Archived: Evolving Care Limited

Evolving Care is a registered domiciliary care agency. It provides personal care to people living in their own homes in the community. At the time of inspection there were 44 people being supported with personal care. People supported included older people and people living with dementia.

People's experience using the service

People felt safe. There were systems to protect people from the risk of abuse and harm.

Medicines were managed safely.

Staff had the training and knowledge to effectively meet people’s healthcare needs.

People were treated with dignity and respect and encouraged to maintain their independence.

People’s choices were promoted, and staff worked within the principles of the Mental Capacity Act 2005

Staff showed kind and caring attitudes to the people that they supported.

The care and support people received reflected their personal needs and preferences.

Processes were in place to monitor and improve the quality of the service.

There was a culture of openness and lessons were learnt when things went wrong to continuously improve the service.

Rating at last inspection:

At the last inspection the service was rated Good. However, we found the service was not consistently well led and this key question was rated as Requires Improvement (The last report was published on 16 May 2018). We found that improvements had been made and the service is now rated good in all key areas.

Why we inspected:

This was a planned inspection to check that this service was meeting the regulations.

Follow up:

We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

At the last comprehensive inspection on 03 and 10 August 2017, we found breaches of Regulations 9, 12, 17, 20A of the Health and Social Care Act (Regulated Activities) Regulations 2014. We gave the provider an overall rating of Inadequate. The breaches related to the provider’s failure to ensure people received care at the right time and in the right way so people’s safety was maintained. In addition, the provider had not made sure people’s care was consistently focused on each person and the provider’s quality checks had not assisted in people receiving high quality care. The provider sent us an action plan setting out the improvements they intended to make.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the provider showed improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this comprehensive inspection, we found the provider had made improvements to the services people received in their homes, and they were now meeting the Regulations. People received care centred on each person, shaped around their individual safety needs, choices and preferences due to improvements in care call scheduling and monitoring. The provider had improved the effectiveness of their checking systems to monitor the quality of the service people received. This included a planned rolling programme of checks targeted on key aspects of the service, such as monitoring care calls, incidents and accidents and people's care plans. Based on the outcomes of the last comprehensive inspection, the provider had increased their oversight of the services provided to support the registered manager in driving through improvements.

Evolving Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults and children. At the time of this inspection 60 people were provided with ‘personal care’ in their own homes.

Not everyone using Evolving Care Limited receives regulated activity; 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 take into account any wider social care provided.

There was a registered manager in post at the time of our inspection. 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 told us they felt safe in the knowledge staff knew how to meet their individual needs. Staff knew people well and the management of care calls supported staff to arrive at people’s homes at the right times so people’s safety was not impacted on. The provider’s management arrangements relevant to scheduling and monitoring people’s care calls now needs to be sustained together with gaining people’s views of their care.

The provider had arrangements in place to make sure there were enough staff to meet people’s assessed needs and risk plans had been developed further. Staff had undergone recruitment checks so the provider could assure themselves potential new staff were not barred from supporting people who used the service.

People were supported by staff who had the knowledge to make sure all safety precautions were taken. This included supporting people with the right equipment so cross infections were reduced. The provider had developed a system whereby the management and staff team were able to learn from incidents and accidents to reduce future risks to people.

People told us they believed staff had received the training they required as their needs were met by the care provided. Staff showed they were aware of people’s needs and how assistive technology and aids could support staff in supporting people’s diverse needs in an effective way.

Staff consistently felt they were supported by their colleagues and the management team. There had been improvements made to follow through staff performance to ensure people received positive outcomes from the care provided.

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. This included involving people in decisions about their day to day care. Staff knew which people may need help to make some key decisions about their lives and understood what action to take so people received the support they needed in these circumstances.

When required people were supported to eat and drink enough. Staff followed the arrangements in place to support people with their health needs.

People were complimentary about the staff they knew well and how they were caring in their approaches. People told us staff supported them in different ways so their dignity and privacy was maintained during the care provided. Staff valued the improved management of care calls as this supported them in providing continuity of care to people in their homes. Staff respected people’s right to confidentiality which included care records being stored securely at the provider’s office. The provider made sure staff had information to support people if they should need an advocate.

People felt their individual needs were responded to by staff who knew how to involve people in their care so people’s choices and preferences became part of their support received in their homes. Staff were consistent in how they responded to changes in people’s needs. Staff told us how daily records together with conversations with colleagues and the management team supported people to receive the right care at the right times.

People told us the improvements made following the last inspection had a positive impact on the care they received and this had influenced people’s responses in stating the service they received was well managed.

Following the last inspection the provider had recognised they needed to have a clearer oversight of the services provided. This was so they could assure themselves care developed was of a consistently high quality. The provider and the management team had worked hard to ensure improvements were driven through however; there has not been sufficient time to show the provider has embedded and sustained their quality assurance systems over a longer period of time.

Further information is in the detailed findings below.

Evolving Care Limited provides personal care for people in their own home. There were 111 people receiving services for which CQC registration was required at the time we inspected.

A registered manager who was also the provider was in post at the time of our inspection. 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 was run.

We found improvements evidenced at the last inspection had not been sustained.

Plans were in place to manage people’s safety but people did not benefit from receiving care based on their assessed needs which was managed in ways that reduced risks to their safety. This was because people did not always receive the care they needed at the time they needed it for the duration required. Some people did not have regular carer staff who knew their safety risks well. Risks to some people were increased because staff did not consistently provide the care they needed to have their medicines as assessed.

Other people did benefit from being regularly supported by the same carer staff. Staff had received training in how to administer people’s medicines. People were comfortable with the staff that regularly supported them and staff understood what actions to take to protect people from the risk of potential abuse.

People did not always benefit from receiving a service where the systems and procedures needed to support their care worked effectively. This included how people’s care calls were managed. The systems used to monitor people’s care had not driven through improvements needed in the care people received in a timely way. The registered manager had not notified us of some important things they are required to do, in law. Staff understood how the registered manager and senior staff expected people’s care to be given, and some of the systems used to monitor the quality of the care people received were working effectively.

People and their relatives let staff know how they wanted their care to be planned, however, people did not always receive their care as it had been agreed. Other people did receive the care they wanted in the ways they preferred. People had been given information on how to raise any concerns or complaints. Processes for managing complaints were in place, but we found there were instances such as missed calls where improvements required were not always sustained.

Staff had not always been given the support required in order to care for some people, including information about people’s needs and regular meetings with their line manager. Other people did receive care from staff with the knowledge and skills they needed to care for them. Further training and one to one meetings with their managers were being planned, immediately after our inspection so staff would be supported to provide good care.

Staff checked people were in agreement for care to be provided and the actions they needed to take to promote people’s rights. Where people received the care that had been planned for them people were encouraged to have enough to drink and eat by staff who respected their preferences and dietary needs. There was a risk some people would not have the care they needed to maintain their health because there care was not always provided as agreed. Staff who cared for people regularly understood risks to people’s health and well-being and worked with people and health professionals to support people to maintain their health.

Some people had not been able to develop meaningful relationships with staff as they were not always supported by the same staff members. Other people had built caring relationships with staff that regularly cared for them. Staff who regularly cared for people listened to them and took action to make sure people were receiving their daily care in the ways they wanted. People were supported by staff who took their need for dignity and privacy into account.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection visit was undertaken on 22 June 2016 and was unannounced. At the time of our inspection visit 55 people received care and support services in their own homes.

There was a registered manager in post at the time of our inspection visit. 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 told us they felt safe with the staff who came into their homes and they knew how to provide the care people required. Staff were able to describe in detail the needs of people they supported and how to promote people’s safety from potential harm or abuse. Staff showed an awareness of the risks to people as these had been identified, assessed and were regularly reviewed. Staff had specific details of all the potential risks to people accurately recorded in their care records to inform staff when supporting people in their own homes to manage these. This was an improvement which had been made following our last inspection in April 2016.

People received their care on time and if staff were going to be late, people were informed of this. Efforts had been made to ensure wherever possible people were provided with care and support from staff they knew well in order to promote continuity of care for people.

People were prompted and supported with their medicines when needed, by staff who had received the training to be able to do this.

People were supported by staff whose backgrounds had been checked before they started to work with people. This was to make sure they were suitable to provide care to people in their own homes and keep them safe. All staff received an induction, training and on-going support in order to support people’s individual needs effectively.

People said they felt the staff and management were approachable and listened to their views about the care they received. They told us that nothing was done without their consent. Staff told us all care was centred on each person and could only be given if the person consented.

People, who needed assistance at meal times, were provided with this by staff who knew their individual dietary needs and recorded the support provided within daily notes. Staff referred people to other health and social care professionals when this was required for advice and support so people’s health needs were effectively met.

People told us they had developed good relationships with staff who they had become to know well and felt staff were caring. The registered manager had listened to people’s views to ensure the care they received was responsive to their particular needs. This included ensuring the planning of staff was based on people’s own expectations of the times they needed their care.

People knew how to raise any concerns and or complaints they had but had not needed to do this. They felt if they did need to raise any complaints these would be listened to with action taken to resolves the issues. The registered manager had acknowledged and taken action when any complaints had been received to ensure people were satisfied with their care.

People benefitted from a service which was well managed by a management team who were responsive to the aspects of the service provision which required to be improved following our last inspection. This included the development of a more consistent approach to regularly monitoring the quality of the service by completing a range of checks. They had also gained regular feedback from people who used the service and their families to make sure continual improvements were made to further enhance people’s care experiences.