Archived: Raye of Sunshine Care Services Limited

Updated 23 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 27and 28 September 2016 and was announced. The provider was given 48 hours’ notice of the inspection because the location provides a domiciliary care service and we needed to be sure that someone would be in to facilitate the inspection. The service had not been previously inspected since registering with the Care Quality Commission at the present location address on 2 December 2014.

The inspection team consisted of one adult social care inspector from the Care Quality Commission and a specialist advisor in medicines. Before the inspection visit we reviewed the information we held about the service, including information we had received since the service registered such as notifications of incidents that the provider had sent us. We also liaised with external agencies including the contract monitoring team from the local authority. Before the inspection, we did not ask the provider to complete a Provider Information Return (PIR).

The people who used the service were all young children with complex care needs who did not have the capacity or capability to contribute their verbal opinion to the inspection. However, we observed and evaluated the interactions between the service users, their parents and care staff which provided evidence of the quality of care provided.

We reviewed the care records of three people that used the service and records relating to the management of the service. We looked at documentation such as care plans, four staff personnel files, policies and procedures and quality assurance systems.

During our inspection we went to the provider’s head office and spoke with the nominated individual/managing director, the office manager, four care staff members and the registered manager. We visited two children in their own homes and spoke with their relatives and two care staff members. We also contacted one other relative over the telephone as part of the inspection in order to seek feedback about the quality of service being provided.

At the time of our inspection there were six children using the service.

Updated 23 November 2016

This inspection took place on 27 and 28 September 2016 and was announced. The provider was given 48 hours’ notice of the inspection because the location provides a domiciliary care service and we needed to be sure that someone would be in to facilitate the inspection. The service had not been inspected since re-registering at the location address on 2 December 2014. At this inspection we found three breaches of Regulations in relation to the management of medicines, maintaining accurate records and monitoring and improving the quality of services.

Raye of Sunshine Care Services Ltd. is a specialist care provider, supporting children in their own homes. The aim of the service is to ensure families remain away from the hospital setting where possible and support is offered to children and their families. The service offered specifically designed training packages directed towards children’s individual care requirements, in partnership with the child’s multi-disciplinary team.

The people who used the service were all young children with complex care needs who did not have the capacity or capability to contribute their verbal opinion to the inspection. However, we observed and evaluated the interactions between the children, their parents and care staff which provided evidence of the quality of care provided.

There was a registered manager in post. 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 received their medications as prescribed and care plans were used to outline key aspects of medicines management. Care staff were familiar with the range of medications used and what they were used for. There was no use of covert medicines being administered at the time of the inspection.

However a much more comprehensive policy was needed in relation to medicines management as the current policy being used for medicines management did not follow clinical, professional and industry guidance. We did not find any evidence of medication audits being undertaken. Staff said they were not always confident that the training they received was sufficient for the complex care packages they were involved with. There were no clear plans in place for reassessment of staff competencies over time, or following medication changes.

These issues meant there was a breach of Regulation 12 (2) (g) the proper and safe management of medicines; of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider did not have appropriate arrangements in place to manage medicines safely. You can see what action we told the provider to take at the back of the full version of this report.

The relatives of children who used the service told us they felt that staff had the right skills and training to do their job. There was a process of staff induction in place which was used to audit the progress of new staff relative to the induction process.

However there was no overarching staff training analysis or matrix in place that would assist the service to understand what types of training were needed and the dates training had been achieved or was planned. The Managing Director and Registered Manager were unclear when asked about mandatory training for their staff.

Staff received supervision and appraisal from a nurse, who acted as their immediate line manager. We saw records in staff personnel files of meetings that had previously taken place.

We found there was insufficient planning in place to ensure that the necessary theory and practical training was provided to the care team.

At the home visits, we observed care staff demonstrated a good awareness of the child’s needs and how to deliver effective care interventions. We found that each package was overseen by a lead nurse who was responsible for care planning, implementation and review.

Families were actively involved in discussing the care plan and in making care decisions on their child’s behalf.

We saw that all care plans had been discussed with the multidisciplinary team and developed by the care provider. Records needed to be more person centred and include more information about the child’s presentation.

Records showed a number of errors and amendments in record keeping, for example some had incomplete dates, some had amendments made that were not initialled, there was some overwriting of errors, some use of abbreviations without a supporting checklist, and minimal evidence of supervision or countersigning by the registered nurse responsible for the care plan.

These issues meant there was a breach of Regulation 17(2)(c)(d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service had failed to maintain securely and accurate, complete and contemporaneous record in respect of each person using the service. You can see what action we told the provider to take at the back of the full version of this report.

Although the provider did not provide services to anyone aged over 16 at the time of the inspection we found that staff had not received training in relation to MCA/DoLS, or best interest’s decision making.

Families we visited were positive about the care team input, and we observed evidence of good, positive relationships between the child, the care team and the family members. At the home visits, it was apparent that care staff were respectful of working within the family home environment, and showed consideration of family privacy and dignity. We observed that staff were kind and caring when delivering care and they treated all the children with consideration and respect.

The needs of children were assessed by experienced members of staff before being accepted into the service and pre-admission assessments were completed.

We found that the service was open and responsive to suggestions and feedback from staff and families.

Relatives told us that should there be a need to complain they felt confident in talking to the manager directly and had regular discussions with management.

There were systems in place to record what care had been provided during each call or home visit.

Care staff said they felt able to talk to the registered manager about any aspect of the care package.

Families were complimentary about the input from qualified nursing staff and felt that they provided good advice and support.

The service was unclear about key quality standards and did not have clear ways of monitoring or reviewing the performance of staff or the organisation.

At the time of the inspection the service did not operate a formal system of auditing and we did not see any evidence of medication audits or quality assurance systems, with the exception of the auditing of staff personnel files.

We found the service had policies and procedures in place, which covered various aspects of service delivery but these needed re-evaluating to ensure the service had incorporated quality standards based on best practice and industry guidance.

These issues meant there was a breach of Regulation 17(2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service had failed to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity. You can see what action we told the provider to take at the back of the full version of this report.

The service worked in partnership with the referring hospitals to ensure timely and safe discharges into the home environment.

The service was able to use health and social care funding in a flexible way in order to meet the needs of the child being supported.