Quality Care of Cheadle

Quality Care of Cheadle is a homecare agency providing personal care to older people and people with physical disabilities. At the time of our inspection there were 27 people receiving a regulated activity from the service. Not everyone who used the service received personal care. The Care Quality Commission (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 felt safe and were supported by consistent carers who had been suitably recruited. Risks were assessed and mitigated as much as possible, and staff followed processes to reduce risk of infection. Medicines were suitably managed, and records maintained.

Systems of oversight were in place and the management team were committed to ensuring the quality of care people received was good. People spoke positively about the culture of the service and felt able to raise concerns. We have made a recommendation about system for oversight of the quality and safety of the service.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability.

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 26 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Quality Care of Cheadle on our website at www.cqc.org.uk

Recommendation

We have made a recommendation that the service review good practice guidance in relation to systems of oversight of the quality and safety of the service including in relation to training provided to staff.

Follow up

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

We last inspected the service in December 2016 when we rated the service as requires improvement. At that time we found the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance.

Following that inspection we asked the provider to complete an action plan to show what they would do to improve the key questions of safe care and treatment and good governance to at least good. At this inspection we found that improvements had been made and the requirement actions had all been met.

At our last inspection we found the service did not have accurate recording systems in place for medicines given to people from pre-filled dosette boxes. At this inspection we found systems were in place to record this and it was now clear what medicines had been given to people. We also found people’s care records had guidance for care workers on when to give ‘as required’ PRN medicines.

We also previously identified the registered provider was not carrying out regular audits of care plans and medication records. At this inspection we found these records were now being audited periodically and risks identified were mitigated.

Quality Care of Cheadle is registered with the Care Quality Commission (CQC) to provide personal care and support to people living in their own home. At the time of our inspection 70 people were using the service and being supported in meeting their care needs.

Not everyone using Quality Care Of Cheadle received a regulated activity; 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.

The service had a registered manager. 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 who used the service and their relatives had a positive view of the service. People we spoke with told us they felt well cared for and that staff were well trained and dedicated. Comments we received included; “I think the carers are marvellous.” Others told us; “They are amazing, really good.” And “They do their very best. I can’t say more than that.”

Care workers were aware of their responsibilities to protect people from abuse and knew what to do if they had any concerns to help ensure people were kept safe. People who used the service and their relatives said they felt safe and well looked after.

People told us they felt involved in planning their care and support and that their choices and preferences were respected. People told us they felt they were encouraged to remain as independent as possible.

The service runs a friendship group and allotment with the aim of reducing isolation for the community as a whole rather than just their service users. At the time of our inspection the service was applying for funding to allow them to expand the friendship group to more locations.

The service had good relationships with the local authority and other agencies and we found they were keen to develop their service in conjunction with other organisations. They had previously taken part in a pilot scheme with the local authority and had suggested different ways of working together.

People using the service and care workers told us they felt supported by management. They told us they would feel comfortable raising any concerns and were confident their concerns would be dealt with appropriately.

The provider was displaying the ratings from their last CQC inspection in line with regulations.

The last inspection took place on 22 July 2014 and the service was meeting all of the regulations we assessed.

Quality Care of Cheadle provides personal care to people in their own homes. The domiciliary care agency is based in the Shaw Heath area of Stockport and covers Cheadle and the surrounding Stockport areas. The agency provides personal care to people in their own homes. They support older people, people with a physical and/or sensory impairment and younger adults. The service currently provides support to 74 people.

The service has a registered manager. 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 this inspection, the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation12 Safe care and treatment and Regulation 17 Good Governance.

Medicines were not safely managed. The registered provider did not have accurate recording systems in place for medicines which were administered to people from pre filled dosette boxes. This meant there was no clear record to say what medicines the person had received. In addition to this, there were no protocols in place for people who needed medicines ‘as required’ (PRN).

Quality assurance systems and record keeping required improvement.

You can see what action we told the provider to take at the back of the full version of the report.

The service had sufficient staff to meet people’s needs. Staff knew how to safeguard people from harm. People told us they received care from a consistent and reliable team of staff.

The registered provider had not ensured that staff had up to date disclosure and barring service checks (DBS). The DBS checks assist employers in making safer recruitment decisions by checking prospective staff members are not barred from working with vulnerable people. Some staff who had transferred from another registered provider had not completed detailed application forms. We have made a recommendation in respect of this.

Staff told us the management team were supportive and they had access to regular training and supervision.

People told us care staff were kind and compassionate .The service had received a number of compliments about the care they provided.

There were strong working relationships with relevant health and social care professionals and staff were proactive in liaising with other agencies when they were concerned about people's well-being.

The registered provider had an up to date complaints policy and, when complaints were raised, these were investigated and responded to. People told us they knew who to contact if they had any concerns.

Staff told us they felt well supported by the management team. There were regular staff meetings and staff described an open culture within the service which meant they could discuss any concerns or issues they had.

People’s views were sought on a regular basis and improvements were made as a result of these.

The summary is based on a visit to the service office where we looked at records and talked to the manager and office manager. Following the visit an expert by experience contacted, by telephone, a sample of people who used the service and relatives of people using the service. We also talked to some care staff.

Is the service safe?

We found that the service carefully assessed and managed risks to people's personal safety to make sure their care was delivered in a safe way.

There were appropriate arrangements in place to manage people's medicines safely and we saw that staff had been appropriately trained in medication administration. With the exception of one person people indicated that they were happy with the way their medication was given. The one incident raised by a relative was followed up with the office manager and the manager of the service.

People we spoke with told us that they felt safe with the care staff. Some comments were: 'I'm not being neglected. They come and make sure that I eat', 'They're very good. I don't have any problems with them' and 'They are very pleasant to have in the house.'

Is the service effective?

The manager told us that a service was provided on the basis of an assessment of the individual's needs and a written plan of care. People using the service, and when appropriate their representatives, had been involved in the drawing up the care plan.

People's care was well planned and was kept under regular review to check it remained effective. Care plans were updated in a timely manner if changes or updates were needed. Some comments we received from people using the service and their relatives were: 'Care plans are kept at home and the carers write in it every day,' 'His care plan is kept at home and they (carers) keep a record of all their visits' and 'They make a note in it (the care file) every visit'.

Some comments from relatives of people using the service included: 'It (the care) enables him to live at home. If he didn't have the service he wouldn't be able to live here', (The carer) 'Is usually someone he knows. They let themselves in to the house' and 'We are very happy with the support we have been given. It's been excellent',

The care staff we spoke with told us that they felt supported by the manager. Some comments included: 'I've been impressed with Quality Care as an employer. They have supported me all the time', 'I feel valued and it feels like a worthwhile thing I'm doing', I wouldn't swap it (the job)', 'When I started I went out with two other carers and shadowed them for about two weeks it's brilliant' and 'You can go to her (the manager) for anything.'

Is the service caring?

The majority of people we spoke with told us they were happy with the care and support they received. Some comments included: 'The care they give you is good', 'One girl is very good. She is excellent. They are all lovely people' and 'I'm quite happy with the care I get.' However one person said 'The care is OK but they are sometimes a bit rushed.' Another comment was 'It depends who comes, some will do more than others.'

The care plans seen contained details of the care needed at each visit and how the care should be given in accordance with people's wishes and personal preference while also maintaining independence. One member of staff said 'As long as you follow the Care Plan it all fits in (in the time allocated).'

Is the service responsive?

The manager told us that quality questionnaires were due to be distributed to people receiving a service or their relatives and staff in order to obtain their views and opinions about the service. We were told that the results would be analysed and a report produced. We saw the report from analysed results of the quality questionnaires for 2013/2013 which was positive. Some people using the service, relatives and staff confirmed that they were able to give comments about the service being delivered.

We saw there was a complaints procedure in place which was also included in the service user guide which we were told each person using the service had received a copy of and it was also included in the staff handbook. People spoke with confirmed that they had not made a complaint but knew what to do if they felt a complaint was necessary. Some comments included: '(If I had a complaint) I'd ring and speak to the lady. She has made that clear', 'If I thought something wasn't satisfactory I'd tell them' and 'When a visit was missed I rang them up and they did something about it.'

We looked at the records of complaints made which showed that everything had been documented and investigations and responses to the complaints were carried out within the specified timelines. This meant that people could be confident that their complaints were listened to and dealt with effectively.

Is the service well led?

The manager and staff had a good understanding of the ethos of the service and their roles and responsibilities. Quality assurance processes were in place to check standards were maintained. People were routinely consulted about their level of satisfaction and feedback was used to improve the quality of the service.

All staff spoken with told us they had regular supervision and annual appraisals. Staff also told us 'The training is immense and classed as compulsory,' 'We're up to date on all our training', 'We've been trained to treat ourt service users as our parents' and 'The manager and senior carers will keep checks on what you have done. We all know we are spot checked. It helps keep standards high'.

The agency ran a weekly club called 'socially yours' in a local church hall. The club was open to all of the people who use d the service and people from the local community. At the time of this inspection visit the club had taken a number of people on holiday to Blackpool to a fully adapted hotel which catered for people with disabilities and provided their own domiciliary care. Five care staff and the manager accompanied the people on their holiday.

All the people we spoke with told us they were happy with the service provided. One comment was; 'Rest assured all the carers are very good.'

We found some improvements were needed to ensure consistent and accurate recordings in peoples care records.

We looked at safeguarding arrangements and found that there were procedures in place and the staff were trained in recognising abuse in vulnerable adults.

We saw some shortfalls in the way the agency managed the administration of medicines.

We looked at staff records and saw that staff had been appropriately recruited.

All staff spoken with were positive about the standard of care provided by the agency.

At the time of inspection, there were 129 people using the service of whom most were elderly and over the age of 65.