Archived: Kingsheath - Birmingham

The registered manager told us that there were 80 people that received a service in their own home.

During our inspection we looked at information to help us gather evidence about the quality of care and support people received. As part of this inspection we visited the agency's office to look at records and spoke with the registered manager and provider. We looked at the care records of three people and four carers. Following our visit to the office we spoke with five people that received a service, three relatives and four carers on the telephone. We used this information to ask the questions we always ask:

Is the service safe?

All the people we spoke with told us that they were happy with the carers and felt safe.

Staff were knowledgeable about the procedures to raise concerns if they suspected any abuse. Staff told us and records showed that they had received training on how to protect people from abuse. Staff knew what actions to taken in the event of emergencies such as not being able to access people's home or people being taken ill. This meant that systems were in place to keep people safe.

Is the service caring?

All the people spoken with told us that the carers were good. One person told us, 'Very satisfied, lovely girls, very kind and caring'. We saw that people received support from staff that arrived to help them at the time they wanted and needed. People were supported by regular staff that knew their needs and those they had built relationships with. One person told us, 'Mostly the same carers other than if they are off duty. They are all very nice.' This meant that people received continuity of care. not sure that we can jump to that conclusion.

Is the service responsive?

We saw that staff had started to carry out reviews of care which also asked their views of the service and what was important to them. We saw that people were listened to and actions taken to resolve issues such as staff not attending a call or been late for a call. The actions had been taken to resolve these issues were recorded. This meant that the service looked at people's changing needs and taking actions to respond to shortfalls in the service.

All the people and relatives spoken with told us that there was always someone available to give them advice on the telephone. Staff told us that they were able to raise concerns and suggestions at staff meetings and supervision sessions. This meant that staff and people felt listened and assured that actions would be taken to address issues.

Is the care effective?

We saw that the care provided was effective and met people's needs. One relative told us, 'They (staff) arrive at the right time 90 per cent of the time. It is now the same carers. She (mum) knows who is going to come. They call her if they are going to be late. They do come and stay the set amount of time. She is happy with the bits and pieces they do'.

Some improvements could be made to the monitoring of records such as daily records, on call logs and staff supervisions.

Is the service well led?

We saw that the staffing structure had been improved so that there were three team leaders in place to monitor and support staff.

There was a registered manager in post but the management of the service had not been effective and at the last inspection we had issued a warning notice because improvements were needed in the care provided and the monitoring of the service. At this inspection we saw that improvements had been made but further improvements were needed before full compliance with regulations was achieved.

We saw that completed questionnaires had been received but there had not been any analysis of the comments made by people. This meant that actions to improve the service had not been identified and actioned.

We saw that staff received training, supervision and checks on their practices so that they provided good care to people.

As part of our inspection we visited the agency's office to look at records and spoke with the registered manager. We looked at the care records of three people and five carers. Following our visit to the office we spoke with 13 people or their relatives and four carers on the telephone. We use this information to ask our five questions:

Is the service safe?

All the people we spoke with told us that they felt safe with the carers when they arrived. However we identified that the service was not safe because some people told us that there were occasions when staff did not turn up to support them or were late for their calls. This meant that on occasions some people had not received the care and support they needed and on occasions had been admitted to hospital as a result. One person told us that they did not think the service was safe. They told us, 'I've been left seriously ill on multiple occasions.' We saw that systems in place to ensure that care was provided as planned were not utilised and therefore shortfalls in the service delivery were not identified. This meant that people had not always received safe care and support.

The provider had policies and procedures in place to protect people from harm. Staff told us and records showed that they had received training on how to protect people from abuse. We saw that people were not always protected from harm because systems in place had not ensured that people received the care they needed and on occasions had suffered ill health because of this. We saw that recruitment records did not always have the appropriate checks in place to ensure that only people suitable to work with vulnerable people were employed.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes and hospitals. The service provided support to people in their own homes. No one living in their home had had their liberty restricted.

Is the service caring?

All the people spoken with told us that the carers were good. One person told us, 'Carers are beautiful people. I have no problems with the carers.' About half the people we spoke with told us that they were not happy with the service provided. One person told us, 'Don't seem to care about the clients in the way they (office staff) talk to us.'

Some staff told us how they tried to ensure that people were kept informed of changes in times of calls that had to be made due to other work pressures. This showed that staff had made good relationships with people.

Is the service responsive?

We saw that questionnaires had been sent out to get the views of people who received a service however we saw that there was no analysis of the views gathered. People we spoke with told us they had not been asked if they were happy with the service they received. Some people told us that when they rang the office on most occasions they were not called back and requests for them to be kept informed of changes in carers and times of calls were not complied with. This meant that some people were left in an anxious state not knowing who was going to attend the call of if anyone was going to attend at all.

One person told us that their care plan had many errors in it and although several requests had been made to update it this had not taken place. Other people told us that once their care plans had been written up they had not seen anyone to determine if their needs had changed. Records we looked showed that there had been no reviews of care plans and risk assessments. One relative told, 'Reviews only take place if people go into hospital.'

We saw that there was a system in place for recording and monitoring complaints however we saw that not all complaints had been recorded. This meant that the complaints log did not reflect how people felt about the service and it meant that actions could not be taken to address the issues raised.

Is the care effective?

We saw that the care was not always effective. We saw that care plans and risk assessments were in place but they were not sufficiently detailed and regularly reviewed and updated to ensure that people's needs were met safely. Some people told us that their regular carers provided good care. Some people gave us examples when other carers did not know how to support them.

Some people told us and records showed that the service was not always effective in providing care and support to people at the agreed times. People told us that they did not always have the same carers. This was a problem particularly at weekends. The service was not effective in keeping people informed of any changes in their care and this was upsetting to some people. Some people told us that they did not receive the support for the amount of time they were paying for. Some people told us that they received care and support from regular carers who came at the designated times and stayed for the agreed amount of time.

Systems in place did not ensure that managers were made aware if calls had been missed or were likely to be missed. This meant that the systems in place were not effective.

Is the service well led?

We saw that the staffing structure was not sufficient to ensure that the service was adequately monitored and developed. There was a registered manager in post but there were no team leaders in place to support the registered manager to carry out spot checks, reviews and supervisions for staff.

We saw that there was a system for monitoring the quality of the service but it did not ensure that any identified dissatisfactions were addressed in a timely manner.

We saw that although staff received training to ensure that they had the skills and knowledge to provide good care they did receive additional support through regular supervision, spot checks and team meetings to ensure that there were good practices being followed.

The lack of appropriate support plans and risk assessments meant that care was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse to protect people from the risk of harm. One person told us, "I have no concerns, I am very pleased".

Recruitment processes were in place which gave people who used the service, some assurances that only suitable staff had been employed. One person said, "The staff are very good."

The lack of regular staff supervision and appraisals meant that staff may not receive the support that they need to deliver care safely and effectively.

Systems were in place for the on-going monitoring of the quality of service but a lack of analysis meant that the provider was not identifying themes and trends in order to learn and improve from findings.