CCS Homecare Services Limited Also known as Comfort Care services

CCS Homecare Services Limited provides a range of care and support services. At the time of our inspection, the service supported approximately 334 people. People had diverse needs, including younger adults with learning disabilities, people with mental health needs, older people and people living with dementia.

Some people received personal care in supported living accommodation. At the time of our inspection, support was provided at 16 supported living sites. Accommodation ranged in size, from single person flats to a development of 16 one-bedroom flats, with shared facilities such as a communal lounge and garden. Most sites supported around five to seven people living with learning disabilities, and some people also required mental health support.

The service supported individuals at four extra care housing sites within the London Borough of Hillingdon. People using the service lived in flats, with access to care support. The size of these buildings ranged from 47 to 88 flats. One of the buildings contained a six-flat unit, used to provide short term care support for people discharged from hospital.

The service also supported people living in their own homes. Some people received support as part of discharge to assess arrangements, meaning they received short-term care following hospital discharge. Other people received care support on an ongoing basis.

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

We spoke with people and families about their experiences of the discharge to assess pathway. People received a welcome letter but did not receive a copy of their care plan. Care was arranged quickly to help people return home at short notice. This meant the service could not provide set visit times. Some people were unhappy with not knowing what time staff were turning up which impacted on their meals and medication. A relative told us, “There was inconsistency with times carers came. My relative felt trapped and stressed because of erratic times.” Another person commented, “They are kind but don’t always stay the right amount of time and turned up at different times.”

Most people felt safe whilst receiving discharge to assess support. Some people provided positive feedback. One relative told us, “It was an excellent transition from hospital to home. She feels safe with the carers who come as they help her confidence and trusts them to do a good job.” Another person advised, “I felt safe with the carers as whatever I asked them to do, they did it. They reminded me of the risks with walking and how to use the zimmer frame.”

We also spoke with people and families in relation to long-term care and support at home. Most people told us they felt safe with the care and support they received. One person told us, “The carers inspect me for sores as it is part of my plan, I self-medicate and I’m treated with dignity and respect”. Another person added, “I feel safe and comfortable when carers are here”.

We heard varying feedback about the consistency of people’s support, particularly regarding punctuality of staff. One person told us, “Lunchtime can be anywhere between 11.00am and 2.00pm. They have never missed a call but won’t give me a time.” Other comments included, “they are fairly punctual”, “carers are often late” and “schedules given to carers don’t seem to correspond with what has been agreed.”

People we spoke with did not know the name of the manager, but there was generally positive feedback about communication with the office. One person told us, “The staff and carers are pleasant and friendly…I’m happy with the office.” Another person told us, “If I have concerns, my relative deals with the office for me. A lady comes out and asks me questions about the support I’m getting and if I need anything from my plan changing”. People also confirmed they were contacted for feedback as part of quality assurance monitoring.

We also gathered feedback from people and families using extra care services. People told us they felt safe and spoke positively about the support they received. People used an alarm system to call for assistance when staff weren’t present. We heard staff responded promptly to the alarm. People received support from regular staff, and we heard staff understood people’s needs and preferences. One person told us, “They do everything they are supposed to do for me, I like all the girls.” At one site we visited, people knew there was a new manager and one person said, “She pops in to see me”. Another person at the same site told us the manager acted quickly when they requested an earlier morning visit, to ensure they received pain relief medicines at the right time.

People spoke positively about safe care received within supported living settings. This helped people achieve good outcomes. People felt there were enough staff to support them and told us they felt supported in relation to medicines and managing the risks associated with COVID-19 infection. Some people’s routines and preferred activities had been impacted by the pandemic, with one person commenting, “It’s difficult to set goals. College finished early.” However, people told us the service had supported them during this period. One relative told us, “[person’s name] used to go to a day centre. They definitely get one to one support three days a week and since he’s been in hospital, he needs extra help. They’ve done really well.” Another person described the activities they now access and enjoy, advising, “I like shopping, television and music. I go to college to do maths, English and cookery.”

We found risks in relation to people’s care and support were not always clearly identified within records. We also identified concerns in relation to the recording of medicines support. We made recommendations the service develop their approach in relation to risk assessments and medicines recording. The service responded to our feedback immediately to confirm they were taking action to address the concerns we found.

We found records in relation to people’s care and support were not always person-centred. Some records contained contradictory or incorrect information. The language used within care plans was not always person-centred. The service was responsive to our feedback and immediately confirmed they would work to make improvements. This included plans to revise staff training and review the content and wording of all care plans and risks assessments.

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.

This service was able to demonstrate how they were meeting the underpinning principles of right support and right culture. We did not look at the component of right care as part of this inspection.

Right support:

• Model of care and setting maximises people’s choice, control and independence.

Right care:

• We did not inspect the Caring domain as part of this inspection and did not look at all the components in relation to right care.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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 29 June 2019).

Why we inspected

The inspection was prompted in part due to significant expansion of the service since our last inspection. We were aware of increased numbers of safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 remains Good. This is based on the findings at this inspection.

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

The service responded immediately to our feedback and commenced action to address the issues we identified. This included updating policies, revising staff training materials and reviewing how medicines administration, care plans and risk assessments were recorded. The service improved information given to people receiving discharge to assess care, to include a summary of the care support in place and approximate visit timescales.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for CCS Homecare Services Limited 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.

People’s experience of using this service: People were supported by enough staff to care for them and keep them safe. Staff had training in key skills, understood how to protect people from abuse and managed safety well. Staff assessed risks to people and kept records up to date. Where people were supported with their medicines, this was managed safely.

Staff provided good care and supported people to eat and drink where this was part of the agreed care package. Managers monitored the service to make sure it met people’s needs in a safe and effective way. Staff worked well together. They treated people with compassion and kindness, respected their privacy and dignity and took account of their individual needs. People were supported to be as independent as they could be. People’s equality and diversity needs were well met at the service.

The registered manager and other leaders ran services well and supported staff to develop their skills. Staff understood the service’s vision and values and how to apply them in their work. Staff felt respected, supported and valued and were clear about their roles and accountabilities.

The provider kept us informed of any significant events and worked well with us and other external agencies to monitor and improve people’s care. Action was taken when things went wrong or people made complaints. We have made a recommendation relating to the duty of candour requirement. The intention of this regulation is to ensure that providers are open and transparent with people who use services and other 'relevant persons' (people acting lawfully on their behalf) in relation to care and treatment. It also sets out some specific requirements that providers must follow when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, providing truthful information and an apology when things go wrong. The regulation applies to registered persons when they are carrying on a regulated activity.

Rating at last inspection: The service was rated ‘Good’ at the last inspection on 16 December 2016. We published our report on 18 January 2017.

Why we inspected: The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

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

We previously inspected the service on 11 October 2013. The service was meeting the requirements of the regulations at that time.

CCS Homecare Services Limited provides domiciliary support to people in supported living properties. Twenty three people were receiving support with personal care at the time of our inspection. People using the service were mostly adults under the age of 65 with learning disabilities or mental health needs. Support was being provided in the Slough, Hillingdon, Surrey and West Berkshire areas.

The service had 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 how the service is run.

We received positive feedback about the service. Comments from people included “Happy with staff” and “Nice people.” One person said their keyworker was “Brilliant.” A relative told us the house manager where their family member lived was “Clearly very committed to her job and interested in the individuals.” They considered their relative was “Provided with all that he needs” and added “The staff have created an environment where he is happy and settled and wants to stay.” Another relative said “I feel very reassured that my (family member) is in such safe hands. I cannot praise the whole lot of them highly enough.” They added “I have only good things to say about Comfort Care Services. They are a wonderful service provider who very much live up to their name.” A social care professional told us “The manager and all CCS staff are extremely approachable, responsive and deal with any issues or concerns that we may raise with them. The management team are open to discussion about improvements or changes and work with the council to deliver high quality services.” They added “CCS endeavour to always put the service user first and at the centre of any support they provide.”

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Risk was managed well at the service so that people could be as independent as possible. Risk assessments had been written to reduce the likelihood of injury or harm to people during the provision of their care.

We found there were sufficient staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through a structured induction, regular supervision and appraisal of their performance. There was an on-going training programme to provide and update staff on safe ways of working.

People told us they were treated with dignity and respect. They were involved in decisions about their care and support and their independence was promoted.

Care plans were centred around the needs of the person and documented how they wished to be supported. Care plans had been kept up to date to reflect changes in people’s needs. People were supported with their healthcare needs and medicines where necessary.

The service was managed well. Staff told us they felt supported and would be confident in raising any concerns about people’s care with the manager or provider. The provider regularly checked the quality of care through visits and audits. Records were maintained to a good standard and staff had access to policies and procedures to guide their practice.

We found there were effective recruitment and selection processes in place. We reviewed four recruitment personnel files. We saw required recruitment checks had been completed and recorded.

People told us care staff were understanding and knew how to help them maintain their independence. One person told us 'Staff take good care of me.' Another person said 'I am fine here ...staff are helpful.' We found arrangements were in place to ensure staff working at the service were properly trained, and supported to provide appropriate care to people.

People we spoke with told us that they were regularly asked for their feedback, to make sure the service was meeting their needs appropriately. They said they felt comfortable approaching the manager with any concerns. Systems were in place to monitor the quality of the service provided, and ensure people had their views listened to.

The care plans and risk assessments provided detailed information about people's needs. The emphasis was on the individual and things that were important to them such as routines, interests and family. Assessments undertaken included risk of falls, mobility and whether a person could administer their own medication. Care plans were up to date and reviewed regularly.

The home had procedures to protect people from the risk of harm and abuse. Staff had received training in safeguarding vulnerable adults and had an understanding of their roles and responsibilities. We spoke with people who told us they were safe. The service had recruitment processes in place which included ensuring that all relevant checks were carried out before a person could start work.

There was a system in place to listen to any complaints people had. We spoke with people and they told us "I have no complaints at all" and "I talk to staff if I am not happy". However one person told us that they had a complaint which they had expressed to a staff member but were not happy with the response.