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St Gregory's Homecare Ltd Good

Reports


Inspection carried out on 25 September 2019

During a routine inspection

About the service

St Gregory's Homecare Ltd, provides personal care and support to people living in their own homes across South Cumbria, Lancaster, Blackpool and Preston. At the time of this inspection they provided 2500 hours of personal care to approximately 170 people across these four areas. The number of hours and people supported varied on a daily basis.

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

People felt safe as a result of the care they received. People gave us mixed views about their experiences of using the service. In some areas people found visit times were not always on time and some people felt they were not kept informed when visits were going to be late. One person reported having to miss medical appointments due to the lateness of visits. We have made a recommendation about staffing.

The service had completed assessments which ensured they were able to meet people's needs. People told us their needs had been reviewed and were properly identified. People said staff had the right skills and knowledge to support them. Staff followed guidance provided by other professionals which ensured care was effective. Staff ensured they sought consent from people before providing care.

People told us staff were caring and kind. Most people felt comfortable when they received personal care and praised the staff’s efforts to put them at ease. One person had not always had their preference for female carers met. People felt their views were respected and felt staff protected their privacy and dignity.

Person-centred care plans included sufficient detail of people's needs and preferences. People had been involved in regular reviews and assessments which helped ensure their care remained appropriate. People were able to raise their concerns and complaints. Some people were not satisfied their concerns had been responded to in relation to the times of visits and consistency of carers.

The registered manager and management team worked closely with staff to embed the aims and values of the organisation. Staff said they felt part of a cohesive team. The registered manager followed effective governance systems which helped ensure care quality was maintained. People were consulted about their experiences of the service including surveys and questionnaires. People told us they knew how to contact the office and managers.

Rating at the last inspection

At the last inspection the service was rated good. Published June 2019.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received, we may inspect sooner.

Inspection carried out on 27 March 2019

During a routine inspection

About the service:

St Gregory's Homecare Ltd, provides personal care and support to people living in their own homes across South Cumbria, Lancaster, Blackpool and Preston. At the time of this inspection there were approximately 2500 hours of personal care to approximately 180 people across these four areas. The number of hours and people supported varied on a daily basis.

People's experience of using this service:

People gave us mixed opinions of their experience of using the service. Some people were very satisfied with the care and support provided. Some people said visits were not always at the time they preferred. We discussed this with the director who advised visits were at the arranged time or within an agreed 30 minute tolerance.

Safeguarding policies and procedures helped to protect people from the risk of abuse and avoidable harm. Staff were trained to recognise concerns and reported them appropriately.

Risk management policies ensured people were supported to manage the risks in their daily lives which related to the care and support provided.

Medicines were managed safely, where the provider had responsibility for supporting people with medicines.

Staff had been recruited safely with all necessary checks being completed prior to them starting work. Staff had received appropriate training to support people safely and effectively.

Thorough assessments identified people's needs and preferences to ensure the provider could meet them.

Staff we spoke with said the team worked well together and followed advice and guidance from community based health staff. People were supported to make medical appointments.

Staff were aware of the importance of getting consent before providing personal care. People who needed support to make decisions had been supported following the best interest principles detailed in the Mental Capacity Act (MCA).

Most of the people we spoke with praised the kindness and caring nature of the staff, where there had been concerns these had been addressed through the provider's complaints process. People were supported to express their views. Staff had received training about dignity in care and could describe how they supported people respectfully. Care plans included details of goals people were aiming for to maintain and promote their independence.

Person-centred care plans included sufficient detail to allow people to receive bespoke support which reflected their preferences. Regular reviews and reassessments helped ensure people's care remained appropriate to their needs and preferences.

The provider had a complaints process which had been followed and the outcomes recorded properly.

End of life care was available including overnight support from the rapid response team which worked closely with hospitals and community based health professionals.

The service was well-led, with a clear focus on high quality person-centred care. Staff reported feeling valued and supported by the management team.

Rating at last inspection:

At the last inspection the service was rated good. Published November 2016.

Why we inspected: We carried out this inspection based on the previous rating of the service.

Follow up:

We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Inspection carried out on 8 November 2016

During a routine inspection

This announced inspection took place on 08 and 10 November 2016.

St. Gregory’s Homecare Ltd is a domiciliary care agency based in Carnforth offering a range of services in people's homes, including people living with dementia, learning and physical disabilities and people with palliative care needs. Services provided includes, domestic support, waking and sleep in night services, 24 hour care and respite care. The service covers an extensive area of the South Lakes with a large rural area and parts of North Lancashire. At the time of inspection the registered provider was supporting 150 people and employed approximately 100 staff.

The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure someone would be in at the office.

There was a registered manager in place. 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.

A comprehensive inspection of St Gregory’s Homecare Ltd took place between the period of May and June 2015. At the inspection breaches of Regulations were identified in relation to health and safety of people, management of medicines, and delivery of person centred care. Following the inspection visit, the registered manager submitted an action plan to show what improvements they were going to make to ensure they met the fundamental standards.

A focussed inspection was carried out in February 2016 to check that improvements had been made. At this inspection visit it was noted improvements had been made to ensure medicines were suitably managed and person centred care was delivered, however there was a continuing breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014 as risk was not sufficiently managed to ensure people were kept safe. We took enforcement action against the provider following this visit.

We used this inspection carried out in November 2016 to ensure action had been taken to ensure all fundamental standards were now being met. We also carried out a comprehensive inspection to review the rating of the service.

At this inspection visit, carried out in November 2016, we found the required improvements had been made. Following the previous inspection visit a working group had been developed to look at care planning systems and ways to improve the quality of the care plans and risk assessments. During the inspection visit it was noted the service was in the process of changing the care planning documentation to make them easier to follow. Systems had been implemented to manage and monitor risk to promote safety.

We noted care plans and risk assessments were reviewed and updated when people’s health care needs changed or when new risks were identified. People who used the service told us their nutritional and health needs were met.

People told us when they required assistance with their medicines, staff were reliable and knowledgeable. Although we received positive comments about the management of medicines we found arrangements for managing and administering medicines were not consistently applied. We have made a recommendation about this.

People spoke positively about the quality of service provided. People consistently told us improvements had been made within the service in the past year. They said staff were reliable and turned up when expected. At the time of the inspection visit the service was in the process of implementing a call monitoring system to track and record staff attendance at visits. The registered manager had introduced the system following concerns being raised about missed visits.

People spoke highly about the staff. They told us staff retention was good and said they had formed positive re

Inspection carried out on 13 January 2016

During an inspection looking at part of the service

We carried out this announced focussed inspection on 13 January and 2nd February 2016. Documentation relevant to the inspection was also collected on 18th January 2016. We last inspected this service in July 2015 during which we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

St. Gregory’s Homecare Ltd is a domiciliary care agency based in the town of Carnforth. It offers a range of services in people's homes, including care and support for people living with dementia, learning and physical disabilities and people with palliative care needs. Services also provided includes, domestic support, waking and sleep in night services, 24 hour care and respite care. The service covers rural and urban areas of South Cumbria, Lancashire and North Yorkshire.

There was a registered manager employed at the service. 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 last inspection in July 2015 we asked the provider to take action to make improvements to the following (Regulated Activities) Regulations 2014, safe care and treatment including the proper and safe management of medications and person centred care. This inspection focussed on whether those actions had been met.

During this inspection we found that there was a continuing breach of Regulation 12 Safe care and treatment of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to the assessing of risk to health and safety of people using the service and doing all that is reasonably practicable to mitigate any risks.

Although people told us that they felt safe receiving care and support from this service we found the provider was not identifying all of the risks associated with providing safe care and treatment. Where risks had been identified they had not always been recorded.

The quality and accuracy of care plans and risk assessments recorded were not consistent and some information about some people’s current care needs had not always been recorded. Where care plans had been reviewed previous risks identified had not always been included in the reviewed care plans.

Where risks were evident staff had not always relayed them to the senior staff who manage the care plans or identified them in people’s care records themselves.

Most people received support from a regular team of staff who they knew and who understood the care and support they required. We saw that people were treated with kindness and respect and people made positive comments about the staff who visited their homes.

During this inspection we found improvements had been made to the management of medications. The provider was still working on systems and processes to continue to improve the safe management of medications.

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

Inspection carried out on 5 May, 29 June and 13 July 2015

During a routine inspection

We carried out this announced inspection between 5 May and 13 July 2015. We last inspected this service in November 2014 during which we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These Regulations have now been replaced with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

St. Gregory’s Homecare Ltd is a domiciliary care agency based in the town of Carnforth. It offers a range of services in people's homes, including care and support for people living with dementia, learning and physical disabilities and people with palliative care needs. Services also provided includes, domestic support, waking and sleep in night services, 24 hour care and respite care. The service covers an extensive rural area of the South Lakes and parts of North Lancashire.

There was a registered manager employed at the service. 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 last inspection in November 2014 we asked the provider to take action to make improvements to the following (Regulated Activities) Regulations 2010,care and welfare of people who use services, safeguarding people who use services from abuse and the assessing and monitoring the quality of service provision. These actions have now been completed, with the exception of the safe management of medicines.

During this inspection, July 2015, we found one continuing breach of Regulation 12 Safe care and treatment of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to the safe management of medications.

We also found two new breaches that related to assessing the risks to the health and safety of people using the service Regulation 12 and to how people’s care needs were assessed and recorded Regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

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

Although people told us that they felt safe receiving care and support from this service we found that they could not be confident that they would always get their medicines as their doctor had prescribed. We found some care plans and records relating to the administration of medications were not always accurate.

The provider was not identifying the risks associated with providing safe care and where these were identified these were not always recorded.

The quality of care plans and risk assessments recorded were not consistent and information about some people’s care needs was not always recorded. Newly implemented quality monitoring systems were not seen to be fully effective.

Most people received support from a regular team of staff who they knew and who understood the care and support people required. We saw that people were treated with kindness and respect and they made positive comments about the staff who visited their homes.

There were enough staff to provide the care people required. The staff had completed training to ensure they had the skills to provide the care and support individuals needed.

Staff knew how to identify and report concerns about a person’s safety. The recruitment process for new staff included all the required checks to ensure that they were suitable to work in people’s homes. This helped to protect people from the risk of abuse.

People had been included in agreeing to the support they received and were asked for their views about the service. The registered manager was knowledgeable about the Mental Capacity Act 2005 and about their responsibility to protect the rights of people who could not make important decisions about their own lives.

We recommended that the service considered the consistency of the quality auditing of their care planning to ensure that accurate information is recorded about the needs of people who used the service.

Inspection carried out on 24, 31 October and 6 November 2014

During an inspection looking at part of the service

During this inspection we checked to see if the provider and registered manager had improved the safety and quality of the service since the last inspection on 26 June 2014. At that inspection we found continuing breaches of a number of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (the Regulated Activities Regulations 2010).

Following the inspection in June 2014 the provider undertook a voluntary agreement not to take new people on to receive services in order to provide a safer delivery of the service. This inspection was to check whether the provider and manager had completed the required improvements to the safety and quality of the service identified when we visited in July 2014.

This was an unannounced inspection. Our inspection team was made up of three Inspectors and we visited the service over three days. We spoke with 20 people who used the service, visited 12 people in their own homes with their permissions; spoke with five relatives, eight care staff, senior management and the registered provider. The local authority commissioning Quality Manager had provided support, advice and guidance to the provider and registered manager since our last visit in June 2014. The provider had also employed a private consultant for advice and guidance to improve the quality and safety of the service.

At the time of our inspection there were 155 people receiving care and support from St Gregory�s Homecare Ltd and approximately 100 employed staff.

We inspected to help answer our five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

Prior to this inspection we received concerning information in relation to the safety of people who used the service. Between 1 August 2014 and 23 October 2014 St Gregory�s Homecare Ltd had submitted 17 statutory notifications to the CQC for allegations of abuse concerning a person who used the service. We saw new policies and procedures had been implemented to support new systems in identifying and acting upon any safeguarding concerns. At the time of the inspection it was difficult to confirm that the new systems would be entirely effective.

One person who used the service told us that where their individual rota had unallocated care staff they were phoned prior to the visit to inform them of who was coming. Another person we spoke with told us that on the odd occasion there had been problems at their night time call running late due to the care staff having to travel quite a distance between visits. We were told by both care staff and people using the service that issues occurred when no travelling time was allocated between visits. A relative we spoke with told us, ��Staff numbers have increased and there is a better consistency of carers�.

For one person we visited in their own home we found that their medications were stored in a locked cupboard for safety. However we did not see any risk assessment about the safe keeping of these medications. There was no guidance available in the person�s home for staff to follow to ensure the medications were kept stored safely.

Is the service effective?

Since our visit in June 2014 there had been significant changes in the systems used to organise the running of the service. One of these changes was the implementation of a new care planning tool. However during our inspection we found concerns with some of the newly reviewed care plans. We looked at 17 of the reviewed care records and plans for people using the service and found issues with six of those.

At this inspection we found that new training facilities had recently been established at the office that allowed care staff to access on line training whenever they wished. All staff had been enrolled for on line training and progress was being monitored regularly. On one of the days we inspected we saw face to face training for the induction of new care staff. Staff we spoke with told us they had received training updates in moving and handling, safeguarding adults and medication management.

Is the service caring?

During this inspection people we spoke with told us the service they were receiving had greatly improved over the last few months. People using the service had been made aware of the concerns we had found in June 2014 because the provider and registered manager had informed them.

People we spoke with told us they were happy with their care and spoke highly of the care staff attending them. One person told us, �Girls that come are very good and always make sure I have everything before they leave�. Another person told us �My carer is very good and knows me well. They [care staff] have sorted out my OT [Occupational Therapy] assessment to help me with my independence.

Is the service well-led?

Care staff we spoke with told us they felt more supported by the senior management and directors. One person told us, �I�ve had two supervisions recently prior to that I had only one since I started working here. I feel better supported�. Another person told us. �One of the directors came to see me while I was working and asked me how things were. It was nice to see they cared�.

At the time of our visit we had a number of concerns that had been brought to our attention via statutory notifications and two complaints about the number of missed visits to people using the service. These had been recognised by the care management system and dealt with via the customer liaison officer. Following investigations made by the service it was found that the majority of these had been caused by the management of rotas. The rota system used was electronic however the information required to generate the rota was done manually and mistakes had been made.

Is the service responsive?

In a number of care plans we looked at we found errors. One care plan we viewed when visiting a person using the service stated that �family supervise medication� however when we spoke with a relative they told us the family did not have any involvement with the medication and relied on the care staff to manage the medications. Another person�s care plan we viewed in their home referred to them having the option of a bath or shower. This person did not have a bath in their home.

The records we looked at for complaints showed that they had been dealt with quicker and that the senior management had analysed the audits. This had helped them to recognise trends and take action to prevent reoccurrence of the concerns that had been raised. The new systems we saw in place were based on a traffic light system which enabled staff to immediately recognise what course of action to take. This meant that the service was learning from the comments or complaints made.

Inspection carried out on 26 June 2014

During an inspection in response to concerns

Our inspection team was made up of two Inspectors. During this inspection we also checked if requirements from the last inspection we carried out in April 2014 had been completed. During the inspection we gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found:

Is the service safe?

During our visit we found concerning information in relation to the safeguarding of a person using the service.Whilst the senior on call considered they had acted appropriately based on the information they had been given at the time. We informed the operations manager to report it to the appropriate authority. This meant that information being received, that indicated people may be at risk of harm, was not appropriately recognised or managed by the service.

We last visited this service in April 2014. We did not see evidence at this visit that the quality monitoring systems in use had been effective in reducing the number of concerns and complaints being raised by people using the service. Nor did we see that where concerns relating to the safety and well being of people had been appropriately recognised or recorded on all occasions. This meant that people who used the service could not be sure that the safety and quality of the service was being effectively monitored and managed by the provider. Nor did we see that comments and complaints had always been taken into account to improve the service.

Is the service effective?

We spoke with the senior administrator who does not have any responsibility for the planning of care. She told us that her role, since our last visit, had been focused on meeting the regulation requirements for the recruitment of staff. We were told they were aware that the appropriate assessments and plans of care had not been completed due to the lack of sufficient staff to manage the workload.

We saw that new checking systems since our last visit were effective in ensuring the required information was in place before people commenced working in people's homes .

Is the service caring?

We visited, with permission, four people receiving care and treatment from St Gregory�s Homecare Ltd in their own homes. We also spoke with two relatives.People we spoke with told us they were �more than happy� with the carers that they received care from. One person told us,"The carers that come are marvellous�� and another said ��They are all lovely��.

People who used the service who we spoke with during our visit told us they had also experienced missed or late visits. This meant that the delivery of care was not planned in an appropriate way in order to meet the needs of the people using the service.

During our visit we looked at the most recent completed satisfaction survey questions asked of some people using the service. This had been completed in May / June 2014 by 17 people. We saw that 15 out of 17 strongly agreed that they felt comfortable and safe with their carers. The same amount of people said their carers treated them with respect and dignity.

Is the service well-led?

People we spoke with during our visit told us they were unhappy with the organisation of the rotas. We were told that on a regular basis people receiving services did not know who or if a carer would be visiting.

Staff we spoke with told us that they did not receive regular supervision or appraisal. One person told us they had not had any supervision since November 2012. Staff also told us of the low morale and pressures of working extra hours. We noted from the action plan audited on 10th June 2014 that the identified required outcome for supporting workers recorded that staff were regularly supervised and had an annual appraisal. This meant that staff had not been appropriately supported in their responsibilities to enable them to deliver care and treatment to services users safely and to an appropriate standard.

Is the service responsive?

We looked at a sample of the reports for calls made to the office during opening times from 16/06/2014 to 22/06/2014. These records highlighted that a number of people using the service were unhappy with the provision. During the period of the week one relative contacted the service three times to report missed visits. Ten calls were made reporting people had been unhappy with the service received. We saw that only one of these had been recognised as a complaint by the service.

We saw that new checking systems since our last visit were effective in ensuring the required information was in place before people commenced working. A comprehensive audit on the records of staff recruitment had been completed in May 2014 and we saw that this had been repeated in June 2014.

We looked at minutes of a manager's meeting held on 9th June 2014. The meeting was recorded as being called to discuss the events that occurred during the last weekend as the on call person had reported having to go out to cover visits due to staffing problems. The meeting was also to discuss how they were to manage the shortfall of 300 hours gaps on the rotas. It was recorded in the meeting minutes that two office staff were to change their working hours to accommodate supporting the gaps on the rota at the weekends.