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Alexandras Community Care Penryn Requires improvement

Reports


Inspection carried out on 29 August 2019

During a routine inspection

About the service

Alexandras Community Care is a domiciliary care service that provides personal care and support to people living in their own homes in the community. When we inspected the service was providing the regulated activity, personal care, to 40 people in and around the Penryn area in Cornwall.

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

People and their relatives told us care was delivered in a safe way and they had confidence in staff’s abilities. Identified risks related to people’s behaviour were not always clearly recorded, assessed and monitored. When allegations had been made these had not been appropriately recorded and reported.

Other risks had been assessed and guidance provided to enable staff to mitigate the risk.

Some people were supported with medicines. Medicine Administration Records (MAR) were completed appropriately to indicate when medicines had been taken. When medicines had been provided in blister packs neither the care plans or MARs individually listed each medicine or the support people would need to take them. This was not in line with national guidelines. We have made a recommendation about this in the report.

There were enough staff to cover all visits. People told us staff were usually punctual and stayed for the allotted time. Staff were able to complete personal care tasks and spend time with people talking and checking on their well-being.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The importance of providing care in line with people’s preferences and offering meaningful choices was a recurrent theme in our conversations with staff.

Staff told us they enjoyed their jobs and were committed to providing a caring service. They were keen to support people to maintain active lives and retain their independence as much as possible. Staff told us they were well supported by the registered manager and acting deputy manager.

People and their families were asked for their views of the service. They told us they were involved in care plan reviews and had opportunities to express their views of the service. People said they would be confident raising a complaint if necessary.

The registered manager and senior management team carried out various audits to monitor the service. These had failed to identify the shortcomings identified in the safe section of this report. We have made a recommendation about this in the report.

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 (report published 7 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the systems to record and report allegations of abuse.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 1 February 2017

During a routine inspection

A&D Community care provides care and support for approximately 75 people living in their own homes in the areas around Falmouth and Truro in Cornwall. At the time of this inspection the service employed 34 care staff.

At the last inspection in April 2015, the service was rated Good for all five of our key questions. At this inspection we found the service remained Good.

The service followed safe and robust recruitment procedures. Staff had received safeguarding training and understood their role in protecting people from avoidable harm.

People told us they were safe and cared for by staff who they knew and got on with well. People’s comments about their care staff included, “They are very good, very helpful” and “I do get on well with every one of them.” While relatives said, “The staff are very good, I think they are excellent” and “I have been very impressed with them.” Staff were well motivated and told us they found their role “very fulfilling.”

There were sufficient staff available to provide all of the service’s planned care visits. Records showed that care visits were normally provided on time and that staff stayed for the allocated time.. People told us, They are pretty well on time. Sometimes five minutes late but never more than that” and “They do have enough time, they don’t rush.” The service’s visit schedules were well organised and staff and people who used the service were provided with copies of their visit schedules each Friday. Staff told us the schedules were accurate and that they had enough time to travel between calls. People told us they had not experienced missed care visits and records showed the service had acted appropriately to ensure people’s safety when a planned care visit had been missed.

Managers visited people at home either prior to the first care visit or during the first week of care provision, to assess risks and identify the individual’s specific needs. This information was used to develop people’s care plans. These documents were accurate, informative and provided staff with enough detailed guidance to enable them to meet people’s care needs. The documents were regularly reviewed by managers who visited people at home to discuss their experience and identify any areas of improvement.

Staff were well trained. There were systems in place to manage staff training needs. All new staff completed formal training and shadowed experienced carers before being permitted to provide care independently. Staff told us, “I had a lot of training at the beginning before I started”, “I did I think nine courses before I started work” and We are always training.” Relative told us, “They do come and shadow before they do the visit on their own.”

Managers and staff understood the requirements of the Mental Capacity Act and recognised the importance of supporting people to make decisions. Care plans included guidance for staff on how to support people to make decisions and people said staff respected their choices. People told us, “They do what I want them to do” and “Certainly yes, they do treat me with respect.”

The service had experienced significant management changes since our last inspection. Although there was a registered manager in place this staff member had other responsibilities that meant they were not routinely present in the office. A new manager had recently been appointed and was leading the service effectively. This manager was based in the service full time and staff told us, “I have noticed a big change, it has improved since the change of manager” and “The new manager is lovely and communicates well.” Records showed staff meetings were held regularly and that staff had received formal supervision.

The service had appropriate quality assurance systems in place and was proactive in seeking people’s feedback about it’s performance. Where issues had been identified managers had worked collaboratively with staff to ensure these were addressed and resolved. People un

Inspection carried out on 21 to 23 April 2015

During a routine inspection

This inspection took place on 21 to 23 April 2015 and was announced 48 hours in advance in accordance with the Care Quality Commission’s current procedures for inspecting domiciliary care services. The inspection team consisted of one inspector and one expert by experience. The service was previously inspected in September 2013 when it was found to be fully compliant with the regulations.

Westcountry Home Care, trading as Alexandra’s, provides personal care to people who live in their own homes in south and west Cornwall. At the time of our inspection the service was providing care and support to approximately 200 predominantly older people.

The organisation was led by a registered manager who works part of each week in each of the service’s offices. 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 and associated Regulations about how the service is run.

People were pleased with the support they received and told us; “I can honestly say that the care is terrific, all of them, their care is second to none”, “Overall I would say they are excellent” and, “I have been flabbergasted, in a good way, at the dignity and respect that they treat me with.”

Recruitment procedures were robust. Staff had received appropriate training and knew how to respond if they had any concerns about a person’s welfare. When accidents or incidents occurred these were appropriately investigated.

The agency employed enough staff to meet people’s planned care needs. Staff received regular training, support and supervision. People told us their care staff were well trained and knew how to meet their care needs.

The service used a call monitoring system to track staff arrival and departure times from individual care visits to ensure people received the planned care. We found staff normally arrived on time and stayed for the full planned care visit. People told us, “They (care staff) are normally on time, never more than 15 minutes late”, ‘I have never been missed, they are very good.’ Staff said: “We definitely do all our visits”. During our inspection we identified two occasions where a care visit had been missed. Both incidents had been fully investigated by the service and where appropriate, changes made to further reduce the possibility of similar incidents occurring in future.

People received care from consistent groups of staff who they knew well. People and their relatives told us they enjoyed their care visits and said their staff took time to chat and laugh with the person they supported during care visits.

People told us their care plans were up to date and we found they were sufficiently detailed to enable staff to provide individualised care. The care plans included information about people’s life history and interests as well as clear guidance on the care each person required. Daily care records completed by staff at the end of each visit were detailed and informative.

People’s feedback was valued by the service. Complaints had been appropriately investigated and resolved to people’s satisfaction. A recent survey found people were happy with the care and support they received.

Staff were well motivated and told us, “The manager is amazing”. Staff were encouraged to visit the service’s office and regular team meetings and team building events were used to ensure office staff and carers worked effectively together as a team.