Archived: Two Counties Community Care Limited - Isle of Wight

Updated 11 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 is 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.

The inspection was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that staff would be available. The inspection was carried out by one inspector and an expert by experience over the 8 and 12 January 2015. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had personal experience of looking after family members receiving domiciliary care services.

Before this inspection, we reviewed the information that we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send tell us about by law. We also gathered information about the service from the Isle of Wight Local Authority Adult Services team.

We spoke with 26 people who used the service or their relatives. We also spoke with seven members of the care staff, the regional director, the training manager and the financial administrator, who was acting as the manager. We looked at care plans and associated records for six people using the service, staff duty rota records, eight staff recruitment files, records of complaints, accidents and incidents, policies and procedures, and quality assurance records.

The last inspection took place 25 October 2013 and there were no concerns identified.

Updated 11 May 2015

Two Counties Community Care Limited - Isle of Wight is a domiciliary care agency providing personal care for a range of people living in their own homes. These included people living with dementia, older people and people living with a physical disability or learning disability. The inspection was carried out over the 8 and 12 January 2015 and at the time of our visit the service supported 156 people.

The service has not had a registered manager in post since before October 2013. 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 have asked the provider to tell us the action they are taking to comply with this condition of their registration.

Although people told us they felt safe, we found the recruitment process was not safe or effective and did not ensure staff recruited were fit to work with people using the service.

Staff were issued with a ‘code of conduct for support workers’, which contained safeguarding information including, confidentiality and accepting gratuities and gifts. They had received appropriate training and were able to demonstrate an understanding of the service’s safeguarding policy and explain the action they would take if they identified any concerns.

There were enough qualified, skilled and experienced staff to meet people’s needs. Most people had a regular team of care staff; some had formed close attachments and looked forward to their visits whilst others said they enjoyed the variety of having different people calling.

Appropriate arrangements were in place to support people with regard to their medicines management. However, the recording of when medicines were administered was not always completed correctly. We made a recommendation with regard to the provider’s approach to recording medicines administration.

People using the service and their relatives told us they felt that the service was effective because people were well matched with care workers who had the appropriate skills to care for them.

Before commencing with the service a pre-assessment was completed for the person to identify their individual needs, their personal preferences and any risks associated with providing their care. People’s risk assessments and those relating to their home’s environment were detailed and contained strategies to enable staff to minimise any risk.

Staff received an induction into their role and had also completed specific training to meet the needs of people they were supporting. Staff were aware of how to use the training they had received for the benefit of people. Senior staff had conducted competency checks for care support workers in people’s homes to ensure staff were appropriately skilled to meet people’s needs.

People’s views and decisions were respected. When appropriate people’s care files containing information about their capacity to make decisions. Care staff liaised with other healthcare professionals to seek advice and support for the service users.

People using the service and their relatives were very positive about the care they received. The comments by people included “They are so lovely to me, they treat me just as my daughter treats me” and “Having been a carer myself I know what good care is and that is what I get; it is superb, fantastic, everything that I need is being done for me”.

People and their relatives had been involved in the planning and review of their care. People were treated with dignity and respect. People received personalised support and care plans were reviewed every six months or when their needs changed. Each person’s care file contained a person centred care support plan, which provided care staff with detailed information about the care people required at each visit.

The provider sought feedback from people or their families through the use of a quality assurance survey questionnaire. The results from the latest survey were predominately positive. The service had good arrangements in place to deal with complaints and people and relatives told us they knew how to complain. Accidents and incidents were monitored and remedial actions identified to reduce the risk of reoccurrence.

People who used the service thought the service was well run. However, we found that the values and ambitions of the provider were aspirational, there was a lack of leadership which had caused confusion and staff feeling undervalued. They expressed concerns over the lack of consistency and direction at a regional level and a sense of “feeling adrift”. Since September 2012 there have been two changes of provider. Neither of these changes has led to a full re-branding of the service, which has led to a mixture different systems, paperwork and policies being used across the service.

We made a recommendation with regard to staff motivation and team building.

All of the policies were appropriate for the type of service, reviewed regularly, up to date with legislation and fully accessible to staff. All staff had easy access to the service’s policies and procedures.

Although the provider carried out a formal audit of the service on a quarterly basis, there was no structure approach to the auditing of records at a local level. This informal approach to auditing was not robust enough to identified the breaches and concerns we have identified.

We made a recommendation with regard to the provider’s approach to quality assurance.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have taken at the back of the full version of the report.