On the day of our inspection 11 people were receiving a regulated service from Vista Home Care Services Ltd.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

People’s experience of using this service:

People were positive about the care staff who supported them. The concerns we had were about the systems and processes used to manage the service, which were not sufficiently robust.

Recruitment records didn’t evidence the process was consistent and robust. We identified areas where improvements were still needed to ensure the service could evidence recruitment was safe.

There was evidence to show some calls had been missed. The process for checking calls had been carried out was not sufficiently robust.

Medication administration had improved, and the service was using medication administration records. There were some gaps in the records, without explanation so it was not always clear whether they had been administered. Further improvement was required in relation to recording of creams and as and when medication protocols.

Although some risks had been identified and measures put in place to reduce the risk of harm, all risks had not been addressed.

Staff had received training and people and relatives felt staff were sufficiently skilled. Staff were receiving regular supervision, performance checks and annual appraisals. Competency checks on medication management and moving and handling needed to be more detailed and robust.

People and their relatives spoke highly about the care staff who supported them. They told us they were kind, compassionate, respectful and listened to them. Positive and supportive relationships had been developed between people, their relatives, and staff.

People were supported to eat and drink to maintain a balanced diet, where required.

There had been some improvement around the assessment of mental capacity for some people to ensure people were supported to have maximum choice and control of their lives. However, not everyone had been assessed in line with the legislative framework. Some care records did not show people had consented to their care arrangements.

There was no clear audit record to show people had been assessed prior to care being provided or that an up to date plan of care had been put in place. There was limited information to confirm people had been involved in the review of their care, and not everyone told us they had a copy of their care plan. People and their relatives told us they had not been involved in a formal review of their care arrangements.

There had been an improvement in the quality of some of the care plans, but further information needed to be added to ensure an accurate record of care was kept.

Complaints had not been recognised although people told us they had informed the registered manager when things had not gone as expected.

The provider had purchased a comprehensive set of policies and procedure relating to all aspects of service delivery and was in the process of adapting these to their service.

Some of the feedback we received confirmed the service was still not well led. Systems of governance were not robust and there was a lack of audits to identify areas to improve. The registered manager openly acknowledged they had focussed on improving areas we highlighted at our previous inspection and had failed to consider other areas where improvements were needed.

During this inspection, we found continuing and new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment, receiving and acting on complaints and good governance. We found a breach a new breach as the provider was not displaying their latest inspection rating. You can see what action we told the provider to take at the back of the full version of the report.

Rating at last inspection: Requires improvement (Report published 18 December 2018)

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

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

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 the inspection they were supporting 27 people although the registered manager was unclear with us as to how many of these people were provided with a regulated activity of ‘personal care’.

There was a registered manager who had been registered since 2014. 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.

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Recent staff recruitment had not been robust. Staff employment history had not been explored, and there was only one reference in one candidate’s file and this did not match any employer listed on their application form. From the records we reviewed, one person had commenced providing care before their Disclosure and Barring Service check had been returned.

People told us they felt safe whilst staff were providing care. However, we found elements of the service which were not safe. For example, we could not always gain a response to the registered providers telephone line. People’s relatives and professionals also reported to us, they had the same issue. This meant it was not possible for people to contact the office for an immediate response. We raised our concerns with the registered manager to ensure they instigated an effective system to ensure people were able to contact the service by telephone.

Rotas we were provided with at inspection were inaccurate as they had the same care worker listed to visit people at the same time. People had told us on a few occasions, calls had been missed which might have been as a result of the way the rotas were designed. We advised the registered manager or these concerns, as they were unaware any calls had been missed.

Risk assessments were not in place for all identified risks such as to manage the risk of falls. Risk reduction plans to mitigate all identified risks needed to contain all the information required to guide staff. Most people at the service had low level needs, however, it was important to ensure all risks were recorded and reduced.

The service mostly reminded people to take their medicines by way of a prompt. However, the recording of the administration of medicines was not in line with current best practice. We also found not all staff had their training to administer medicines refreshed or their competency checked by a person assessed as competent to do so. The registered manager agreed to rectify this immediately and had put a system in place shortly after the inspection had finished.

We found training for staff was not all up to date, although some had been undertaken following the announcement of the inspection. Supervision and appraisal records did not follow nationally recognised best practice in terms of quality. The registered manager had not kept up to date with nationally recognised best practice guidance in the provision of community based domiciliary care services.

The majority of people supported had the capacity to consent to their care and treatment. However, the registered manager and staff did not have a good understanding about the Mental Capacity Act 2005. The registered manager had not understood, they needed to formally assess people’s capacity when a person’s ability to consent declined or fluctuated.

Relatives and people using the service told us staff were very kind and caring, and people were treated with dignity and respect. Our conversations with staff confirmed they were caring and were passionate about providing care that was centred around the individual and to their preferences. They could describe to us how people liked their care to be provided. However, people and their relatives told us about missed calls, which meant the care they were expecting was not always provided.

The registered manager did not have an effective system in place to ensure personal information was stored confidentially. They did not understand their responsibilities to do so under data protection legislation.

The registered manager told us there had been no complaints. However, during our discussions with people using the service and their relatives, they highlighted areas of care they considered could be improved and told us they had reported these to the registered manager. The registered manager had not recognised these concerns as an opportunity to learn and drive continuous improvements.

There was a lack of systems and processes, including regular audits which meant the registered provider was unable to identify where quality and safety needed to improve. Up to date nationally recognised guidance had not been implemented by the registered manager, although policies had been updated by their policy provider to reflect best practice. The registered manager had failed to notify CQC about significant events, which they are required to do so by law.

We found several breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Vista Home Care Services Ltd provides care and support to people living in their own homes in the Dewsbury and Batley area of Kirklees. On the days of our inspection 15 people were receiving support with personal care.

The registered provider is also the registered manager for the service. 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 told us they felt safe; staff had received safeguarding training and were aware of their responsibility to report any concerns to their manager. Care plans contained risk assessments which were relevant to people’s individual needs. The registered person had a robust system in place to vet potential employees. All staff were trained and assessed as competent by the registered person, to administer people’s medicines.

New employees were supported in their role and there was a programme of on-going refresher training for existing staff. Staff received regular supervision to ensure they had the skills and competence to meet people’s needs.

Staff had received training in the Mental Capacity Act and were understood people’s rights to make decisions about their lives.

Staff were caring and kind. People’s privacy and dignity was respected and care plans reflected the need to encourage people to retain their level of independence.

People had care plans in place which noted the tasks they required support with. Staff told us these were reflective of people’s needs and were updated at least annually.

The registered person had a system in place to monitor the performance of the service. Staff were monitored at regular intervals and audits were completed of people’s daily records. The registered provider asked people and staff for feedback, this information had been reviewed and fed back to staff.

Below is a summary of what we found. The summary is based on speaking with the manager, speaking with relatives of people who use the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with four relatives of people who used the service. They all said they felt their relative was safe.

People were at risk of medicines not being administered appropriately.

Is the service effective?

When speaking with staff it was clear they cared for the people they supported.

Mandatory training for staff was not up to date. Staff had not received supervision during 2014.

Is the service caring?

Prior to the service accepting a new service user, the manager visited the individual to assess what their needs were.

One relative of a person who used the service told us, 'Really good staff. They are excellent.'

Is the service responsive?

We spoke with four relatives of people who used the service. They all said they knew how to complain. We saw the service had received two complaints since January2014 which had been fully investigated.

Is the service well-led?

The registered care provider also manages the service on a daily basis.

Only two of the four staff we spoke with had any knowledge of whistleblowing procedures.

The service has a quality assurance system, although not all audits were formally recorded.

Four staff we spoke with all told us they felt supported by their manager.