Everlasting Care Ltd is based in North Shields and provides a domiciliary (care at home) service for approximately 70 people most of whom are elderly or have physical and/or mental health related conditions living throughout North Tyneside.
We last inspected the service in December 2014 and rated the service as ‘Good.’ At this inspection we found the service required improvement. This was because they were not meeting some legal requirements.
A registered manager was in post and this manager had not changed since our last inspection of the service. The registered manager was also the provider. 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.
The registered manager was on annual leave at the time of our visit to the office. On her return, we spoke with her about the service and our findings. She shared further documentation for us to review which had not been accessible to the office staff at the time of inspection.
A robust induction programme such as the ‘care certificate’ had not been fully implemented at the service and because of this some staff had not had their competency assessed against the minimum standards which are expected. Formal ‘on-the-job’ competency checks of experienced staff were not always conducted. Training had not always been routinely refreshed and specific training to meet the needs of the people who used the service such as dementia awareness and challenging behaviour was not routinely arranged.
Risk assessments had not always been carried out to address the individual risks people faced in their daily lives. Those which were in place did not consistently contain plans for managing or reducing risks and required some further development. We have made a recommendation about this.
Some checks were carried out to monitor the quality and safety of the service. Although there was no evidence of auditing or analysis of the overall service, the oversight of service delivery through spot checking of care staff and the records kept in people’s own homes had been effective to a degree and highlighted some areas for improvement which were promptly addressed by the office staff. The issues we found regarding the lack of individual support plans, risk assessments and training had been partially identified prior to our inspection but were not fully addressed. We have made a recommendation about this.
Recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people and there were sufficient numbers of staff employed by the service to meet people’s needs and preferences. We saw evidence of a shadowing period for new staff. All staff were supported though an annual appraisal however formal periodic supervision sessions were not carried out.
There were safeguarding procedures in place. Staff were knowledgeable about what action they should take if suspected anyone was at risk from harm or abuse. The local authority safeguarding team informed us that were no on-going organisational safeguarding matters regarding the service.
Medicines continued to be managed safely and administration procedures were followed correctly by care workers. People's nutrition and hydration needs were met and they were supported to access healthcare services when required to monitor health and well-being.
People’s rights under the Mental Capacity Act 2005 (MCA) were protected. Care staff supported people to have maximum choice and control of their lives in the least restrictive way possible; company policies and procedures supported this practice. Care records showed people were involved in their care and support.
We observed lots of positive interactions between staff and people who used the service. Staff demonstrated a caring and compassionate attitude and they protected and promoted people's privacy and dignity.
All staff were very positive about working for the company, which they described as ‘family run’. They all told us they felt valued and enjoyed their roles. We observed that they projected this positivity when they engaged with people.
Person-centred care plans devised by the service were not always in place. Those which were detailed the individual care and support people required. Information from other agencies such as the local authority was available to staff. Reviews of people’s needs required further development. We have made a recommendation about this.
Care staff demonstrated that they knew people’s likes, dislikes, preferences and routines. Arrangements for social and emotional support met people’s individual needs.
There was a complaints procedure in place. We reviewed the complaints received by the service since our last inspection and saw they continued to be responded to thoroughly and in a timely manner.
We have identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 entitled Staffing. You can see what action we told the provider to take at the back of the full version of the report.