Archived: Starcare West Cheshire Branch

Starcare Limited is a domiciliary care service. At the time of the inspection 262 people received support from the service, with 261 of those receiving personal care. The CQC only inspects where people receive personal care. This is to 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

Some people told us they did not always know which staff would be attending, if the call was going to be late and said they did not have a regular carer. The registered manager explained that factors such as the impact of the COVID-19 pandemic had, at times, impacted on staff absence which in turn had affected call times on occassion. We have made a recommendation that the registered provider reviews systems in place, to ensure there is a consistent approach and that audit systems include assessment of consistency of staff.

Quality assurance systems had been improved since the last inspection and were, overall, effective. However, medicines audits had not always identified issues noted within the inspection. The registered manager took immediate action to address this.

People received their medicines from trained and competent staff. Procedures were in place to protect people from abuse and people told us they felt safe with the staff who supported them. Staff were aware of the procedures to follow to prevent and control the spread of infection and received specific guidance about the COVID-19 pandemic. Risks associated with individual’s needs were assessed and regularly reviewed with measures in place to mitigate these. Recruitment procedures were safe.

People were treated with dignity and respect. People told us that staff were “kind” and “polite.”

Each person had a personalised care plan which was detailed, person-centred and included assessment of people’s specific communication needs. We saw that people had been involved in planning their support. People were aware of who to contact if they had any concerns.

People and relatives were positive about the culture of the service and staff. Staff felt supported in their roles. There were opportunities for people to provide their views of the service they received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 7 June 2019) and there were multiple breaches of regulation. At this inspection we found sufficient improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 7 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing, person-centred care, governance and informing CQC about significant events as required.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed to Good. This is based on the findings at this inspection.

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

People’s experience of using this service:

We identified four breaches of regulations. These were in relation to good governance, person centred care, staffing and notifications.

We were made aware that a significant number of staff had recently left the service which was adversely affecting the delivery of care. Currently, peoples’ visits were not always planned in line with their needs and preferences wishes. Staff did not consistently arrive when expected and did not always stay for the full duration of the call. This impacted negatively upon the safety and wellbeing of those people concerned.

Care plans and risk assessments were available to support staff in providing the correct level of personalised support. People and relatives said that they were involved in the planning of their care but were disappointed that not all staff read or followed them.

The overall governance of the service was not robust and not everyone received a service that was person centred. It had failed to ensure that issues were not only highlighted but also resolved and improvements sustained.

We have made a recommendation about the management of medication. People were supported with their medicines but improvements were needed to record keeping and the planning of visits.

We have made a recommendation about the assessment and recording of mental capacity. People were supported to have maximum choice and control in how they wanted their support to be delivered. However, records and systems in place did not support this practice.

Staff received adequate training and support. People were confident in the ability of staff to provide the physical support that they needed. Some improvements were required in the approach staff took to supporting people living with dementia and mental health needs.

The registered provider was keen to stabilise the service and to make improvements. They reflected and acted upon feedback following the inspection.

The majority of people we spoke with were satisfied with actual support they received from the staff that visited them and felt it met their needs. They were complimentary about the staff and felt they were professional, caring and respected their dignity.

Staff told us they felt very much supported by the organisation and they were valued as employees. There were good systems in place to ensure that staff had the opportunity to speak about their work and to meet with others.

Rating at last inspection: This service was rating Good at the last inspection (report published 15 October 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We have requested an action plan from the registered provider as to how they plan to address breaches in regulation and make improvements to the service.

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Starcare Limited is a domiciliary care agency that provides a range of care services to people in their own homes. The offices are based in the city of Chester. There is limited car parking to the side of the building. The service covers the geographical areas of Chester, Ellesmere Port, Neston, Frodsham, Crewe, Middlewich, Winsford, Northwich and the surrounding areas. There are currently 350 people who use this service and who are supported by 168 staff.

The previous inspection was undertaken on 6 January 2014 and the service met the regulations we assessed at that time.

There was a registered manager in place, who was also the managing director and owner of the service. For the purposes of this report they will be referred to as the registered manager. They had been registered for eight years. 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 told us the staff were kind, caring and helpful. They said “The staff are trustworthy”, “The attitude of the staff is very good”, “The staff are nice”, “I like all the staff who come to me” and “I have got some good carers”.

People had mixed views about the punctuality of the staff and whether they were informed. We found that systems were in place to monitor this and that where issues occurred these were dealt with by the registered manager.

People said they were felt safe with the staff. Staff were aware of safeguarding policies and procedures and had undertaken safeguarding awareness training. The registered manager understood the principles of the Mental Capacity Act (MCA) 2005 and the implications of it on people who used the service. Staff had an awareness of the MCA through the induction process and safeguarding training.

Staff recruitment processes were in place which meant that people were protected from staff that were unsuitable to work with people who may be deemed vulnerable. Staff had undertaken an induction and had access to supervision sessions and training relevant to their job role.

Care plan documentation was person centred and gave good information about the individual needs of each person. A risk assessment was tailored to each person’s particular requirements. Some people were supported with their medications and these were well managed by the staff. All documentation seen was up to date.

Some people were supported with meal preparation and the purchase of food. A financial record was kept where food was purchased by staff and this was reviewed by senior staff during monitoring visits.

People had access to information about the service that included a service user’s guide. However most people telephoned the service and spoke to the registered manager to obtain verbal information about Starcare. An initial home visit was undertaken by senior staff prior to the service starting.

A complaints policy was available and each person had a copy within the service user’s guide which was within their care plan file. Processes were in place and complaints made had been dealt with in a timely manner.

Quality assurance processes were in place which included observations of staff to ensure that care and support standards were being maintained, reviews of people’s care and an annual questionnaire for people who used the service. There were also a range of audits undertaken in relation to the service provided that monitored its safety and effectiveness.

A range of policies and procedures were in place. We found that throughout some of these reference was made to past legislation and a review was needed to ensure these reflected up to date guidance. The registered manager agreed to undertake this.

Care records were person centred with clear guidance to staff on the support required by each person. People's individual needs and preferences had been taken into account and people had been given a choice in how they wished to be cared for. Care plans were regularly reviewed and updated when a person's needs changed. Relatives confirmed that consent to any care plan changes or personal care was always sought by staff.

All necessary checks to safeguard people against abuse had been undertaken in the employment of staff and a regular training programme for all staff ensured they had the qualifications, skills and experience to undertake personal care. Staff were regularly supervised and appraised in their job role through spot checks and follow-up visits undertaken by team leaders.

The provider had systems in place to adequately assess and monitor people's individual risks such as care plan audits, care reviews and regular contact with the person and/or their relatives. An annual survey and quality monitoring visits were undertaken to collect people's/relatives views on the service provided. The survey results for 2013 showed people who used the service and/or their relatives were satisfied with the service provided.

One person's relative told us 'My relative really enjoys the company of the staff. They (their relative) only had wonderful things to say about the Starcare staff.' Another person told us 'I have just had a review with the senior, they (the staff) are very good it is a very well run place and the staff are very kind and respectful.'

In the office the service had a methodical management procedure for the referral process. The manager told us they had daily meetings to review all aspects of the business which included the step by step management of new and existing people who used the service.

We viewed care files and found them to be person centred. A process was in place to support scheduled reviews every three months.

We spoke with staff who told us they felt well supported by both the management and their peers. They said they worked well as a team. The manager told us that they had their own training facilities where training was delivered to the staff to keep them updated on care delivery courses and mandatory training. This was supported by our discussions with staff who told us that training was encouraged.