Jacaranda Healthcare Limited

Jacaranda Healthcare Limited is a domiciliary care service that provides personal care to adults with a range of support needs including people living with dementia. At the time of the inspection the service was providing personal care to 52 people living in their own homes in the local community.

Not everyone who used the service received personal care. 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 told us they felt safe with the care staff that supported them. Staff were aware of signs of abuse and how to report them, they felt confident that management would respond to any concerns.

People told us that they received support from regular care staff who mostly arrived on time and stayed for the allotted time. People told us staff always wore Personal Protective Equipment (PPE) and safe infection prevention and control practices were followed.

The provider had systems in place to assess risks to people before undertaking their care and support. However, we found that risks were not always fully and comprehensively assessed within care records. People received their medicines safely, however, the provider was not consistently following national guidance in the management of medicines.

People were supported by care staff who were skilled and trained to meet their support needs. Care staff told us they were well supported through supervision and annual appraisals.

People were supported to eat and drink enough where this was an assessed need. Care plans were person centred and detailed peoples background history and preferences. The service supported people to access relevant health care services where required.

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 provider had systems in place to monitor the quality and safety of the service. People and relatives spoke positively of the service and felt the service was well managed. The registered manager sought the views of people who used the service and people and relatives told us that the management team would respond to any requests or concerns.

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 2 March 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected Jacaranda Healthcare Limited on 8 and 19 December 2017 and the service was rated requires improvement. This was because we found four breaches of regulations. These related to medicines management, safe recruitment of staff, staff training and support and governance of the service.

At this inspection we found improvements and the service was no longer in breach of the regulations, and the service is now rated good overall.

The service had a registered manager in post. 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.

Since the last inspection the registered manager, together with external consultancy support had set up systems and processes to support the management of the service more effectively.

Medicines were safely managed by staff. Audits took place of medicines management and the quality of care provided by staff to people. Training and supervision were taking place regularly and the recruitment of staff was safe.

There was a complaints process in place and we saw that accidents and incidents were recorded. Staff understood the importance of safeguarding people from abuse and knew how to raise any concerns they had. The service had safeguarding processes in place.

Care plans were person centred, holistic in their approach to people’s needs, up to date and comprehensive. Risk assessments were in place and gave staff guidance in mitigating risks to people. The service worked in partnership with other healthcare professionals to ensure that people’s individual well-being was supported.

People told us staff were kind and caring and treated them with dignity and respect. There were enough staff who had time for their caring responsibilities, although staff were often late for calls. People told us staff were skilled in caring for them and understood their needs.

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.

People, relatives and staff were positive about the registered manager and the management of the service.

Further information is in the detailed findings below.

Not everyone using Jacaranda Healthcare Limited receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, which is help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had a registered manager. This 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.

At the first inspection of this service, in June 2016, the service was rated ‘Requires Improvement’. A subsequent shorter inspection in March 2017 established the provider had addressed all concerns arising from the previous inspection, but the rating was not changed because to do so required consistent good practice over time. The service’s rating from this current inspection remains ‘Requires Improvement’, the second time it has received that rating based on a comprehensive inspection.

At this inspection, we found people were not always safely supported with their medicines. There were instances where records demonstrated people had not received their medicines as prescribed. There were also inaccuracies and omissions on records of medicines support.

Recruitment procedures for recently recruited staff were not consistently robust at ensuring all reasonable checks, such as written reference and criminal record checks, were carried out before they worked in people’s homes.

We found staff did not always receive appropriate support and training to deliver effective care. This was primarily because new staff were not always fully trained before working with people, although there was better training of established staff. We also identified that staff working with someone who had diabetic needs did not have the skills and experience for this.

The service’s governance processes and audits were not consistently effective as they had not identified the concerns and service shortfalls we found. Office records were not always easily accessible and accurate, and oversight summaries such as for missed visits were not always up-to-date.

The service had enough staff to meet people’s needs, but feedback indicated visits were not always punctual. However, people’s feedback about the service was otherwise mainly positive, especially for staff who visited them regularly.

The service and care staff treated people with kindness, respect and compassion, and gave emotional support when needed. People's privacy and dignity was respected and promoted.

The service worked in co-operation with other organisations such as healthcare services to deliver effective care and support.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People’s views on the service were regularly sought and acted on.

People’s individual needs were met through the way the service was organised and delivered. This was particularly evident for helping some people regain skills and independence.

The service took steps to assess and manage safety risks to people, and to protect people from abuse. It supported people to eat and drink enough and maintain a balanced diet.

The service listened and responded to people’s concerns and complaints, and used this to improve the quality of care.

The service promoted a positive and inclusive culture in support of achieving good outcomes for people. Staff reported being well-supported overall.

Some systems at the service enabled sustainability and supported continuous learning and improvement. In particular, the service was in the process of introducing new software systems by which to plan and monitor the timing and quality of care visits better.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now meet legal requirements. This report only covers our findings in relation to those requirements and other areas where improvements were noted.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

Jacaranda Healthcare limited is a domiciliary care provider based in Barnet providing personal care and support to people in their own homes. People currently using the service include young people with physical disabilities, mental health, frail elderly and people with dementia. At the time of this inspection 58 people used the service.

At this inspection we found the service remained Requires Improvement. We found the provider had made some improvements, but these required more time to be embedded. A new format was introduced for assessing risks, an audit of staff recruitment files audit carried out and gaps identified being addressed by the service. New systems for monitoring the quality of the service had been introduced; this includes a more robust system to monitor missed calls.

We have made a recommendation in relation to staff recruitment.

Further information is in the detailed findings below

Jacaranda Healthcare limited is a domiciliary care provider based in Barnet providing personal care and support to people in their own homes. At the time of this inspection 39 people used the service.

There is a registered manager in post. 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 were supported in their own homes and told us they felt safe and satisfied with the service provided.

The provider had some systems in place to monitor the quality of the service, however improvements were required to ensure that all areas of care delivery were audited to identify any areas of concerns or weakness, so that people benefitted from a safe and reliable service. We saw that the provider was working closely with the local authority to improve the quality of the service.

Risks to people's safety and welfare were not always identified or action taken to reduce the risk. Care plans did not always reflect the care and support being provided by carers.

Systems were in place to ensure that people who used the service were protected from the risk of abuse. However, some staff did not have an understanding of what safeguarding means.

The provider followed the principles of the Mental Capacity Act 2005 (MCA 2005) and ensured that people consented to or were supported to consent to their care and support.

People were supported to choose what they wished to eat and drink and felt care staff understood their needs.

People were treated with dignity and their privacy was respected. People were encouraged to be as independent as they were able to be.

There was a complaints procedure and people knew how to use it. The provider took the appropriate action when complaints were raised.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were relating to risk assessments, safe care and treatment, staff training and governance.

You can see what actions we told the provider to take at the back of the full version of the report.