Care Connect UK

Connect Care UK is a domiciliary care agency providing personal care to people in their own homes. At the time of the inspection, 82 people were receiving support with personal care.

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

Not all risks were safely assessed and mitigated to maintain people’s safety. Risk assessments had not been completed or reviewed for some people. Information was not always available to inform staff how to manage any identified risks. Medicines were not always managed safely. Records were not completed consistently to a high standard.

Systems in place to monitor the quality and safety of the service were not always effective. Some of the concerns found during the inspection had been identified by the provider’s systems. However, this had not always resulted in a sufficient and timely response to help keep people safe.

The provider responded immediately after the inspection and provided an action plan to improve safety and quality.

People and relatives told us they felt care was delivered safely by staff who knew them. Staff were safely recruited and deployed in sufficient numbers to meet people’s care needs. Safeguarding policies and procedures were in place to guide staff in their practice. Effective infection prevention and control procedures were in place, including those relating to COVID-19.

The previous registered manager left the organisation in December 2020. The provider was in the process of recruiting a replacement and reviewing management responsibilities. The directors of the company were providing governance and oversight on an interim basis. The provider recognised the value of regular communication with people using the service, relatives and staff. The provider acted in accordance with their duty and shared information in an open, honest and timely manner.

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 good published on 23 January 2019.

Why we inspected

We received concerns in relation to the management of the service and staff training. As a result, we undertook a focussed inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well sections of the report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to risk management, the management of medicines and the governance of the service.

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.

We gave the service 48 hours’ notice of our intention to inspect, as the service provides domiciliary care, and managers and staff are often working in the community, so we wanted to be sure someone would be available to speak to us.

Care Connect is a domiciliary care agency. They provide support in people’s own homes. At the time of our inspection Care Connect were supporting over 40 people in the Sefton area.

The service was last inspected in December 2017 and was rated as Requires Improvement overall.

Care Connect provides personal care to people living in their own houses and flats in the community as well as specialist housing. It provides a service to older adults and younger disabled adults. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks relating to personal hygiene and eating. Where they do, we also take into account any wider social 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.

Everyone we spoke with said they felt safe with the care they received from staff at Care Connect.

There was a variety of risk assessments in place to help keep people safe, however, we found some of these required additional detail.

Staff were being recruited safely. Each staff member had a disclosure and barring service (DBS) check completed before they started this.

Medication was being administered safely to people in their own homes.

Rotas were completed electronically and sent to staff every week. Staff confirmed they had no concerns with their rotas and were often scheduled to visit the same people. There were enough staff to cover calls.

Incidents and accident were documented when they occurred and the registered manager audited these for evidence of any patterns or trends.

Training took place and covered a range of subjects. All training took place in the registered office and was conducted by the in-house training manager who was a qualified trainer. Each new member of the care team who had never worked in health and social care before were expected to complete the Care Certificate.

Supervision for staff took place regularly. Some supervision were due in December 2018.

Records clearly indicated where people had provided their consent to receive care and support from Care Connect and in other instances, where people did not have capacity, decisions were appropriately made in the persons ‘best interest’ and in the least restrictive way as possible.

People confirmed they were supported with their nutrition and hydration needs by the staff.

Everyone we spoke with said they were well cared for by Care Connect. People told us that staff were considerate and mindful of their privacy and dignity. Care plans reflected choice and dignity.

All confidential and sensitive information was securely stored and protected in line with General Data Protection Regulation (GDPR).

Information recorded in the care plans we viewed was person-centred. Care plans contained information about what to do on each call and how the person liked their care routine to be carried out. We saw that some of the care plans would further benefit further personalised information which we discussed with the registered manager at the time of our inspection.

People were getting care which was responsive to their needs. We saw that staff were completing food charts and recording fluid intake for people who required support with their dietary needs

Complaints were documented and responded to appropriately. The complaints policy had been made available to people in the service user guide, and everyone we spoke with said they knew how to complain.

Information was available for people in alternative formats. We saw copies of care plans and policies which could be provided in different formats when requested to support people’s understanding.

The staff had completed training in end of life care. End of life care was provided in a dignified and sensitive manner; people’s advanced decisions and wishes were respected and people had the opportunity to express their end of life preferences and desires.

Everyone we spoke with said they liked the registered manger and knew who they were.

The registered manager discussed opportunities they had taken to learn lessons when things went wrong.

There were robust quality assurance procedures in place. Audits highlighted when there were concerns. Records showed all audits which took place monthly, quarterly and yearly.

The culture an ethos of the company was friendly and client driven. The registered manager was clearly proud to be part of the company and the staff were equally as positive about the registered manager.

Team meetings took place every month. We saw minutes of the last few meetings and saw copies of these were shared with staff. Agenda items included medication, training, rotas and health and safety.

There was also a process in place to gather feedback from people who used the service and from the staff providing the care.

The service worked in partnership with other organisations, such as the local authority.

Care Connect UK Limited is a large domiciliary care agency based in Blundellsands. The service supports approximately 500 people in their own homes in the Sefton area of Merseyside.

The service was last inspected in November 2015 and was rated Good. At this inspection we rated the service Requires Improvement.

We received mixed responses regarding whether the service supported people to feel safe, particularly in respect of staff allocation and how this was communicated to people. People told us they did not always receive advance notice of who would be supporting them, and at what times, which made some people concerned. We have made a recommendation regarding this.

There had been recent changes to the management structure at the service following the departure of the last registered manager in May 2017. Their replacement left in August 2017. The current manager was appointed on the 30 October 2017 and was not yet registered with the Care Quality Commission. 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.

We received a number of comments regarding the lack of communication and organisation at the service, specifically in relation to office based staff.

There was a lack of audits being completed at provider level which meant that the issues around poor communication and staff rostering had not been effectively managed in the absence of a consistent registered manager. We have made a recommendation regarding this.

People who used the service told us they felt safe when receiving care and support from care staff.

The registered provider had experienced operational issues in respect of staff recruitment which had impacted upon their ability to meet the demands of their contract with the local authority. Nevertheless, the registered provider ensured all existing referrals were managed safely as a priority and that sufficient numbers of staff were allocated to meet people’s needs.

There were processes in place to ensure that staff were recruited safely. This included a satisfactory DBS check and two references.

People told us they were happy with the support they received with their medication. Staff were trained in medication administration and there were regular audits completed in respect of Medication Administration Records to check their accuracy. Errors had been identified and actions were taken in response.

Staff had received training in ‘Safeguarding’ to enable them to take action if they felt anyone was at risk of harm or abuse and understood the reporting procedures.

Accidents and incidents were recorded and appropriate action was taken to address any issues identified.

Staff were assisted in their role through induction, supervisions, observations and an annual appraisal. Staff also felt confident to raise any issues or support needs informally.

The manager provided us with a staff training plan and this showed staff received training to ensure they had the skills and knowledge to support people effectively.

The service operated within the principles of the Mental Capacity Act 2005 (MCA). People told us that consent was sought and staff offered them choice before providing care.

Staff encouraged people’s independence whilst providing assistance and prompts where necessary.

People spoke highly of the individual carers who supported them. People described the carers as “fantastic”, “caring” and “respectful.”

The majority of people told us that carers stayed for the allocated time and had sufficient time to complete the necessary tasks and have a chat.

Care files contained succinct information about people’s routine and preferences. A breakdown of each person’s call time stipulated how they wanted to be supported.

People had access to a complaints procedure and we saw that formal complaints were managed effectively.

We looked at processes in place to gather feedback from people and listen to their views. Annual surveys were issued to people using the service to seek their views, capture trends and improve the service delivery.

Quality assurance procedures were in place as well as regular audits in respect of medication and care planning. We saw that the new manager had plans to further develop these systems to make them more robust but these were not yet fully embedded.

Regular monitoring visits were completed by senior staff to promote quality of care.

Further information is in the detailed findings below.

At this visit we found action had been taken to address the record keeping issues identified at our previous visit. However, because the changes had only been recently implemented it was not possible to assess how well they were embedded into practice at the service, or to assess the effectiveness of any monitoring.

Their comments included: 'They don't rush me; they know what I can do.','The staff are very good.' and 'They (Care Connect) provide an excellent service.'

All the people we spoke with told us they valued the same care workers attending to provide consistent support. There were two people who were not regularly receiving support from the same staff. One person had recently started receiving a service and had several staff visiting them in one week. Another person received a service every day but had one day were different staff attended. We spoke with the provider who was aware of the situation and were trying to find consistent staff to visit both people. People told us that on occasions their regular carers didn't attend but they knew in advance, as they were sent a rota. They said they had usually met the staff before so the staff knew what to do.

People who received a service told us the staff knew what support they required and did everything that was needed for them. We looked at six care records in the office and a further two in the homes of the people we visited. We found them to contain relevant and current information about the person's needs.