New Care Services & Cornerstone

New Care Services & Cornerstone provides personal care to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive a regulated activity. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection 62 people were receiving personal care.

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

This was a targeted inspection that considered recruitment processes at the location. Based on our inspection we found staff had been employed following robust recruitment procedures and had received training suitable to their role.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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 04 March 2020).

Why we inspected: We undertook this targeted inspection to check on a specific concern we had about recruitment. The overall rating for the service has not changed following this targeted inspection and remains good.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

New Care Services & Cornerstone provides personal care to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive a regulated activity. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection 62 people were receiving personal care.

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

People were protected from abuse and avoidable harm. Risks to people’s safety were identified and managed. There were enough staff to keep people safe and to meet their needs. The provider had systems to monitor the safety of the service and took action where they identified issues. They ensured lessons were learnt from any safety incidents. People received the support they needed to take their medicines safely.

The manager assessed people’s needs and people received the support they required. The staff were skilled and competent to provide people’s care. They provided people with the support they needed to enjoy their meals and drinks. 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 staff treated people with respect and were caring towards them. The staff spoke about people in a respectful way and promoted their independence, privacy and dignity. The staff and manager asked people for their views about the care provided and respected the decisions people made.

Care was planned and provided to meet people’s needs. The staff provided people with personalised care that met their needs and took account of their wishes. The provider had a procedure for receiving and managing complaints about the service. People received the support they needed at the end of their lives.

The provider had developed a positive culture and people received person-centred care that met their needs. The provider and manager monitored the quality of the service and had identified areas which could be further improved. People were asked about their views and knew how to contact a member of the management team. The staff worked cooperatively with other services to ensure people received the care they required.

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 3 July 2017).

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

New Care Services & Cornerstone is registered to provide personal care to people in their homes for children from four to 18, younger adults, people living with learning disabilities or autistic spectrum disorder, physical disability, sensory impairment, dementia, mental health, people detained under the Mental Health Act and older people. The office is based in the centre of Preston.

The service had 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.

At the last inspection on 24 May 2016 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to assessments of people’s mental capacity, risk assessments, safe management of medicines and staff training. During this inspection we found improvements had been made.

Since our last inspection improvements had been made in the records relating to the safe handling of medicines. Staff discussed safe practice when dealing with medicines. Audits were taking place on MAR charts which included actions taken as a result of findings.

We saw evidence of risk assessment in place to maintain people’s safety in their own home along with any risks associated with the care provided by the service.

Staff demonstrated the system in place to allocate staff to people’s visits. We received positive feedback about the timings of the visits people received however not all people confirmed they received the required amount of time for their visits every time.

Staff demonstrated and understanding of how to deal with allegations of abuse. We saw records had been completed as a result of investigations that had been completed.

People who used the service told us they were happy with the skills of the staff delivering their care. There was evidence of completed staff training taking place that would ensure staff had the required knowledge and skills to deliver effective care.

Staff we spoke with understood the basic principles of the Mental Capacity Act 2005 and the importance of ensuring consent was obtained from people. Care files had been updated and the registered manager told us that appropriate assessments would be completed where concerns around capacity were identified.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were positive about the support they received from their regular staff. However some said when alternative staff undertook their visits the support was not as good.

We saw details in people’s care records that reflected their needs, likes, and dislikes choices and wishes and how they liked them to be met. Staff had access to guidance to help them deliver good care.

People told us they were involved in the development of their care plans. We saw care files were up to date and reflected people’s current and individual needs.

The was a policy and procedure in place to guide people on how to deal with complaints. There was a system in place that records investigations into complaints as well as the actions taken as a response. We saw positive feedback about the service as well as evidence of completed investigations. Some people gave mixed feedback about how the service dealt with their concerns.

We saw evidence that the provider sought the views of people who used the service. People confirmed they had been asked for their opinions in surveys. Records confirmed and staff told us they attended team meetings and were able voice their views.

The service had a manager who was registered with the Care Quality Commission. Systems were in place to monitor and review the quality of service provided. There was evidence of recent audits taking place.

We last inspected this service in October 2013. At that inspection we found the service was meeting the legal requirements in place at the time.

New Care Services & Cornerstone [Delta Care] is a privately owned domiciliary care agency. They are situated in Preston near the city centre. The agency provides care staff to support people in their own homes. They provide assistance with tasks such as personal care, food preparation, medication administration and household chores. The service supports people around Preston, South Ribble, and surrounding areas. Services are provided to older adults, adults with physical disabilities, adults with memory loss or dementia, adults with complex needs and adults with specific conditions such as strokes.

At the time of our inspection New Care Services & Cornerstone provided services to two hundred people.

The registered manager of the service was present throughout our 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.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. People’s views on the service’s reliability were mixed.

People’s medication was not effectively managed. We found a significant number of medication errors. However medication training and audits had been undertaken.

The majority of staff we spoke with told us they were given enough time with people, time for travelling and that visits to people did not overlap. However, some staff told us they had to leave some visits early to get to the next visit in time. This was however not widespread.

We looked at care assessments undertaken for six people. Some risk assessments had been carried out. However, risk assessments for people’s personal care needs had not been done. The service followed safeguarding reporting systems as outlined in its policies and procedures. Allegations of unsafe care had been identified and actions had been taken to investigate and safeguard people.

We found the service had promoted staff development but there were significant shortfalls in training. Training records showed some training had been undertaken. However, some essential training had not been undertaken for areas such as, mental capacity, dignity, and nutrition. Significant shortfalls were found in other areas of training such as fire risk awareness, dementia, diabetes, equality and diversity and managing challenging behaviours. Staff told us they felt well supported by management and we saw evidence that regular supervisions had been undertaken.

We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act [MCA]. People's care records had no evidence of mental capacity assessments. This was a breach of regulation.

Feedback about care staff and the care that people received was positive. However, some people raised concerns around reliability of the service due to care staff not turning up, or not following the rota.

We found the way people's needs were being met was not entirely person centred. Some files had no details about people’s likes and dislikes. People told us care staff were not always introduced to them before providing care. There were assessment processes in place, which helped to ensure staff had a good understanding of people's needs before they started to support them. However care plans drawn from the assessments were basic and did not always contain detailed information about people’s identified care needs and the risk assessments around the identified needs. We made a recommendation about this.

Staff and people who used the service told us that the management team were approachable. However, they found office staff [care coordinators] difficult to deal with. We found the registered manager was familiar with people who used the service and their needs. When we discussed people's needs the registered manager showed good knowledge about the people in their care.

We looked at staff meeting minutes; they showed staff were involved in discussions about improving the service. Management encouraged the staff team to provide good standards of care and support. There was a staff incentive and rewards system to encourage staff to improve and stay motivated.

The service had a complaints procedure which was made available to people they supported. People we spoke with told us they knew how to make a complaint if they had any concerns and the service had sent information on how to make a complaint to all people.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, audits, spot checks and care reviews. Surveys done showed people were satisfied with the service they received. However when we spoke to people some raised concerns regarding consistency, reliability and punctuality of carers.

We made a recommendation about quality assurance for medication.

The registered manager and the leadership team were receptive to feedback and keen to improve the service. They showed us various pieces of work that they were undertaking to improve the service. These included a new log in system to monitor care visits, a new care plan and new policy documents that they had purchased and were ready to introduce. Management worked with us in a positive manner providing all the information we requested.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included Regulation 12 – Safe care and treatment, Regulation 11 –Consent and Regulation 18- Staffing. You can see what action we have taken at the end of this report.

We were told staff were reliable and flexible in their work. They stayed for the right time and were respectful to them and their homes. People said, 'They are a fantastic team and they know how to treat me. I have physio support and the carers were trained up to help me. They are very flexible and will always do that bit extra for you. They even wrapped up my Christmas presents for me'. And 'They help me have a shower and I have to say they are absolutely first class'.

Staff had been trained to give people the help and support they needed to take their medicines safely.

People were cared for by staff that been recruited properly and were of good character. We were told staff were helpful, reliable and punctual. 'I just don't know how they (Health Care Recruiters) manage it, but every new member of staff they have sent to me has been first class'.

People were consulted about their experience of the service and were confident to exercise their right to make a complaint or comment.

Quality monitoring survey showed people thought the service was very good. For example people wrote, 'My carer is excellent. She is always thorough neat and good company and extremely willing to help in whatever is asked of her'. And 'The carer is very reliable and good at her job. She makes me feel confident knowing she is there to share my problems'.

People told us they felt safe in their home. They had arrangements in place for staff to gain entry and to keep their home secure when they left. Staff were respectful to them and their property. They were consulted all the time about the service they received and could request for changes to be made, for example times of visits, carer preference and tasks they required doing.