Archived: Pinner Court (Harborne) Limited

Pinner Court is registered to provide the regulated activity of personal care. This service is a domiciliary care agency [care at home]. It provides personal care to people living in their own homes within a retirement complex (The providers housing scheme). It provides a service to older adults. There were seven people using this service at the time of our inspection, one person was in hospital and one person was on holiday.

Not everyone using Pinner Court receives the regulated activity; the Care Quality Commission (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 last inspection in August 2017, we judged the service as requires improvement in the key questions of safe, effective and well-led and we rated the service Requires Improvement overall. During this inspection we identified two breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We were concerned because the provider had failed to ensure their recruitment procedures were robust and their quality monitoring systems continued to require improvement.

This inspection took place on 14 August 2018 to follow up on our previous findings. During this inspection the service demonstrated to us that improvements have been made and we identified that in some areas further were needed. We found the service was now meeting the regulations.

There was a registered manager in post at the time of the 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.

People were protected from the risk of abuse because staff were aware of the action to take if they suspected abuse had occurred. Staff were also aware of the provider's whistle blowing policy and told us they would use it if they had concerns. People told us there were sufficient staff deployed by the service to meet their individual needs. The provider followed safe recruitment practices when employing new staff. People told us staff followed safe infection control practices. The registered manager had taken some steps to improve the management of medicines but further were needed.

People told us care staff had the skills and knowledge to care and support them effectively. Staff told us they received regular training based on the needs of people using the service. People were asked for their consent before care was provided and the decisions they made were respected. Staff had received training on the Mental Capacity Act (2005) and they supported people to have maximum choice and control of their lives and support them in the least restrictive way possible. People were supported with their dietary needs and support to maintain their health and wellbeing, when necessary.

People were supported by caring staff that protected their privacy and dignity. People had support to make decisions and choices about their care and maintain their independence.

People had been involved in the planning of their care and were supported by staff in line with their individual needs and preferences. People knew how to complain and expressed confidence that the provider would address any issues they raised.

Some action had been taken to improve the systems used to check and audit the quality of the care provided at the service. However, further improvement was needed. The service had not monitored incidents effectively to reduce the risk of repeat occurrence. Staff felt well supported in their roles. There was a culture of openness and honesty and staff felt able to raise concerns or suggestions. People and staff felt supported and were confident in the management of the service.

Pinner Court are registered to provide personal care. They provide domiciliary care to people who live in their own homes within a retirement complex (The providers housing scheme). There were 11 people using this service at the time of our inspection.

At our last inspection in July 2016 we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not benefitting from a service that was well led, or operating effective governance systems. This was because quality audit systems in place were not effective at identifying and managing risk or driving up improvements. There were no effective systems in place to analyse trends when accidents had been reported to prevent the likelihood of further occurrences for people. Some care plans lacked detail of risk assessments that would potentially minimise the potential of harm to people. There were no effective systems in place to ensure recruitment processes were safe. There was a lack of systems in place to check that staff competency had been assessed to provide some assurance that people were safely supported. There were no effective systems in place to ensure staff were supported, received regular training or their performance appraised to ensure that they provided a consistent service that met people’s needs. Some care records did not contain current information in relation to people’s individual needs. The registered manager was not aware of changes to regulations and some key developments and requirements in the care sector. The failure to keep their knowledge current, meant that there was a risk that people would not be provided with support and care that complied with the regulations. In addition, whilst people’s views had been sought, the information gained had not been captured for analysis or used to support with the continual drive of improvement. Following the inspection the registered provider submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook this announced inspection on 03 August 2017 to check that the registered provider had followed their own plans to meet the breach of regulation and legal requirements. Although the registered provider had addressed some of the concerns that we had identified at our last inspection, the systems and records in place to ensure the quality and safety of the service were still not effective and this inspection identified a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to good governance and was not meeting the standards required by law in an additional regulation.

A newly recruited registered manager had been in post since May 2017. They were present throughout the 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.

Recruitment processes were not robust and failed to provide assurance that people were supported by staff who were suitable and adequately skilled to meet their needs. We saw evidence that some staff had started providing care to people before suitable checks had been completed. People were not always protected from the risk of unsafe practice because risks associated with their health conditions had not consistently been assessed and staff did not have sufficient guidance on how to support people safely. The management of medicines was not robust and we could not consistently determine from some records that people received their medicines as prescribed. People felt safe when receiving support from staff. There were a suitable amount of staff available to meet people’s needs in a timely manner.

Staff told us that they had the appropriate knowledge and skills to meet the needs of the people they were supporting. However records identified that not all staff had completed training in key areas and staff had not been observed to ensure that that their learning had been put into practice. People told us that staff asked their consent before providing care and support. Staff we spoke with had a good understanding of the Mental Capacity Act (2005) and what it meant for the people who used the service. People were supported, when necessary, to eat and access food that they enjoyed. Staff worked with other professionals to ensure that people received the health care that they needed.

People told us that they were treated kindly and had developed positive and caring relationships with the staff who supported them. People were involved in making decisions in all aspects of their lives. People described how they were supported with dignity and respect. Staff described examples of how they promoted independence and maintained confidentiality when supporting people.

People were supported by a consistent and responsive staff team who had a good understanding of people’s needs and individual preferences. People’s care plans demonstrated that they were supported to have maximum choice and control of their lives. People were involved in developing and reviewing their care plans and support needs. People could be assured that appropriate action would be taken if they raised concerns or complained.

The registered provider had not implemented an effective system to monitor the quality of the

service, although they had agreed they would do so after our previous inspection. They had not taken all reasonable measures to ensure records minimised risks to people's health and wellbeing. People, relatives and staff consistently told us that the appointment of the newly recruited registered manager had resulted in a positive impact on their experiences at Pinner Court.

We identified that there was a continued breach and one new breach of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 27 July 2016 and was announced. We gave the provider 48 hours’ notice of our visit because the location provides a domiciliary care service [care at home]; we needed to make sure that there would be someone in the office at the time of our visit. The service was last inspected in June 2014 and was meeting all the regulations.

Pinner Court are registered to provide personal care. They provide domiciliary care to people who live in their own homes within a retirement complex (The providers housing scheme). There were 8 people using this service at the time of our inspection.

There was a registered manager in post and they were present during 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.

Risk management plans and risk assessments were not in place for staff to follow to ensure people were protected from the risks associated with their specific health conditions. People told us that they felt safe with the support from the staff who provided their care. Staff understood their responsibilities to protect people from potential abuse. People told us they received a reliable service and had not experienced any missed calls. The recruitment processes did not ensure that people were supported by staff who were suitable to meet their needs. Medication management and support from staff with prescribed topical creams needed to be improved.

Improvement was needed to ensure staff had the appropriate knowledge, skills and support needed to carry out their role effectively. Staff did not fully understand the principles of the Mental Capacity Act 2005; however, people told us that staff gained their consent prior to providing care and support. Care plans did not detail known risks to dietary needs of people who required support. People had access to health care professionals when necessary to maintain their health and well-being.

People told us that they had built up close relationships with the staff who provided their care and support. People and their relatives described the staff as being kind, thoughtful and attentive. Staff worked in ways that promoted and maintained people’s dignity and independence.

People told us that the service was responsive to their needs and staff worked flexibly to support them. Care was planned with people’s involvement but we found care plans were not always up to date with people’s changing needs and did not contain person-centred information. We were advised that there was a complaints procedure in place. People and their relatives told us that they would feel confident to raise any concerns or complaints.

The quality assurance systems in place were ineffective to monitor the quality and safety of the service delivered. Staff were not involved in the development of the service. People and their relatives spoke positively about the registered manager. People had been consulted to find out their views on the care and support provided but this information was not used to drive improvements to the service.

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

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We checked people's care plans and found them to be detailed, relevant and up to date. We spoke to care staff and they demonstrated that they were aware of people's health needs and personal preferences. This meant that people were receiving safe and appropriate care.

We spoke to people who received care from this agency. People told us they felt safe with the carer's who supported them. Comments included, 'I feel safe here and the carer's are very trustworthy' and 'Yes I do feel safe and secure thanks.'

We saw that the agency had appropriate safeguarding procedures in place. These were detailed and fit for purpose. We checked staff training records and saw that most staff had received recent training in relation to safeguarding vulnerable adults. We spoke to staff and they demonstrated that they understood their role with safeguarding vulnerable people and knew what action to take should it be necessary to do so.

We concluded that people who received care and support from this care agency were safe and protected from harm and inappropriate care.

Is the service effective?

People's needs were assessed and care and support was planned and delivered in line with their individual care plans. We found that each person had their own individual plan of care and support which included assessed needs, risk assessments and useful information about their health conditions. These records were neatly presented, detailed and up to date.

Care staff told us that they were well trained, competent and able to meet the needs of the people who used the service. Training records showed that staff had received appropriate training in a number of relevant topics, including: moving and handling, infection control, food hygiene, safeguarding vulnerable adults and medication.

People and their relatives told us that they were happy with the care they received and the care staff who supported them.

We concluded that care staff had the appropriate skills and knowledge to ensure that people received safe, effective and appropriate care and support.

Is the service caring?

People were supported by kind and attentive staff. It was apparent during our observations and time spent talking to people who received care, that staff were attentive, patient and caring towards them. Staff treated people with respect and dignity. Comments included, 'The carers are really wonderful' and 'The staff are all very good and very professional.'

We spoke to relatives of people who received care and support. They were also complimentary about the standards of care being delivered and the competence of staff delivering care and support.

We concluded that people received good care which was delivered with compassion and respect for their dignity and human rights.

Is the service responsive?

There were good arrangements for making sure that people could express their views about the service. We saw records including a customer satisfaction survey (questionnaires) which showed that people had been consulted about their preferences and the care and support they received. This meant that people were supported in promoting their independence and had regular opportunities to discuss and influence the care and support they received.

We found that care staff had regular meetings with the management team at the agency where they were able to discuss their training and development needs, welfare and any concerns they had about the people they were caring for.

We found that the agency had a comprehensive complaints policy.

We concluded that people and their relatives who receive care and support from this agency were listened to in a way that responded to their needs and concerns.

Is the service well-led?

Records showed that this care agency has had the same permanent registered manager for more than 3 years and that most members of staff had worked at Pinner Court for many years. Staff retention was very good.

We found that the registered manager was supported by the provider's regional management team and received regular supervision meetings. This is an effective means of ensuring that the manager and staff are complying with the provider's policies and procedures and delivering a good service to people receiving care.

Records showed that the provider had an effective system to regularly assess and monitor the quality of service that people received.

We concluded that there was effective leadership at this agency and people received safe care and support and were treated with respect, dignity and consideration.

People and their relatives were complimentary about the care staff who supported them. Comments included, 'Nothing is too much trouble for them' and 'The care staff are competent and quite delightful.'

We examined care plans and found that people's needs were properly assessed and that care and support was planned and delivered in line with their individual care plans.

We interviewed care staff and checked personnel files and training records and concluded that people who used services were safe and their health and welfare needs were being met by staff who were fit, appropriately qualified and physically able to do their jobs.

Examination of records revealed that Pinner Court had a robust, clear and accessible complaints policy and that people who used services could be confident that their comments, concerns and complaints were listened to and dealt with effectively.

We found that all records were kept securely and could be located promptly when needed and files were securely stored when not in use.

Relatives of people using the service also made complimentary comments about the service. Comments included, "We have received very good reports, our relative is very happy there" and "Our friend speaks very highly of them."

The findings of our inspection identified that, overall care and support was delivered in a way that ensured people's safety and welfare.

We observed that care staff were attentive, polite and that the manager was approachable and responsive to feedback. It was clear that the staff had a good knowledge of all of the people who used the service and were familiar with their preferences and health conditions.

We found that people using the service and their relatives were asked for their views about the service they received. In addition the provider undertook regular audits of the services provided to inform practice and identify developments needed.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that the provider did not always have an effective record keeping system regarding people's care and health needs.