Archived: District Carers Limited

District Carers Limited provides personal care to people care in their own homes. At the time of the inspection personal care was provided to 123 people whose ages ranged from 42 to 99 years and had needs such as physical disability, sensory impairment, dementia and frailty due to old age.

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.

At the previous inspection of 3 May 2016 we found the provider had not ensured assessments of risk were adequate to ensure those risks would be mitigated. We made a requirement for this regulation to be met. The provider sent us an action plan of how this was to be addressed and at this inspection we found the regulation was met.

At the previous inspection of 3 May 2016 we recommended the provider put in place a plan for formal supervision of staff as we found staff supervision was inconsistent. At this inspection we found staff supervision was well organised and included observations of staff working with people in their homes to check their competency. Staff told us they felt supported in their work.

Since the last inspection the provider has implemented an IT system whereby each staff member has smart phone which included all the relevant information about their daily work including people’s care plans. Staff completed their daily records on these. The system had a number of benefits to people, staff and the management; for example people and relatives could make comments by directly accessing the records. We noted the system needed to have time to embed as there were a few problems with it. These included staff not being able to fully access the system at times due to poor connectivity. We also noted the IT records did not always have details of people’s medicines. We have made a recommendation regarding the monitoring of care and medicines records.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said the staff provided safe care.

Sufficient numbers of staff were provided so people’s care needs were safely met. People commented that care staff attended at the agreed times. Since the last inspection we received two complaints that staff did not always attend to people at the agreed times. We looked into this during the inspection by asking people about this and by looking at records; these allegations could not be substantiated. We sent surveys to people to ask for their comments about the service; one person and one relative said they did not always get a weekly rota supplied. We spoke to six people or their relatives and these all confirmed they received a weekly rota detailing which staff were coming to see them.

People generally received their medicines safely, although we noted the record system used by the staff did not always detail people’s prescribed medicines which staff needed to administer. This was isolated to two occasions and is referred to in the Well Led section of this report.

Staff were trained in a range of relevant subjects such as moving and handling, dementia awareness, infection control, the Mental Capacity Act 2005 (MCA) and food hygiene. Newly appointed staff received induction training to prepare them for their role.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005. The service had policies and procedures regarding the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff were trained in the MCA and had a good awareness of the legislation. People were consulted and had agreed to the arrangements for their care

People were supported with the preparation of meals where this was needed.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed.

Staff had positive working relationships with people. Staff acknowledged people’s rights to privacy and choice. People told us how staff treated them with kindness with compassion. Staff said they treated people in the way they would want a member of their family, or themselves, treated. Staff listened to people and treated people in a way which made them feel valued.

The service had a complaints procedure, and people said any concerns or queries were responded to.

People were involved in discussions about their care and said their needs were met. The staff regularly reviewed people’s care by visiting them in their homes. People told us the staff spent time talking to them after the care tasks were completed which they enjoyed.

People and their relatives’ views were sought as part of the service’s quality assurance process.

The registered manager understood their responsibilities to report specific incidents to the Commission but had not done so for one investigation.

There were a number of systems for checking the safety and effectiveness of the service such as regular audits. Staff said they were supported by the management team.

District Carers Limited (previously known as Carewatch (Worthing and Arun) Limited) provides care and support to people in their own homes. The service delivers care to people living in the coastal strip between Bognor Regis and Lancing and to people living in rural areas in mid-Sussex such as Storrington and Pulborough. At the time of our inspection, approximately 148 people received support from District Carers Limited.

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.

Some people’s risks had not been identified, assessed or managed appropriately. Care records, in some instances, provided inaccurate information and guidance for staff. People felt their risks were managed safely and that they were protected from abuse and harm by trained staff. There were sufficient numbers of staff to meet people’s needs. However, some people felt they were not always informed if staff were going to be late. A small minority said they did not always receive rotas to inform them which staff would be supporting them in the week ahead. New staff were employed once all necessary checks had been undertaken with regard to their suitability. People’s medicines were managed safely.

Staff did not always receive regular, formal supervision meetings and some staff had not received annual appraisals. We have made a recommendation to the provider to put a system in place to plan formal, regular supervision meetings with staff. Staff did meet with their supervisors informally, but records of these meetings were not kept. New staff were required to complete the Care Certificate, a universally recognised qualification and shadowed experienced staff in their induction. All staff completed an essential training programme in a range of areas and were encouraged to take additional qualifications. Staff understood the requirements of the Mental Capacity Act 2005 and their responsibilities to people under this legislation. Staff supported people in their healthcare needs and contacted healthcare professionals if needed.

Staff knew people well and positive, caring relationships had been developed between people and staff. Staff felt they had time to spend with people and have a chat during their visits. People were involved in making decisions about their care and were encouraged to express their views. They were treated with dignity and respect.

Care plans provided detailed information about people’s care needs and support for staff. Some care plans did not have complete personal histories for people, their likes and dislikes. People were involved in reviewing their care plans. They knew how to raise a complaint and the provider acted upon complaints in line with their policy.

The service was well led and people were asked for their views about the service. Staff were also asked for their feedback and any identified issues were acted upon by the provider. Staff described the culture of the service in a positive way and of the need to provide the best possible care to people. The majority of people said they would recommend the service to others. There was a range of audits in place to measure the quality of the care delivered.

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

Our inspection was undertaken by one inspector. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with the provider, the manager and from looking at records.

If you want to see the evidence supporting our summary, please read the full report.

People's care records were accurate and fit for purpose. The provider was in the process of transferring records from a paper format to an electronic format. There were comprehensive risk assessments in place that addressed each element of people's care. Care plans were reviewed and updated regularly.

Our inspection was undertaken by one inspector. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with ten people who used the service, five relatives, six staff and from looking at records.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People we spoke with confirmed that staff completed daily records which were kept in people's homes. These records showed what care or support had been provided.

Where people needed support to take their medication, we saw that appropriate arrangements were in place. Staff were knowledgeable about the help they were allowed to give people with their medication and instances where they were unable to assist, for example, with non-prescribed medication.

Staff underwent a comprehensive training programme at induction which was regularly refreshed. They were encouraged to undertake further training, for example, Qualifications Credit Framework in Level 2, Health and Social Care. The service had recently recruited new staff to ensure that there were sufficient staff to meet people's care and support needs safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care agencies. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

People's care records did not always include a comprehensive risk assessment that addressed each element of their care. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

Staff we spoke with told us that they recognised a person's ability to consent to their care and treatment could change over time. They said they would always, 'Have a chat with the customer' and ask them, 'Are you happy for us to support you?'

Care records we looked at showed that people gave their consent by signing their care plans. Where people were unable to give their consent, then their relatives were consulted.

Care plans were reviewed approximately every three months and field staff undertook visits with people to discuss whether any changes to their care or support were required.

Is the service caring?

People we spoke with were complimentary about the staff who visited them. One relative told us that when their relative was unwell, the member of staff had stayed over their allocated visit time, to make sure they were all right.

One person we spoke with described staff as, 'All very, very kind and very, very nice and all that they do, they do with tlc (tender loving care)'.

Is the service responsive?

People told us that they had not always been informed when staff were going to be late arriving for a visit. As a result, the service had set up a system whereby staff would call the office if they were going to be late arriving to their next visit. The office would then ring the next person to let them know how late the visit might be.

People told us that the service was able to be flexible and that they could change their visit times to fit in with their hospital appointments.

Is the service well led?

Carewatch undertook regular quality audits to obtain feedback from people who used the service. One said, 'I can't say anything bad. The care I get is top notch. I have no worries whatsoever'. The service also asked the staff for their comments through an employee survey. One member of staff told us, 'I feel it is the best run and has the most caring staff. They run as efficiently as they can and they do care'.

There were effective systems in place to monitor complaints and to deal with these effectively.

People who used the service told us they were 'very happy' with the care provided. They described the care as 'excellent' and 'always brilliant' and three people said the care staff were 'very professional.'

People told us they felt involved in their care and support. Most said they didn't mind that there were a 'high number' of care staff providing support.

We found there was some lack of clarity with regard to how people should be assisted with medicines.

Staff were recruited in a way which ensured all the necessary checks were carried out and they were trained and supported prior to working alone.

There were systems in place to monitor the quality of the service provided.

We saw there was a lack of thorough and up to date documentation with regard to the care needs and management plans for people receiving a service.

People confirmed they were involved in the assessment of their needs and care plans developed followed by reviews although we noted that they were not always regular or documented. We were invited to the home of the family of a person who was receiving care from staff supplied by Carewatch. We were told by relatives of this person that whilst they had on occasions had cause to discuss the continuity of staff and some aspects of required personal care, on the whole they were satisfied with the staff.

The staff we spoke to confirmed that they had regular training and some had been offered additional training opportunities, for example NVQ qualifications. They told us they had regular supervision with their field based supervisor and those staff who had worked there for more that a year had received an appraisal. This meant that staff had the opportunity to review their performance and to identify additional learning or support.

There were systems in place to monitor the quality of service and to investigate and respond to concerns or complaints.