KEYFORT North West

KEYFORT North West is a domiciliary care service which provides personal and nursing care to people living in their own homes across the county of Cumbria who have a significant physical, neuropathic and complex care needs. There were 9 people using the service at the time of this inspection.

Not everyone who used the service received personal care. The service also provides a social, community-access service for several other people. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People said they received a bespoke service from their staff teams. They praised the staff for their care and kindness. People and relatives said staff were reliable and on time. There was good continuity of care so they had the same regular care staff members. Staff knew how to support each person in the way they preferred.

People and relatives said the service upheld their safety and they felt safe and comfortable when staff were supporting them. There were enough staff to cover everyone’s visits and to provide a contingency for any gaps. Any potential risks to people were assessed by the provider and safety measures put in place. The provider checked if staff were suitable to work with people. People had confidence in staff’s abilities and competence.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Records about consent were detailed and clear.

The provider had governance system to check the quality of the service. A management team had good oversight of the service and had improvement actions in place to address some historic gaps in staff refresher training.

People and relatives did not always feel communication with the provider was practical or effective. People said the service did not have a local office and contact by telephone was difficult. Staff felt valued and supported but also commented on communication with colleagues as an area for improvement. We have made a recommendation about improving contact between the provider and people.

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 (published 19 June 2018).

At our last inspection we recommended the provider made improvements to contingency staffing arrangements. At this inspection we found the provider had acted on the recommendation and staff contingency arrangements had improved.

Why we inspected

We carried out this inspection due to the length of time since the last inspection.

This report only covers our findings in relation to the key questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for KEYFORT North West on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation for the provider to support improved communication with people and staff.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Keyfort North West is a domiciliary care service. It provides personal and nursing care to people living in their own homes in the community who have a significant physical, neuropathic and complex care needs. The office is located near Carlisle but it provides support across the county of Cumbria. There were 15 people using the service at the time of this inspection. The service also provides a social, community-access service for several other people. CQC only inspects the service being received by people provided with the regulated activities of personal and nursing care.

At the last inspection of Keyfort North West (formerly known as Neuro Partners North West) in March 2016 we found the provider had breached two regulations. These related to the lack of contingency arrangements in place to cover unexpected absences of staff and the lack of access by management staff to current records about people’s care needs.

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 Well-Led to at least good. During this inspection we found improvements had been made to both areas, although we have made a recommendation about making continuing improvements to contingency staffing arrangements.

There was a registered manager in place at 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.

People said they felt safe and comfortable with their support staff team. Staff were trained and confident in how to report any concerns or safeguarding matters. There were detailed risk assessments in place to show staff how to keep people safe, for example when using specialist mobility equipment or when managing people's health needs. People’s medicines were kept in their own homes. If people need assistance with their medicines they were supported safely and appropriately by staff

Staff felt they had very good training and their competencies and skills were continuously checked. Staff were supervised and supported in their roles. People were supported to have choice and control of their lives and staff sought permission before assisting them. People were assisted to access health services when they needed them and their staff teams worked well with health care professionals.

People and relatives told us support staff were friendly, caring and helpful. They said staff treated people with dignity and respect. Staff respected people’s choices and decisions and supported them in a way which promoted their independence wherever possible.

People (or their relatives where appropriate) were fully included and involved in decisions about their care service and how their staff teams were managed. This meant people received a personalised service that was tailored to their individual needs. Support staff were very familiar with the way people wanted and needed to be supported.

The registered manager and management team were all relatively new to the service and had worked hard over the past year to look at ways of improving the service. The provider had quality assurance systems in place and a clear, achievable business plan that aimed to continuously develop the service.

Neuro Partners North West (Neuropartners) is a provider of domiciliary care and nursing services. They provide support for people with acquired brain injury or other complex needs. Their office is located in Carlisle but they provide support across the county of Cumbria.

The registered manager had recently left the employ of Neuropartners. 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. There was a temporary manager in place and we were aware of this prior to our inspection as Neuropartners had informed us of their interim management arrangements.

Staff in the service were aware of different types of abuse and knew how to report it.

Medicines were stored in people’s own homes and managed appropriately.

Staff had been provided with mandatory training and given additional training specific to their role.

The service assessed people’s nutritional and hydration needs and provided support accordingly. Staff recorded people’s food and fluid intake.

Staff worked with other health and social care provider’s to help ensure good outcomes for people who used the service.

Staff had developed good relationships with people and communicated in a warm and friendly manner.

Staff were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

Support plans were based on assessment and reflected the needs of people.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. We found evidence that the temporary manager and her team were dealing with complaints in accordance with the provider’s policy.

The temporary manager and her team carried out audits and quality checks to try and ensure the service was meeting the requirements of the Health and Social Care Act.

People told us that the service was currently well-led.

We found evidence of the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Regulation 18 – Staffing (1) Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed.

Regulation 17 – Good Governance (2) (c) Maintain securely and accurate, complete and contemporaneous record in respect of each service user.

We also made the following recommendations:

We recommend the service considers current good practice guidance in relation to supporting people to make informed choices.

We recommended that the service consider current guidance to continue to operate effective recruitment and selection procedures.

We looked at the support documentation held by the provider and used this information to assess that standards of quality and safety were being met. We found there were detailed support plans in place that enabled staff to provide the level of support needed. Staff we spoke with told us the information they received aided them to provide a specialist service. Service users received a level of care designed to meet their individual needs. Comments included, 'This is the best service I have worked in. It really is rewarding'. Also, 'Service users get the best service because it is well planned and monitored'.

We looked at training records that demonstrated staff supporting people had been provided with a range of opportunities to develop skills and competence to carry out their roles safely. In addition to mandatory training, staff were provided with service specific training in order to have the skills and competencies to meet the needs of individual service users.

We saw there were systems in place to make sure the agency was being managed and monitored in the best interests of people using the service.