New Concept Care Selby

What life is like for people using this service:

Lots of checks were completed by staff, the registered manager and provider to check the quality and safety of the service. The provider had reflected on their approach and planned to make changes to how they recorded checks of the service. This included a review of the accident and incident system, medicines system and risk assessment of people’s care needs.

Overall, people received care in a timely way from a regular team of care workers. However, people felt they needed better communication from the office to know who would be visiting their home and when staff would be delayed. The registered manager agreed to look at how improvements could be made to communication.

Everyone we spoke with told us that staff were kind and caring and that they were treated with respect. Staff showed a genuine motivation to deliver care in a person-centred way based on people’s preferences and likes. People were observed to have good relationships with the staff team.

People’s health was well managed and staff had positive links with professionals which promoted wellbeing for them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had received appropriate training and support to enable them to carry out their role.

The registered manager and senior team worked well to lead the staff team in their roles and ensure people received a good service. People, their relatives and staff told us they were approachable and that they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service.

More information is in Detailed Findings section below.

Rating at last inspection: Good (report published 14 January 2016)

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

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

The inspection took place on 29 and 30 November 2017. It was an announced comprehensive inspection. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the office.

At the time of our inspection, 89 people were using the service.

There was a registered manager in post. 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.

Staff had a good understanding of mental capacity, however documentation did not support staff and mental capacity assessments required detail and clarification on whether people could consent to care. Lasting Power of Attorney (LPA) records were not available and best interest meetings had not always taken place when necessary. Least restrictive options for care had not always been considered. We have made a recommendation for the provider to use the Mental Capacity Act 2005 code of practice to guide staff actions.

People were asked for their opinions through questionnaires and face-to-face meetings. However, people had not had access to the collated and analysed results. We have made a recommendation for the provider to ensure people receive the collated results of surveys and the actions taken to improve the service.

Audits did not always identify issues and when issues were identified, they were not always followed up. We have made a recommendation for the provider to produce clear action plans for audit findings, to ensure these are carried out and to use the results of audits to drive continuous improvements in the service.

People told us they felt safe in the care of the staff. People were protected from abuse and avoidable harm by staff who had received training in safeguarding vulnerable people. Checks and auditable processes were used to ensure people were billed correctly and safeguarded from financial abuse. Personal risk assessments and hazard identification assessments helped to keep people safe but we found further risk assessments were required to ensure all needs were properly assessed.

People received their oral medicines as prescribed although more care was needed with the application of topical creams.

People were supported by staff that had been recruited safely, received a thorough induction which was linked to the Care Certificate, and had received sufficient training. Staff received supervision and appraisal as required, and spot checks on their competencies were completed by management. Staffing levels were sufficient to meet people’s needs, however sometimes staff were late to attend calls. We found rotas could be improved to enable staff to attend calls on time.

Staff had access to sufficient personal protective equipment (PPE) and had received training in infection control. The location premises were well-maintained and had been adapted to enable access for people with disabilities. Accidents and incidents were investigated and the outcomes used to develop the service and the practice of staff.

People were supported with their nutritional and health needs when required. People told us staff were caring and understood their needs. They said continuity of care was good and they received care from the same members of staff whenever possible. People also said staff asked their consent, and respected their privacy and dignity.

Staff were aware of the need to maintain confidentiality; records were stored securely and computers were protected by passwords. Policies took into account people’s individual choices and equality and diversity needs, however policies were not always up-to-date and did not always reflect best practice.

People were supported to access activities in the community and staff would accommodate their changing plans. People were encouraged to be as independent as possible and involved in their care. We found the care was person-centred, people’s needs were met and they were treated as individuals. However, some records required updating to reflect recent changes in people’s needs.

People were happy with the management of the service and the care they received. The culture of the organisation was open and supportive. People told us they generally had no complaints, but if they did, they were certain their concerns and complaints would be addressed. We saw previous complaints had been dealt with in a professional way. Information was communicated to staff through newsletters, meetings, memorandums and by phone. Information for people who used the service was available in different accessible formats.

The provider undertook business continuity exercises and used the results to drive improvements in service provision. The service worked with external services to address issues, and actions had been taken; training had been adapted accordingly and procedures were being reviewed. The registered manager was aware of their responsibilities for completing notifications and these had been submitted as required to CQC and to safeguarding authorities.

The people we spoke with and their relatives were very complimentary about the care they received. They told us they were more than happy as their needs were currently met. One person commented: 'We couldn't manage without them.' Another said

"They do everything I ask of them."

People told us they felt safe when carers were looking after them. One person said 'They wear a uniform and have an ID badge; I know them anyway but the uniform and ID badge do give you extra confidence, when they are in my home.'

People told us they had a rota, so they knew who was coming to them. All of the people we spoke with could not remember ever having a time when the carer did not turn up when expected. They thought there were enough people to deliver the care needed.

The staff we spoke with told us they had received induction training and further mandatory updates which included moving and handling and safe administration of medicines.This meant people could be assured the staff were kept up to date with the knowledge and skills they needed to deliver care and support safely.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received.