Archived: Superior Healthcare

This service is a domiciliary care and nursing agency. It provides personal care and treatment to people living in their own houses and flats in the community. It provides a service to children, younger disabled adults and older adults. Many people using the service had significant and ongoing healthcare needs. There were 52 people receiving a service from Superior Healthcare at the time of our inspection.

The registered manager had been working at the service since July 2017 and was registered with the Care Quality Commission CQC) shortly before our inspection. A registered manager is a person who has registered with the CQC 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 on 3 October 2016, we asked the provider to take action to make improvements to the way they assessed and mitigated risks, managed medicines and ensured that information within care plans reflected people's assessed needs and preferences.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe and responsive to at least good. The provider had completed all the actions and the key questions, safe and responsive are now rated good.

The way people’s medicines were managed had improved since our last inspection. Guidance was available to staff and people received their medicines as their healthcare professional had prescribed. Medication administration records contained updated guidance to staff and were fully completed. Changes in people’s health were identified quickly and staff supported people and their relatives to contact their health care professionals. People were supported to eat and drink enough and prepared meals to their preferences. Staff followed safe practices to prevent infections.

People received care tailored to them. Assessments of people’s needs and any risks had improved since our last inspection. Guidance was now available to staff about how to keep people safe and provide each person’s care in the way they preferred. Staff supported people to take part in leisure activities they liked and played with children to support their development.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The registered manager knew when assessments of people’s capacity to make decisions were needed. Staff assumed people had capacity and respected the decisions they made. When people needed help to make a particular decision staff helped them. Decisions were made in people’s best interests with people who knew them well, including their relatives. The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS), and had checked to make sure no one was deprived of their liberty.

People told us staff were kind and caring and treated them with dignity and respect at all times. People were given privacy. Staff were kind and caring to people and supported them if they became anxious. Everyone was supported to be as independent as they wanted to be. People who wished to, were supported to develop their independence. People received care in the way they preferred at the end of their life from staff and health professionals.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager and provider. People and their representatives told us they were confident to raise any concerns they had with staff and that any concerns they had raised had been acted on. Complaints received were investigated and responded to. Action was taken to prevent to concerns occurring again and people received an apology.

Staff were deployed in teams to provide people’s care and treatment. Staff deployment was based on the needs of the person and the skills and competence of staff. Staff rotas were planned in advance and any gaps of leave were covered. Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supported to meet people’s needs and had completed the training they needed to fulfil their role. Checks were completed to make sure training had been effective and staff were competent. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The provider and registered manager had oversight of the service and checked the service people received met the standards they required. People, their relatives and staff were asked for their feedback and any concerns were acted on and used to improve the service. Accidents and incidents had been analysed and action had been taken to stop them happening again.

Staff felt supported by the registered manager, they were motivated about their roles. They shared the provider’s visions of a good quality service and were encouraged to be transparent in their communication with people and their relatives. An experienced member of staff was always available to provide the support and guidance staff needed, including outside of office hours. Records in respect of each person were accurate and complete and stored securely.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We had been notified of all significant events at the service.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in their public office and on their website.

Superior Care Whitstable provides care and support to people in their own homes. The service is provided mainly to younger adults and children. At the time of the inspection there were approximately 49 people receiving support with their personal care and one person was receiving nursing care. The service undertakes to provide care and support to people in Kent and at the time of the inspection this was mainly delivered in Canterbury and Thanet. Since the last inspection the domiciliary care service providing only short visits to mainly older people had transferred to another provider. It now provides staff to cover visits for as little as 1.5 hours although the majority are longer visits/shifts of up to 10 to 12 hours, which could be part of a 24 hour care package. The provider contracts with the Local Health Authority, Clinical Commissioning Groups, Disabled Childrens’ Services and people that fund their own care and support including people whose care is managed by a case manager.

The service did not have 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. A registered manager’s application was received following the inspection.

People told us they received their medicines when they should and felt their medicines were handled safely. However there were shortfalls in some medicine records and a lack of guidance about some areas of medicine management.

Risks associated with people’s care had been identified, but there was not always sufficient guidance in place for staff, to ensure people remained safe.

People and parents had been involved in the initial assessment and the planning of people’s care and support and some people had chosen to involve their relatives as well. Care plans contained detailed information about clinical tasks that were required, but other areas, such as personal care lacked information to aid consistent care and support according to people’s wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan.

There were audits and systems in place to monitor that the service ran efficiently. These had been effective in identifying most of the shortfalls highlighted during the inspection, but not all.

People felt safe using the service and when staff were in their homes. The service had safeguarding procedures in place for both children and adults. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People had their needs met by sufficient numbers of staff. People received a service from a team of regular staff, who had been trained in complex care tasks to match their needs. New staff underwent an induction programme and then shadowed experienced staff in people’s home where they would be working and had their competencies checked.

People or their representatives had signed records to show their consent for the care and support people received in line with their care plan. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection although people had made Lasting Power of Attorney arrangements and some people had a Do Not Attempt Resuscitation (DNAR) in place. Some parents made decisions and some other people chose to be supported by family members when making their decisions. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. Staff understood this process.

People were supported to maintain good health and they told us how observant staff were in spotting any concerns with their health and taking appropriate action.

People felt staff were kind and caring. People and parents said they were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were caring and patient in their approach and knew people and their support needs well.

People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their health, age and physical disabilities. Staff had built up relationships with people and parents and were familiar with people’s personal histories and preferences.

People told us that communication with the office was now good and had improved over the last 18 months, if there were any queries they telephoned and action was taken. Most people felt confident in complaining, but did not have any concerns. People had some opportunities to provide feedback about the service provided. People felt the service was well-led and well organised. There was an open and positive atmosphere in the office and staff were committed to improving the service people received.

The provider’s aim for the service was ‘excellence in care’ and we found this principle was followed through into practice.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

We spoke to 13 people who used the service or their families. Everyone one spoken with was very pleased with the service they received. People said they received the care they wanted and needed and that they were consulted with regard to their plan of care and had confidence in the skills and experience of the staff who supported them. People told us that the communication had been very good with the agency. People spoken with had no concerns with the quality of care and were complimentary about the staff and the support offered. People told us they felt safe when they received a service from the agency.

People told us that the communication had been very good at the agency. They were kept informed about who would be visiting and were updated when this changed.

People spoken with confirmed that they had given consent to their care and felt in control of the care they received. Overall people spoken with had no concern with regard to the quality of care and were very complimentary about the quality of the staff and the support offered. People told us they felt safe receiving a service from the agency.

However staff did not give medicines to people who used the service safely. In that medication recording charts were not seen to be kept in good order and completed appropriately. Examples were seen of many gaps within the MAR (Medication Administration Record) charts and some medicines were not signed for at all. Some medications did not show dosage or frequency.