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Inspection carried out on 20 June 2018

During a routine inspection

This inspection took place on 20, 22 and 25 June 2018 and was announced. This service is a domiciliary care agency based in North Tyneside. It provides personal care to people living in their own homes throughout North Tyneside. Services were provided to adults with a wide range of health and social care needs. At the time of our inspection there were 65 people receiving a service.

Not everyone using Everlasting Care receives regulated activity; The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service had a registered manager in post. The registered manager had been in post since the service first registered in 2014. 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 in April 2017 we rated the service as 'Requires Improvement', we asked the provider to take action and make improvements to the induction and training of staff at the service. We also recommended that guidance was sought around specific risk assessments and a review of quality monitoring and record keeping was completed. We found these actions had been promptly completed and good practice has been sustained. We have therefore rated the service as 'Good'.

People were supported by staff to maintain their health, safety and welfare in their own home. The office staff had fully completed risk assessments of the known risks people faced. These were reviewed and updated to reflect changes in people’s needs. Care records now included information in case of an emergency within people’s homes.

New staff had received a company induction and a robust induction programme was now fully embedded into the service. Staff training was up to date. Most staff told us they now received regular supervision sessions, an annual appraisal and staff meetings took place. Records confirmed this. Staff told us they felt supported by the office staff.

The registered manager ensured the service was properly monitored. We saw audits had been improved and new audits and analysis of all aspects of the service had been implemented. We saw action plans were in place to ensure any issues highlighted were dealt with promptly.

Policies and procedures were in place to help staff safeguard people from harm. Incidents of a safeguarding nature had been recorded, investigated, reported and monitored. The local authority had no concerns about the service. People told us they felt safe with the regular support from staff.

Medicines were managed safely. Medicine administration records were up to date and fully completed. Competency checks on care workers were now in place to ensure staff remained competent in their role. Regular unannounced spot checks were conducted to ensure high standards were maintained.

Staff recruitment continued to be safe and robust. There were enough staff employed to safely meet people’s needs. People told us that care workers did not rush their duties and that they had regular care workers who arrived as expected most of the time.

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.

Care plans had been re-written and now included person-centred information. We saw a new review system had been implemented following our last inspection to ensure people received suitable care to meet their needs.

People told us that care workers made meals of their choice. External healthcare professionals were involved with people’s care to monitor their health and welfare.

Without exception, people and relatives told us their care workers were friendly and they were respected in their home. People said their dignity and privacy was always maintained.

There was a complaints policy in place. We saw all complaints and minor issues had been logged, investigated and resolved in a timely manner. No-one we spoke with raised any complaints about the service.

Customer and staff surveys had been carried out which showed mostly positive results. Our pre-inspection questionnaire responses corroborated this.

Inspection carried out on 25 April 2017

During a routine inspection

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.

Inspection carried out on 11 December 2014

During a routine inspection

We undertook an announced inspection at Everlasting Care Ltd on 11 December 2014. We told the registered provider two days before our visit that we would be coming. This was due to the nature of the service and to ensure people who used the service and staff were available to assist us with the inspection.

This was the first inspection at this location. A previous inspection undertaken on 11 February 2013 at the registered providers previous location found there was a breach of regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found an issue with record keeping at the service. We said, “People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.” We said this had a minor impact on people who used the service. At this inspection we found that improvements have been made and the registered provider had rectified the issues identified.

The service is registered to provide personal care and support to people within their own homes; some of whom are living with dementia or related conditions, learning disabilities, mental health issues and/or a physical disability. At the time of our inspection there were 66 people using the service that received support and personal care.

The service had a registered manager in place who had been registered with the Care Quality Commission to manage 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.

The registered provider had policies and procedures in place which were there to protect people from abuse. Staff we spoke with understood the types of abuse and what the procedure was to report any such incidents. Records showed staff had received training in how to safeguard adults. A whistleblowing policy was also in place. Staff we spoke with again demonstrated what process to follow when raising concerns.

Social work or healthcare professionals assessed the dependency level of people who used the service. They then decided the correct staffing needed to provide effective support to people. Records showed the registered provider had sufficient staff in place to meet people’s needs.

Staff received training that was specifically designed to give them the correct skills for their role. Records and staff confirmed they had received the training required for their role. Staff received supervision and appraisal.

There was an effective recruitment system in place to ensure that those staff employed were safe to work with vulnerable people. Suitable checks were carried out for prospective candidates before they started working with people.

People’s medicines were managed effectively and the registered provider had policies and procedures in place to provide staff with guidance in this area. Staff demonstrated a good knowledge of how to manage people’s medicines safely.

Mental capacity was assessed by either social work or healthcare professionals and this information was shared with the registered provider who used them to develop care plans for people. Where people lacked capacity, decisions were taken in their best interests. Care plans included instructions on how they should be supported and included their needs, likes and dislikes.

People told us staff knew them well and had a good understanding of their needs. They said staff were respectful to them when supporting them. People’s wellbeing was monitored and people were supported to access support from healthcare professionals such as, general practitioners.

The registered provider measured quality assurance by providing people with surveys to obtain their views on the quality of the service they received. The registered manager also monitored safety and quality at their head office and in people’s own homes. The areas monitored included; health and safety, infection control and fire safety. We saw staff views were obtained during individual one to one supervisions and staff meetings and that these meetings were recorded.

The registered provider kept records including; care plans, risk assessments and staff files. These were well maintained and fit for purpose. We saw they were stored securely.