Archived: Q Care - Hereford

People who used the service and their families were pleased with the care they receive from the care workers who visit them. One person told us they have a fairly small group of regular carers and that they were all 'very kind and helpful'. We asked if the care workers were polite and made the person feel safe; they told us, 'Oh yes, I can only speak for the ones that come to me but I am very happy with mine'. Another person told us they had been able to develop a 'rapport' with their small team of care workers. One person was concerned about their relative having too many carers and that there had been an occasion when a care worker did not arrive.

One person who uses the service and two of the staff we spoke with mentioned some shortcomings in communication with the office both during and outside office hours. This did not appear to be such a widespread concern as in August indicating some improvement in communication.

The care workers we spoke to were all enthusiastic about their work and considered that they provided people with good care. Some told us that care records were not always up to date or correct and one said that they visited some people where they had not seen any care records. When we checked care records kept at the Q Care office we found that progress in updating these had been limited. One relative told us they had needed to provide guidance to new carers who had not visited their relative before.

The arrangements for managing people's medication did not provide effective safeguards for checking problems. The agency's checks of medication records did not identify any concerns but we found matters which should have been followed up to make sure people were receiving their medication correctly. At our previous inspection we were concerned that medication training provided to staff was not adequate. During this visit we were told that staff had subsequently received medication training from an external company.

Improvements had been made in relation to adult safeguarding and the registered manager had attended a safeguarding course aimed at managers run by the local authority. The service had begun to recognise and report concerns about people's welfare to be looked into under the multi-agency safeguarding process.

At our previous inspection we were concerned about the quality and effectiveness of staff training. The registered manager told us that training is now being provided by training managers from the organisation's head office or external training providers. Some staff we spoke to had some concerns about the thoroughness of training they had done. The provider assured us that staff training arrangements were being improved.

The organisation's arrangements for monitoring the quality of the service had not been effective. We could not be confident that the registered manager and the provider had been monitoring the improvements that were needed or providing effective leadership to bring these changes about.

Following our inspection we arranged a meeting with the nominated individual for Q Care. They acknowledged that additional management time was needed to support the registered manager in making the necessary improvements at Q Care. They assured us that this support would be provided and that they would be taking an active role in this. They and the registered manager assured us that they were committed to improving the service they provide and making sure that this is supported by effective management. We took these assurances into account in deciding that we would not take enforcement action. We have made compliance actions and emphasised to the provider that it is essential that they provide us with a robust action plan.

People who use the service and relatives were pleased with the direct care from the care workers. People described them as friendly and respectful. One person said that their relative has two main carers and that 'Nothing is too much trouble for them'. Another relative described the care workers who provided care for their family member as 'Absolutely perfect'.

People who use the service, relatives, care workers and local authority staff told us that the agency could improve their communication. People we spoke with gave us some examples which included the office phone not being answered and a family who felt they were not kept informed about a problem which developed over a period of time. One person who used the service told us that the staff at the office are 'not bothered'. Care workers we spoke to told us that during the last year they felt the office support had declined and there was a lack of organisation which had frustrated them.

Care workers we spoke to said they enjoyed their work and visiting the people they provided care to. Some told us that care plans had not been updated when peoples' needs had changed. This reflected what we found when we checked the care records at Q Care's office.

We found that the arrangements for managing people's medicines did not show what, if any action they took when a concern was noted. Concerns about a person's medicines reported by care workers were not addressed by senior staff, which delayed better arrangements being made for the person. Staff training in medicines was being done by internal staff at the agency and we are concerned that the trainers' own training was not adequate.

Arrangements for adult safeguarding concerns were disorganised and senior staff could not find current procedures or correctly explain the processes for dealing with suspected abuse.

Staff training records showed that courses were generally arranged internally. We found that some essential courses were overdue for renewal or had been facilitated by trainers who were not suitably trained or qualified to provide the training. The training for two staff who provided moving and handling training and did risk assessments for people had expired in May 2010.

Although people were happy with the staff they saw each day we found no evidence that Q Care's corporate systems for monitoring quality and improving standards are effective.