Archived: Radis Community Care (Reading)

Radis Community Care (Reading) is a domiciliary care agency. It provides personal care and support to people living in their own homes. At the time of the inspection 49 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People and relatives were confident people were safe and well protected from the potential risks of abuse and avoidable harm. Staff received training to safeguard people from harm and were knowledgeable about the risks and potential signs of abuse.

Safe and effective recruitment practices helped ensure staff were of good character and sufficiently experienced, skilled and qualified to meet people's needs. People, relatives and staff confirmed there were enough experienced, qualified staff to meet people's needs. Staff were trained and supported people to take their medicines at the right time as prescribed.

People, their relatives and staff felt the service was well led. Quality assurance systems identified where the service needed to improve and ensured the service was safely managed. The registered manager was responsive to any issues raised during the inspection and demonstrated a passion and enthusiasm for driving improvements where identified.

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

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 6 September 2019).

The provider was served with a warning notice after the last inspection for breaches in Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to confirm the provider has now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Follow up

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

Radis Community Care (Reading) is a domiciliary care agency, providing personal care support to people living in their own homes. At the time of the inspection, the service was supporting 48 people with their personal care needs.

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

Where people were prescribed ‘as required’ (PRN) medication, the service did not always have protocols or guidance in place to ensure that staff knew when to administer PRN medicine.

Care records were not always up to date and accurate. Governance systems were not always effective and did not always identify actions for continuous improvements. Audits in place were not always effective.

People were protected from the risks of abuse and said they felt safe with the staff providing their support and care. People and their relatives told us they felt safe with the staff who supported them.

Medicines were handled correctly and safely. People's rights to make their own decisions were protected. 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.

People received effective care and support from staff who knew them well. People benefitted from a service which had an open and inclusive culture and encouraged suggestions and ideas for improvement from people who use the service, their relatives and staff.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 13 May 2019) and we found breaches in regulation 12 (Safe care and treatment), regulation 11 (Need for consent) and regulation 17 (Good governance).

The provider completed an action plan after the last inspection to show what they would do in relation to a breach in Regulation 12 (Safe care and treatment) and by when to improve. The provider was served a warning notice for breaches in regulation 11 and regulation 17.

At this inspection enough improvement had been made in relation to regulation 11. However, not enough improvement had been made in relation to regulation 12 and 17 and the provider was still in breach of these regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection to check the provider had made the necessary improvements and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We carried out an announced inspection of this service on 12 March 2019. Breaches of legal requirements were found. The provider was asked to make improvement after the last inspection to show what they would do and by when to improve by in relation to regulation 12 (Safe care and treatment), regulation 11 (Need for consent) and regulation 17 (Good governance).

The ratings from the previous comprehensive inspection for those Key Questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified continued breaches in relation to Regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to end of reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Radis Community Care (Reading) is a domiciliary care agency based in Reading, providing personal care support to 48 people living in their own homes.

Overview of findings:

Staff were not always trained or regularly assessed as competent to administer medicines in line with the provider’s policy, clinical guidance and best practice.

Where people were prescribed ‘as required’ (PRN) medication, the service did not always have protocols or guidance in place to ensure that staff knew when to administer PRN medicine.

Audits had not always been undertaken. Those that had, did not always identify gaps or highlight trends, themes or lessons learnt.

Care records did not always clearly reflect how staff were meeting people’s specific health conditions.

Care records did not always reflect what decision people could make for themselves when they lacked capacity.

Where others signed consent to care forms on behalf of people who received support, it was not always clear they had the legal authority to do so.

Where lessons learnt had been identified following complaints, concerns, accidents and incidents, the registered person had not always implemented the required changes to improve the service.

Recruitment processes were in place to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

People told us they felt safe with the staff who supported them.

People's right to confidentiality was protected and their diversity needs were identified and incorporated into their care plans, where applicable.

People and their relatives said staff were caring and respected their privacy and dignity.

People felt the service they received helped to maintain their independence where possible.

People knew how to complain and knew the process to follow if they had concerns.

Staff felt the management was supportive and approachable. Staff were happy in their role which had a positive effect on people's wellbeing.

Rating at last inspection:

The service was inspected on 15 July 2016 (published 27 August 2016). We found the provider was in breach of Regulation 11 of the Health and Social Care Act, (Regulated Activity) Regulations 2014, (Need for consent). We conducted a focussed inspection to follow up this breach on the 6 February 2017 (published 4 April 2017). We found the provider was compliant at the time of that inspection.

Why we inspected:

This was a planned comprehensive inspection.

Enforcement:

Full information about CQC’s regulatory response can be found in the full report which can be found on our 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 re-inspection programme. If any concerning information is received we may inspect sooner.

At the previous inspection we identified a breach of Regulation 11 of the Health and Social Care Act, (Regulated Activity) Regulations 2014, (Need for consent). People’s rights may not always have been protected because it was not always clear care and treatment was provided with the consent of the relevant person. We also made a recommendation the registered manager referred to relevant guidance to develop systematic and demonstrable monitoring systems for the service.

At this focused inspection we found the registered manager had taken, or was in the process of taking, action to address the areas identified. The service was now compliant with Regulation11.

Radis Community Care (Reading) is a domiciliary care agency based in Reading, providing personal care support to 84 people living in their own homes. A registered manager was 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.

We found staff understood the need to obtain day to day consent from people before providing their support and people confirmed they did this. People and their representatives had been involved in planning the care and had consented to care plans. Where others had the legal authority to make care decisions on behalf of people, this was documented. Where the involvement of others had otherwise been authorised by the person supported, this was also documented.

The registered manager had put new systems in place to monitor the operation of the service and had an effective management audit process in place. Team meetings had been held regularly and there were plans to further improve team working.

People’s views about the quality of the service were sought systematically and any issues identified were acted upon and resolved.

Radis Community Care (Reading) is a domiciliary care agency that provides personal care and other support to 101 people in their own homes. The service is operated by GP Homecare Limited.

The service had a registered manager as required to manage its day to day operation. 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 and relatives felt staff were caring and kind and worked in ways that supported people’s dignity and privacy. They felt staff involved them in their care and encouraged them to do what they could for themselves. People told us staff asked how they liked things done and respected their wishes. People felt consulted about their care needs which were regularly reviewed.

Complaints were responded to and addressed appropriately by the registered manager and records described the action taken to resolve them. The views of people and their relatives about the agency’s operation had been sought by means of a detailed survey. The feedback was mostly positive and where issues had been raised they were included in an action plan and addressed.

Medicines recording and management systems had improved since the previous inspection to reduce the risk of potential errors. However further work was needed to ensure that all staff had their competency assessed periodically with regard to medicines management and also moving and handling.

Staff knew how to keep people safe and were aware of the signs of possible abuse and how to report it. They felt the registered manager would respond appropriately to any concerns raised.

Where others gave consent on behalf of people who received support, it was not always clear they had the legal authority to do so. This was a breach of Regulation 11 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. (Consent). This meant people’s rights might not always be safeguarded.

Staff training had improved and there was a rolling programme of induction and training to ensure staff remained up to date with their skills and knowledge. However, there was a need to improve the induction process. This was reported to be about to be addressed by the adoption of the Care Certificate induction process.

The level of detail in risk assessments had been improved. People were safer because these documents included information for staff on how to address identified risks. The level of detail in care plans had also improved and they provided the information staff needed to provide people’s care in a person-centred way, respecting their wishes.

A robust staff recruitment process helped ensure that staff had the necessary skills and approach to care for vulnerable people. People usually received support from a regular team of staff who mostly arrived on or around the time they were due and provided the required care according to people’s wishes and their care plan. People’s consent was sought with regard to the day to day care support provided.

Staff received regular support through supervision meetings and annual appraisals; and were kept in touch with changes and other information via regular newsletters. However, team meetings were infrequent, so opportunities to discuss care practice with colleagues were limited.

The service had an overall development plan which identified goals and how they would be measured. However, the views of the staff team had not been sought recently to monitor morale and identify any concerns.

Management monitoring systems had improved. However, it was not always possible to see evidence of the monitoring that had taken place.

We have made a recommendation the registered manager refers to relevant national guidance to enable her to demonstrate a more systematic approach to the monitoring of records, events and the completion of cyclical tasks.

Our inspection of the 20 May 2014 found major concerns. This was because the provider had not taken steps to protect people against the risks of receiving care that was inappropriate or unsafe. We issued the provider with a warning notice which required the service to be compliant with regulation 9 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 by 25 July 2014.

At this inspection there was evidence that the service was making continual improvements to ensure all of the people who used the service had a plan of care. However, we found further actions by the provider were needed to be fully compliant.

We looked at six plans of care. We saw that comprehensive initial assessments had been completed and person centred plans had been developed from them. These had been put into place in June 2014 and July 2014. We found that risks had been identified, assessed and that risk action plans were available. However, we noted that some of the risk action plans did not always contain enough detail to identify and minimise risks to people and care staff.

Below is a summary of what we found. The summary describes what people who use the service, relatives and staff told us and the records we looked at.

If you would like to see the evidence that supports our summary please read the full report.

Is the service safe?

All of the care records we reviewed contained a risk assessment form. However, not all of the forms were complete. There was a risk that people were not safe because the provider had not completed risk assessments fully. They had not put plans in place to manage risks safely when they had been identified.

We have asked the provider to take immediate action to meet the requirements of the law in relation to the safety of people who use the service.

There were some recruitment and selection processes in place. However, not all of the appropriate checks were undertaken before staff began work. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to requirements relating to workers.

Is the service caring?

We spoke with three people who use the service and two relatives. All of them were complimentary about the care they or their family member received. One person said the care workers were: '100% as far as I'm concerned' and another: 'I am really happy with my girls.' A relative told us: 'staff are excellent' and 'they are very kind and gentle'.

We looked at the care records for four people who use service. All of the care records contained an assessment of people's care needs. However, care plans were task focused and did not consider people's preferences. One record did not contain a care plan. There was a risk that staff would not be able to meet people's needs because they were not given enough information about each person's care requirements.

We have asked the provider to take immediate action to meet the requirements of the law in relation to the care and welfare of people who use the service.

Is the service effective?

People and relatives we spoke with told us staff asked for consent before supporting people with care. A relative said: 'they (staff) always ask permission before they do anything'. Staff described to us how they would ask for people's consent before they supported the person with personal care tasks.

However, the provider had not always taken the necessary steps to assess people's capacity to ensure they were asked to give consent if they were able. The provider did not have suitable arrangements in place to ensure that valid consent was obtained by people who use the service. There was a risk that people's capacity to consent would not be suitably tested. The provider had gained consent from an individual who was not lawfully able to give it.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to consent.

Is the service responsive?

Most of the people and relatives we spoke with told us they were involved in the care planning process. One person did not have a care plan. There was a risk staff were not able to meet the person's needs. Staff told us they were kept up to date with any changes to people's care needs via telephone and updates in people's care records. Care workers also told us if they felt a person's care needs had changed they would inform mangers. Managers would then visit the person and carry out a new assessment of needs.

Is the service well led?

There were some quality monitoring processes in place. These included telephone calls to people who use the service, incident analysis and staff spot checks. The provider had completed a quality audit in June 2013. The report concluded with 25 recommendations to ensure quality standards were being maintained. However, there was no evidence that any of the actions identified in the report had been completed by the provider.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to assessing and monitoring the quality of the service provided.

In this report the name of two registered managers appear who were not in post and not managing the regulatory activity at this location at the time of the inspection. Their names appear because they were still a registered manager on our register at the time of our inspection. In this report we have referred to the person managing the service on the day of our inspection as the acting manager.

The provider was reporting applicable incidents to us as required by the regulations.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register.

Some mandatory training had been completed including moving and handling. However, most of the staff had not received training updates for safeguarding of vulnerable adults, infection prevention and control or medication since they began employment with the provider. There was a risk that people who use the service would not have their health and welfare needs met by staff who were competent.

We spoke with the manager who told us they had implemented new processes for quality checks. These included contacting people who use the service by telephone on a regular basis, to see if people were happy with the quality of the service they provided, and spot checks for members of staff when they were providing care to people. Most of the people we spoke with confirmed these quality checks were taking place. One person told us they were 'happy with the service' and another said 'the carers are really lovely'.

The provider had not reported applicable incidents to us which concerned the provision of care and welfare to people who use the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register. The person currently managing the location was in the process of registering.

People using the service told us staff were respectful of their dignity and privacy. Staff respected people's choices and treated people as individuals.

We found that the provider had not ensured that all of the essential staff training, supervision and appraisals were being done, or being scheduled for the future.

The provider was not regularly assessing and monitoring the quality of the service they provided.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.