Archived: Always There (Crewe)

Updated 8 May 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 1 December and 10 December 2014 and was unannounced. On the first day two adult social care inspectors visited the offices of the registered provider and on the second day one returned. Two experts by experience were also part of the inspection team. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service in this case older people. The inspection team also included a specialist adviser with expertise in the care of people with learning disabilities.

The inspectors visited people in their own homes both in the Crewe area and Staffordshire areas. The specialist adviser visited two of the homes provided as part of the supported living scheme.

The provider gave us a list of people who used the service from which we chose 60 people. We wrote to these people saying we would like to contact them by telephone. Where a relative or family carer received the letter we spoke to them if they wished this.

The experts-by-experience spoke with 28 people who used services as well as 16 relatives or family carers. Inspectors spoke with eight people either in their own home or when they visited the office of the registered provider. Three people or their relatives contacted the inspectors directly when they heard we were undertaking the inspection.

We looked at 15 sets of care notes and seven staff files and spoke with seven care staff as well as care coordinators, the quality assurance manager and the manager. We looked at policies and procedures retained in the office as well as service audits.

We contacted the commissioning and safeguarding staff from the three principal local authorities in whose area the registered provider gave a service.

Updated 8 May 2015

This inspection took place on 1 December and 10 December 2014 and was unannounced. At the previous inspection of this service we found that it was not compliant with the regulation relating to the management of medicines. The registered provider sent us an action plan detailing how they were going to improve this and at this inspection we found that the necessary improvements had been made.

Always There (Crewe) provides personal care and support services to people in their own homes. The agency is registered to provide services to older people, older people with dementia and adults who may have learning or physical disabilities, mental health problems or sensory impairment. At the time of our inspection there were 104 people who used the service in Crewe and 46 in Staffordshire. A further 25 people received a service commissioned by the Stoke on Trent local authority. A service for 17 people with learning disabilities was also provided across the Cheshire East and Cheshire West and Chester local authority areas. People who used this service also lived in their own homes but usually in group living situations with allocated staff to support them. People shared household bills and other tasks within these houses.

At the time of our inspection there was no registered manager at Always There (Crewe). However we were aware that the current manager was in the process of registering and this was completed a few days after the second day of our inspection. 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 that some people who received a service from Always There (Crewe) did not always feel they could not rely on the service. Some people who received the service in their own homes told us that they did not think that staff had sufficient time to deliver the service they needed or had agreed. They felt that sometimes they could not be sure that they would know in advance who would be visiting them to provide care or that it would be someone they would know and who would know them. They told us that staff did not always attend at the times agreed. We found that staff did not always spend the amount of time at visits that had been agreed with people who used the service or the commissioners who had arranged the service for them. Where this happened it compromised the care which it had been planned would be provided. The registered provider had failed to ensure that people always received care that was safe and appropriate.

This was in breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were not adequate systems in place across the whole service to make sure this did not happen. The registered provider relied mainly on systems installed by local authorities to monitor its performance. In those areas where these systems did not operate the manager did not have suitable alternative means of monitoring the service provided.

This was in breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that staff were aware of what was needed to keep people safe from abuse or harm. Staff were well-trained. Medicines were stored and administered properly and staff acknowledged the important of acknowledging peoples’ choices and preferences where they could. However some people felt that it was difficult to complain and some people who did complain did not feel that their comments resulted in the changes they wished.

You can see what action we told the provider to take at the back of the full version of the report.