Radis Community Care (Coventry)

Radis Community Care (Coventry) is a domiciliary care service providing personal care and support to 162 people at the time of inspection. The service provides support to adults who have a range of needs, including those living with dementia, learning disability and/or autism and physical disabilities. The service provides long term support to people and a short-term, fast response service for up to six weeks. The short-term service supports people ready for discharge from hospital to return to their own homes. At the time of our inspection there were 162 people using the service.

People’s experience of using this service and what we found

Managerial oversight at the location required improvement to ensure all risks were identified and acted upon to ensure people received safe care. We did not find any evidence people were harmed due to the improvements required.

Assessment of people’s risks to ensure staff provided safe care was not always consistent. People’s care records did not always contain comprehensive information for staff to follow. However, staff demonstrated good understanding of people’s needs and risks and people felt safe with the care staff provided.

Medicines were not always administered safely as most staff required updated training. Procedures on preparing and administering medicines covertly was not always followed. Infection control policy and staff training required improvement; however, staff demonstrated knowledge in effective infection control procedures.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s experience of care call times and duration of care visits varied and the service was in the process of recruiting more staff. People told us they had positive and negative experiences when contacting the office and management team. Improvements were being made by managers to obtain people’s views and experiences about the care they received to drive improvement.

Staff felt supported by the registered manager. The service worked closely with external health and social care professionals to ensure people’s needs were met in a safe and timely manner.

People were protected from the risk of abuse and the service had systems in place to respond to concerns and learn from incidents.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 02 September 2019).

Why we inspected

The inspection was prompted in part due to concerns received about a substantiated safeguarding concern regarding a person’s care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this full report.

We found no evidence people had been harmed due to the improvements required and the registered manager took immediate action to mitigate risks where required.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Radis Community Care (Coventry) on our website at www.cqc.org.uk

Enforcement

We have identified a breach in relation to the managerial oversight and management of risk within the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

Staff understood how to keep people safe and protect them from avoidable harm. There were safe procedures to manage people’s medicines and to prevent the spread of infection.

People’s needs were assessed to ensure they could be met by the service. Staff knew how to manage risks associated with people’s care.

Staff were recruited safely, and there were enough staff to provide the care and support people required.

Staff received training and support to be effective in their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Where required, people were supported with their nutritional needs and to maintain their health and well-being.

Staff were caring. They respected people’s rights to privacy and dignity and supported people to maintain independence.

People were involved in planning and agreeing their care. Care plans contained the information staff needed to provide personalised care. However, plans had not always been developed for some known risks. The manager took immediate action to rectify this.

Systems were in place to manage and respond to any complaints or concerns raised.

The provider had processes for assessing and monitoring the quality of the service, but these had not always been implemented consistently. Some quality assurance processes and records management required improvement.

Rating at last inspection: Good. The last inspection report was published on 23 July 2017.

Why we inspected: This was a planned inspection based on the date and the rating of the previous inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

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

Part of the service provided by Radis Community Care Coventry was a short term enablement service. This was a time limited service, for up to six weeks that supported people so they could come out of hospital, return to their own homes and regain skills during the enablement period.

Following our last comprehensive inspection of the service in June 2015 we found the provider was not providing the standard of service we would expect, in three key areas, and we rated the service ‘Requires Improvement’. During our comprehensive inspection in January 2017 we found the required improvements had been made.

We visited the offices of Radis Community Care on 26 January 2017. We told the provider 48 hours before the visit we were coming so they could arrange to be there and for staff to be available to talk with us about the service.

The service had a registered manager. 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 felt safe using the service and staff understood how to protect people from abuse and keep people safe. There were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely. The character and suitability of staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

There were enough staff to deliver the care and support people required. Staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. People told us staff had the right skills to provide the care and support they required.

The registered manager and staff understood the principles of the Mental Capacity Act (MCA). Staff respected people’s decisions and gained people’s consent before they provided personal care.

People told us staff were kind, respected their privacy, and promoted their independence. Care plans provided guidance for staff about people’s care needs and instructions of what they needed to do on each call. Staff visited the same people regularly and knew how people liked their care delivered.

Staff felt supported to do their work effectively and said all the management team were approachable and knowledgeable. There was an out of hours’ on call system in operation, which ensured management support and advice was always available for staff.

People knew how to complain and information about making a complaint was available for people. People and staff said they could raise any concerns or issues with the management team, knowing they would be listened to and acted on.

The management team checked people received the care they needed by monitoring the time staff arrived at people’s homes, reviewing people’s care records and through feedback from people and staff.

Quality assurance systems were in place to assess and monitor the quality of the service. These included asking people for their views about the service through telephone conversations, visits to review their care and annual questionnaires. There was a programme of other checks and audits which the provider used to monitor and improve the service.

We saw quality monitoring was now taking place to a far greater degree than previously. We saw the service was now regularly doing and recording 'spot checks' on care, and were conducting regular telephone contacts with people who used the service. The parent organisation had identified that the service needed additional support and was giving this by providing a representative from the organisation to audit services and having an area operational manager to advise and support in resolving identified issues.

We saw medication administration had improved. One person who had previously raised concerns about medication told us 'Things have improved, they are making progress.' We saw individual medication forms in place that gave clear guidance on medication for the person supported.

People we spoke with who used the service were generally very positive about it.

'No complaints,' 'Very happy' and 'Staff are lovely' were some of the things people told us. People were very complimentary about individual staff. Any negative comments concerned a small number of specific visits where different staff were used and agreed times were not kept. We spoke with the manager about these, particularly the need to ensure people were kept informed if there was a problem.

Staff told us they felt well supported and trained. Several staff said they were not happy with frequent changes in their rotas. This tallied with the concerns of some clients that they had too many different staff. Many staff also felt unhappy with the recent changes to travel allowances. One person who used the service was concerned that 'good staff leave because they are not rewarded properly.'

We looked at the complaints log and saw that complaints were responded to.

We noted that improvements were needed in the administration and recording of medications and in monitoring this to ensure it was done correctly.

Staff were very positive about the service and the support they were given to carry out their roles. One staff member told us 'It's well-organised, they treat staff very well.'

The people we spoke with who use the service were generally positive about it. 'Quite satisfied' 'very good' and 'very happy' were among the things people said to us about the service.

Where people had concerns, it was usually to do with the different staff used when their 'regular' care staff was not working. One person said 'It's fine when she (usual care staff) is here; some of the others don't come on time, and don't know what to do.'

Other people who used the service were very happy with a team of staff who provided the care. One person told us 'They're regular, work as a team, comfortable with them.'