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Archived: Saffron Care Agency Inadequate

Reports


Inspection carried out on 17 May 2018

During a routine inspection

This comprehensive inspection took place between 17 and 30 May 2018, the first day was unannounced. We last inspected this service in September 2017 where it was rated 'Inadequate’ overall. At that inspection, we identified nine breaches of regulation. The Care Quality Commission (CQC) took enforcement action against Saffron Care Ltd and imposed a condition on the provider’s registration. This required the provider to send us fortnightly and monthly reports on the areas of greatest concern and risk. This also included a requirement that the provider must give us information about the actions taken in response to any issues.

We met with the provider to confirm what they would do and by when to improve the service. The number of people who used the service had decreased from 260 to 156 people. The registered manager was receiving support from the organisation who sub-contract packages of care to them and the local authority quality assurance and improvement team (QAIT). Despite this support, this inspection has shown widespread and significant shortfalls, and some deterioration, in the service. The only improvement made, that has had a positive impact, was to staff recruitment.

Saffron Care Agency is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults. Not everyone using Saffron Care Agency receives 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. At the time of this inspection the service was providing care and support to 156 people.

The service had a registered manager who was also the provider. 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 concerns from people who used the service, staff and the local authority. In response to those concerns we brought forward this unannounced inspection. Prior to us starting this inspection the local authority placed the service back into a multi-agency safeguarding process due to the concerns they had received. We also shared our concerns with the local authority commissioners and safeguarding team. Concerns related to late visits and people being rushed during their visits, lack of staff training, medicines not being administered appropriately, poor communication and lack of response to complaints, and poor staff attitude.

People who used the service were still not safe. We looked at people’s visit records and found staff were not always recording the time they arrived and left visits. This meant the registered manager could not assure us that visits were being carried out as agreed. We found examples of people being rushed, not getting their full visit time, and care being missed. Incidents that should have been reported as safeguarding alerts had not been sent to the local authority without delay. People did not always receive their medicines as prescribed.

When people’s regular staff were not working, staff who carried out visits didn’t always know people or how to meet their needs. We found examples of staff being expected to use equipment when they had not received appropriate training. This included training in how to put on support stockings, using a hoist, catheter care, and supporting people with their oxygen and nebulisers. Some people told us they felt unsafe. One person said “I have issues relating to my safety and the training or lack of training of carers on using my hoist”.

People told us when their regular care staff were not working, they did not receive th

Inspection carried out on 12 September 2017

During a routine inspection

Saffron Care Agency is registered with the Care Quality Commission (CQC) to provide personal care to people in their own homes. At the time of the inspection the service was providing care and support to 260 people.

At our previous inspection in October 2015, the provider was meeting all of the regulations.

The service had a registered manager who was also the provider. 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 concerns from people who use the service, staff and the local authority. In response to those concerns we undertook this unannounced inspection which commenced on 12 September 2017 an ended on 25 September 2017.

Prior to us starting this inspection, the local authority placed the service into a multi-agency safeguarding process due to the concerns they had received. We also shared our concerns with the local authority commissioners and safeguarding team. These concerns related to missed and late visits, poor standards of care, medicines not being administered appropriately, allegations of financial abuse, and the registered manager’s lack of response to complaints.

We found significant concerns which meant some people did not always receive their care as planned and were placed at risk of harm. Some people’s packages of care are currently being reviewed by the local authority commissioners. In addition, the local authority quality monitoring team are working with the registered manager and staff to support them to bring about improvements. The registered manager made a voluntary agreement with us to stop taking new packages whilst the required improvements are made.

People had not received appropriate care and support. We found evidence that people had experienced missed visits. People were not always receiving their calls as planned. For example, one person told us “they usually come about 6.00pm to get my tea, the other evening it was about 9.50pm”. Visits were not planned to allow for the gap between medicine doses or meals. Some people told us that staff did not stay for the length of time they were supposed to and they felt rushed. One person said “I should have 45 minutes. Some care staff rush me and at lunchtime some are only here 10 minutes.” Staff told us they had to shorten visits as they had too many people on their rota and no travelling time in between. This showed the deployment of staff was not effective to ensure that people received their call as planned.

People did not always feel safe. People did not always know who would be visiting them or when they would receive a visit. Some people felt unsafe as staff did not know how to meet their needs. For example, one person said “My biggest worry is that some carers do not know how to handle my sling and hoist and I have had to point out to them what they are doing wrong”. Incidents that should have been reported as a safeguarding alert had not been sent to the local authority. People did not always receive their medicines as prescribed. The registered manager had not carried out required pre-employment checks to ensure staff were suitable to work with people.

We received mixed views from people and relatives we spoke with in regards to staff training. Some people and relatives felt staff were well trained, whilst others told us that care staff needed more training on delivering care. Some staff felt supported but others felt support needed to be improved. Team leaders had observed staff’s care practice. However, our findings during the inspection showed the checks completed on staff’s competency had not identified and resolved these issues.

People and relatives gave us mixed views regarding the staff working for the service. Some people

Inspection carried out on 15 October 2015

During a routine inspection

Saffron Care Agency provides care and support to mostly older people, who live in their own homes. The services provided include personal care and domestic work.

The provider of the service also worked as the registered manager in day to day charge of 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.

We visited the office on 15 October 2015. At the time of this announced inspection 180 people were using the service. Our last inspection took place in August 2014 when it met the regulations we looked at.

People and their relatives were positive about the way staff treated them. Each person we spoke with told us their care workers were kind and compassionate. Comments included “The girls are fantastic, kind, considerate and we have a laugh”; “If I need a cuddle, they’ll give me one. I’m blessed”; and “They are marvellous. I don’t know how they can be so cheerful in the mornings but they are”. People were happy and relaxed when we visited them in their homes. Staff treated people with respect and kindness. People responded to this by smiling and engaging with staff in a friendly way.

People and their relatives told us they felt safe when they received care. People told us ‘I generally get the same people and I feel very safe with them” and ‘I have no worries at all when they are in the house.’ There was an on call system for people to ring in the event of an emergency out of office hours. One relative told us it was easy to contact the service in the evenings and at weekends, and they had received a response in the middle of the night.

Care plans described in detail the support people needed to manage their day to day health needs. Staff knew people well and were able to tell us how they supported people. During a home visit, we saw staff responded to people’s requests and met their needs appropriately. Most people had a regular team of staff who had the appropriate skills to meet their needs. Nearly everyone we spoke with said it is very important that they got the same care staff as far as possible because they were not comfortable with 'change.' Comments included “‘I really like to have the same one or two staff and that normally happens”; “I do know who is coming”; and “I’m very happy with the way they do things”. One person said, “I used to have the same staff all the time but now they’re all different”. We spoke with the registered manager who told us the staff member who allocated visits had recently left. They told us this had caused some issues but was now improving.

Rotas were sent out to people each week with visit times and the names of staff who would support them. People said “If they are a bit late they normally let me know”; “They never let me down” and “They’re occasionally late, it’s very rare”. One relative told us some visits had been too early previously but this had improved. The service was flexible and responsive to changes in people’s needs. People said “I have my own routines and they are always very flexible. I don’t always want the same thing at the same time but I only have to let them know” and “They are extremely flexible, you can ring up and change things at short notice”.

Safe staff recruitment procedures were in place. This helped reduce the risk of the provider employing a person who may be a risk to vulnerable people. People were protected by staff who had completed safeguarding training and knew what to do if they were concerned that a person was being abused. Staff told us they had completed training. One staff member said “It’s so much better, we used to just watch DVDs, now we have face to face training. We can discuss issues about our practice and ask questions”.

Risk assessments had been undertaken and included information about action to be taken to minimise the chance of harm occurring to people and staff. Where people were supported to have their medicines this was done safely. People had received their medicines as they had been prescribed by their doctor to promote good health.

People told us the registered manager knew them well. Comments included “The owner is very good. He is a very practical and sensible person”; “He pops down to see how things are; he’s the best” and “We get on very well”. Staff told us they worked well as a team and found the registered manager and team leaders approachable. Comments included “(The registered manager) is brilliant, he knows every aspect of every client”; “I feel able to go to them constantly, they’ve been really supportive” and “They’re always there at the end of the phone, they’re all fantastic”.

People felt that the management were extremely responsive when they had any concerns. For example, one relative told us, “Most care staff do the job really well but the odd time I’ve had a little problem, I usually get through to the owner and he always deals with thing quickly and reassures me not to worry”.

The provider had systems in place to assess and monitor the quality of care. The service encouraged feedback and used this to drive improvements. A healthcare professional told us the registered manager was responsive and helpful, and always willing to discuss things.

Inspection carried out on 6 August 2014

During an inspection looking at part of the service

At our inspection of 25 February 2014 we had concerns because care staff had not received appropriate training. We found that the service had not made improvements at our last inspection of 17 June 2014. We took enforcement action and issued the service with a warning notice. At this inspection on 6 August 2014 we found the service had made improvements.

At our previous inspection in June 2014 we also had identified that the provider did not have an effective system in place to ensure that records were accessed promptly. At this inspection we found improvements had been made.

We spoke with the Registered Manager. We reviewed staff training records and access to records.

We considered all the evidence we had gathered under the outcomes we inspected. We considered our inspection findings to answer the questions: Is the service safe and effective?

This is a summary of what we found.

Is the service safe?

The Registered Manager told us they had recently employed a Training Manager to work between 24 and 30 hours per week. We saw that most staff had completed training updates in safeguarding, manual handling, infection control, health and safety, medication, dementia, food hygiene and first aid. Any staff that had not yet completed training were booked on courses within the following month. This meant that staff were appropriately supported in relation to their responsibilities. This enabled them to deliver care and treatment to people safely and to an appropriate standard.

Is the service effective?

Team leaders had a key to the office and locked filing cabinets so they were able to access records when they needed them. The Registered Manager told us that all the information about the agency was now stored on a secure computer server. This meant team leaders had access to the information they needed to ensure people�s needs were met.

Inspection carried out on 4, 5, 17 June 2014

During a routine inspection

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with eight people who use the service, two relatives, the Registered Manager, and nine staff. We also reviewed records relating to the management of the service which included, five care plans, daily care records, training records, and quality assurance records.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, concerns, and investigations. This reduced the risks to people and helped the service to continually improve. We received some information of concern about the quality of the care being provided. We spoke with the Registered Manager about the concerns. They told us they had taken action to ensure improvements had been made. We found that the areas of concern had been addressed and systems had been put in place to prevent any further reoccurrence. We received concerns that people were not receiving their medicines at the times they needed them and in a safe way. People told us they were happy with the way staff supported them to take their medicines. People confirmed that staff kept a record of the medicines they had administered. We found that medication systems in use meant people had their medicines at the time they needed them and in a safe way.

Is the service effective?

People who used the service told us they were happy with the care they received. Comments included "They do everything they can. They can�t do any more�, �I look forward to them coming and enjoy their company� and �We�re in a nice routine. They leave everything where I can find it�. We spoke with staff who told us how they met people's care needs. We looked at care plans and spoke with the people who used the service. This gave us evidence that staff knew people well. People�s health and care needs were assessed. Care plan reviews had been carried out to ensure they reflected people�s current needs. Staff had not received appropriate training to ensure they were able to deliver care and treatment to people safely. Most people who used the service told us they were confident that staff had the skills and experience to do their job and understood their care needs. Comments included �they know what they�re doing� and �they know just how to do it�. However, one person commented �when they start they should have more tuition before they come out�. We looked at the staff training matrix and found that training had expired or there was no evidence that it had ever been completed.

Is the service caring?

Feedback from people about the staff was positive, for example; "I�ve got to know the staff, they�re really good to me� and �They cheer me up�. When we spoke with staff it was clear they genuinely cared for the people they supported and knew them well.

Is the service responsive?

People�s needs had been assessed before they started to receive care. The service carried out an assessment to ensure it was able to meet people's needs. We saw evidence that people�s care was adjusted when their needs changed. For example, we went on a home visit to a person whose needs had increased recently. The service had arranged a short term care package. The team leader attended the person�s home with the staff to provide extra support and assess the person�s needs for their future care package. This meant the person�s care needs were met appropriately. We saw the complaints procedure was available in people�s care plans. People told us they felt able to speak to the manager or staff if they were unhappy about something. They felt confident that the service would deal with any matters to their satisfaction.

Is the service well-led?

People who used the agency told us they were asked about the quality of the service. For example, people told us how the Registered Manager had carried out one of their visits and checked how things were going. People commented �I can�t think of anything that could be better� and �they�ve done well, let�s hope they keep up the good work�. The service had doubled in size in the past year. The Registered Manager told us they were aware that they needed the right team in place to support the growth and maintain quality. The service had three team leaders in post at the time of our inspection with a further team leader due to start in July 2014. Staff we spoke with told us they felt well supported. They told us they found the Registered Manager to be approachable. Staff told us they were pleased with the support they had received from the team leaders. Comments included �they are a nice addition to our team� and �I know who to talk to if I want something to be done. It gets addressed�. Quality assurance records were not available for us to look at as the Registered Manager was on leave. We returned for a third day of inspection to see the records.

Inspection carried out on 25 February 2014

During an inspection in response to concerns

We had received some information of concern about the quality of care provided by this service. We spoke with the manager about the concerns and looked at records. We found that where issues had been identified, these had been addressed promptly.

People who used the service told us they were very happy with the care they received. Comments included �I�m very happy, they do everything they can to help�; �they�re very, very good� and �so far, so good�.

We found the care plans contained enough detail so care workers knew how to meet people's needs. One healthcare professional told us �They are happy to work jointly with us and have informed us of issues�.

We had received some information of concern about staff training. We found that some care workers were up to date with their training. Other care workers had not completed training in a number of areas including infection control, first aid, health & safety, fire, food hygiene and medication. This meant that not all care workers had completed training to keep them up to date with current best practice.