Archived: Giles Care Ltd

Giles Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults with mental health needs. At the time of the inspection the agency was supporting 24 people, only 15 were receiving personal care. CQC only inspects the service being received by people provided with personal care, where they do we also take into account any wider social care provided.

People’s experience of using the service:

People told us they felt safe and supported by staff in the way they preferred. Potential risks to their health and welfare had been assessed and there was guidance in place for staff to mitigate the risks. Checks and audits were completed to make sure people received a high standard of support. People and staff were asked their opinion on the quality of the service and suggestions for improvements.

People’s needs were assessed before they started using the service. People were involved in developing their support plan and asked their opinion about the quality of the service. People were supported by staff who were passionate about supporting people to live their life fully and preventing discrimination relating to their religion or sexuality. Staff supported people to become more independent and develop their life skills and activities. People were encouraged to lead healthier lives and keep as active as possible. Staff supported people to attend healthcare appointments and express their views about their support.

People were supported by staff who had been recruited safely, received training appropriate to their role and received supervision to develop their skills. Incidents had been recorded and analysed to identify how to keep people as safe as possible. People told us they knew how to complain and raise any issues they may have and these had been resolved to their satisfaction. The management team worked well with other agencies and continued their learning to ensure people were supported effectively.

Rating at the last inspection:

Requires Improvement (report published 28 February 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found the service now met the characteristics of Good in all areas. The overall rating is now Good.

Follow up:

We will continue to monitor the service.

Giles Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults with mental health needs. At the time of the inspection the agency was supporting 20 people. Visits varied in length and frequency depending on people’s individual needs. Not everyone using Giles Care receives a regulated activity, 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 is provided.

We last inspected Giles Care in December 2016 when three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safe care and treatment, good governance, fit and proper persons employed and staffing.

At our inspection in December 2016, the service was rated ‘Requires Improvement’. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do and by when to improve the key questions to at least good. We undertook this inspection to check they had followed their plan and to confirm they now met legal requirements. Improvements had been made, all breaches had been met, however, we have made recommendations for further improvement.

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 the service is run.

At the last inspection the provider and registered manager had oversight of the day to day running of the service, but had not kept up to date with regulatory requirements. Since the last inspection, they had attended forums to update their knowledge. There were now systems in place to ensure that the service was compliant with regulation and the quality of the service was audited. However, the audit of support plans had not identified the shortfall found at this inspection. We have made a recommendation about ensuring audits are comprehensive.

Potential risks to people’s health and welfare had been assessed and there was detailed guidance for staff to follow to mitigate the risks. People had support plans, however, these did not contain detailed guidance for staff to support people in the way they preferred. The plans did identify people’s goals and aspirations but not how people should be supported to achieve their goals. During the inspection, people told us how staff were supporting them to become more independent and achieve their goals. Support plans did not reflect the support being given. We have made a recommendation about sourcing guidance in planning support.

Previously staff had not been recruited safely and had not received training appropriate to their role. Since the last inspection, two new staff had been recruited and appropriate checks had been made, checks missing from previous staff files had been rectified. Staff had received essential training and were completing training in specialist health topics. Staff told us that they felt more confident following the training. There were sufficient staff to meet people’s needs.

Staff received one to one supervisions and appraisals to discuss their training and development. The senior support worker completed spot checks to ensure staff were working to the required standard, any concerns were addressed during supervision.

Staff knew how to recognise signs of discrimination and abuse. They were confident that any concerns they had would be dealt with appropriately. Incidents were analysed and the registered manager worked with other professionals to put strategies in place to stop them from happening again. People were supported to take their medicines safely. Staff understood their role to prevent infection, staff used gloves and aprons when appropriate.

Before people received support from the service, the registered manager met with them to ensure the service could meet their needs. An assessment was completed with the person, their relatives and other professionals. Staff worked with healthcare professionals to ensure people received the support they needed. People were supported to lead healthier lives, they were encouraged to eat healthily and take up exercise. Staff supported people to attend appointments with GP’s and other health professionals.

Staff supported people to be as independent as possible, people were supported to cook meals and keep their flats tidy. People were encouraged to express their views about the service and their support. The service had a policy for complaints, people knew how to raise complaints with staff, and these had been recorded and responded to promptly.

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 support this practice.

Staff supported people to enjoy activities of their choice and maintain relationships with friends and partners. People were treated with kindness and their dignity was respected. The support from staff had made a positive impact on people’s physical and mental health. The service did not provide end of life care.

Senior staff met with people at least monthly, to discuss their needs and to monitor the quality of the service they were receiving. These meetings were recorded and any actions required were taken promptly. People were encouraged to be part of the community and join groups to meet people and gain confidence.

The provider had a clear vision for the service, this was to provide outstanding care which is safe and of high quality, that promotes dignity and open communication. The registered manager and staff told us that the service had improved since the last inspection and the support people receive was responsive and person centred. There was an open and transparent culture, staff told us they felt supported by the management team.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This meant we could check that appropriate action had been taken. The manager was aware that they needed to inform CQC of important events in a timely manner.

This is the second consecutive time the service has been rated Requires Improvement.

Giles Care Limited is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection the agency was providing a service to 10 people. The agency provides social support to a further 12 people. Visits varied in length and frequency depending on people’s individual needs.

The service had a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.

The registered manager had an understanding of the day to day running of the service and knew people well. The registered manager did not have systems in place to ensure that the service was compliant with regulations and had not audited the quality of the service they provided

The provider had not notified the Care Quality Commission (CQC) that the office address of the service and contact telephone numbers had changed. Providers are required to inform CQC of any changes. The provider started the process to make the changes once it was brought to their attention.

People told us that they felt safe using the service, however, people were not always fully protected from harm. Staff had not been recruited safely, new staff had not completed an application form and references had not always been obtained.

Risks were not always managed safely. Care plans did not contain details of how to support people to be safe and had limited information on how to reduce risk. Staff were responsive to people’s needs but care plans did not contain up to date information on people’s health care needs, or how staff should support the person.

Staff told us that they received training that was appropriate for their roles. The provider did not have an accurate record of training that staff had attended and future training needs had not been identified. New staff had not received core training, such as safeguarding, mental capacity and moving and handling, as part of their induction programme.

Staff told us that they were supported by management, however, staff had not received regular one to one supervisions or an annual appraisal to highlight their development needs. The registered manager did not have systems in place to audit and monitor the quality of care being provided and identify any shortfalls.

People were supported by staff who knew them well, people told us that staff respected their decisions and preferences when giving support. Staff asked people’s consent before providing support. People were prompted and supported to take their medicines safely to maintain good health.

People told us that the staff had not missed any calls and they were on time, if staff were going to be late they would telephone. The provider was unable to tell us how many hours of support the staff provided, so the provider was unable to confirm that there were sufficient staff available to meet people’s needs and whether staff had the capacity to take on any new people.

The service had policies and procedures for complaints, people knew how to raise complaints with staff, these had been dealt with promptly, and recorded. Staff understood how to raise safeguarding concerns and staff had access to up to date guidance.

We observed a warm relationship between staff and the people they supported, they appeared comfortable in each other’s company. Staff knew people well, we observed staff recognising and responding to people’s anxieties.

Staff supported people to remain independent. People were supported to access health care appointments, to remain as healthy as possible. People were supported to shop and staff ensured people bought enough food to maintain a healthy diet.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.

People told us that they received the care they wanted, and we found that all the records we reviewed included an agreement detailing the care to be provided, signed by the agency and the person receiving care.

We reviewed five care records out of a total of 20, and found that all of them contained care plans which had been written and regularly reviewed based on assessments of each person's needs. We spoke with staff members who said that they referred to the care plan and risk assessments regularly to ensure they were able to meet the person's needs.

We reviewed four staff files and found that they all contained detailed information on staff, which had been sought prior to their starting work. This information included performance in previous roles, declarations on criminal status, qualifications and experience. We noted that all new staff completed an induction programme which followed national guidance. This meant that the provider could be assured that only suitably qualified and experienced staff were recruited at the agency.

We found that the provider had implemented ways to gather feedback on the service from people, as well as monitoring the quality of the service provided through spot checks and staff appraisals. People told us that they had no complaints, but felt confident to raise any issues of concern with the staff and manager.

Staff had received guidance from supervisors and their work was monitored to make sure that they continued to meet people's needs in a reliable way. This was being done through individual supervision meetings with supervisors, staff meetings and spot checks. We also saw that annual appraisals were carried out to promote professional development and reflect any regulatory and / or professional requirements. Staff told us that they felt supported and received sufficient training. This helped ensure that people's health and welfare needs were being met by a competent staff team.

People told us that they were satisfied with the personal care they received and that their independence was encouraged. One person said, "I can do most things but they give me help where I need it".