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Wealden community Care Limited Requires improvement

This service was previously registered at a different address - see old profile

Reports


Inspection carried out on 4 July 2019

During a routine inspection

About the service:

Wealden Community Care provides personal care to people living in their own houses and flats. It provides a service to older adults, some of whom are living with dementia. Not everyone using Wealden Community Care receives a 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. At the time of the inspection there were approximately 110 people using this service.

People’s experience of using this service:

People didn’t always receive their calls on time and staff didn’t always stay for the full duration of their visit. Some people were happy with this flexibility but the majority of people did not like it. There was no audit or quality assurance check in place to monitor times and durations although the service did have a call monitoring system in place. There was a mixture of feedback from people receiving care from this service. Some people described staff as caring and kind but other people did not. When some people had complained to the office there had been no written response or record of an outcome. People told us office staff had sometimes been uncaring in their response.

Although some audits and checks were being completed, they had failed to adequately address the re-occurring medicine errors. Some care plans did not contain much person-centred information. Risk assessments were not always detailed or fully completed in relation to known risks. Recruitment processes were not always followed correctly to ensure staff were safe and competent.

The management team did not always actively engage staff in staff meetings. People were engaged via questionnaires and phone surveys.

People were involved in decisions around their care and encouraged to be independent where possible. People’s rights were protected in line with the principles of the Mental Capacity Act 2005. Staff were up to date with mandatory training and received regular supervision. There was an effective communication system in place and referrals to healthcare professionals were made where required. The service completed pre-assessments to ensure they could meet people’s needs and followed national guidance and best practice. The registered manager had links to local organisations where best practice, knowledge and training resources were available.

Rating at last inspection:

Good (25 June 2018)

Why we inspected:

The inspection was prompted in part due to concerns received about unsafe medicines management, staff turning up late at visits, staff being uncaring, unsafe care and treatment. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Caring, Responsive and Well Led sections of this full report.

Enforcement:

You can see what action we have asked the provider to take at the end of this full report.

Follow up:

We will continue to monitor the service closely and will return to inspect the service again in line with our policies.

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

Inspection carried out on 26 March 2018

During a routine inspection

We inspected the service on 25 March 2018. The inspection was announced. Wealden Community Care is a domiciliary care agency registered to provide personal care to adults with physical disabilities, learning disabilities, and dementia. It provides care to people living in their own houses and flats. Not everyone using Wealden Community Care receives a 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. At the time of the inspection Wealden Community Care provided a service to 73 people.

The service had a registered manager. 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.

At the last comprehensive inspection on 2 December 2016 the overall rating of the service was, ‘Requires Improvement’. We found that there were six breaches of the regulations. This was because the registered provider had not ensured people were kept safe from risks or avoidable harm. We also found they had not ensured that safe recruitment procedures were followed. Furthermore, they had not ensured medicines were being managed safely. In addition, we found that the service had not kept complete and up to date records of each person. The registered provider had not ensured that consent was sought in line with the Mental Capacity Act 2005 (MCA). Also, we found care was not always delivered in a person centred way. Lastly, we concluded that the registered provider had not ensured that quality monitoring was effective in highlighting shortfalls in the service. We told the registered persons to take action to make improvements to address each of our concerns and they subsequently told us that this had been done.

At this inspection we found the action taken was sufficient to meet the breaches identified above. Our other findings at the present inspection were as follows. People were protected from abuse. Staff were able to identify different types of abuse and were confident in reporting concerns when required. There were a sufficient number of staff on duty to meet the needs of the people using the service. Staffing levels were planned around the needs of people and rotas showed these were consistent. People were protected by the prevention and control of infection where possible. Accidents and incidents were reported by staff in line with the provider’s policy, and the registered manager took steps to ensure that lessons were learned when things went wrong. The registered manager kept a log of incidents concerning the safety of staff, and took appropriate action. However, the registered manager had not submitted one notification to us relating to a safeguarding incident.

People’s needs were assessed and their care was delivered in line with current legislation. When the service was responsible, people were supported to eat and drink enough to maintain a balanced diet. Appropriate referrals were made to dietician and Speech and Language teams. Staff received training which ensured they had the skills and knowledge to deliver effective care. Staff we spoke with had a good level of knowledge about the roles and responsibilities when supporting people. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff worked together to ensure that people received consistent and person-centred support when they moved between different services.

Staff were encouraged to develop positive, caring relationships with the people they supported. Staff supported people t

Inspection carried out on 2 December 2016

During a routine inspection

We inspected Wealden Community Care Ltd on 02 and 06 December 2016. The inspection was announced so that we could ensure people and records we would need to see were available. Wealden Community Care Ltd is a domiciliary care agency registered to provide personal care for people who require support in their own home. The organisation is registered to provide care to people with a learning disability or autism spectrum disorder, dementia, older people and younger adults. At the time of our inspection Wealden Community Care Ltd were providing care to 160 people who had a range of needs from old age, cerebral palsy, dementia, mental health, Alzheimer’s disease and end of life care. The service employed 55 staff and one office manager. The registered provider had four care co-ordinators who manage a geographical location of care calls. The registered provider used an electronic tracker where carers log in and out of care calls using a telephone line.

At the time of our inspection there was a registered manager at the service but they were no longer in day to day control. 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. However, the registered manager confirmed they would de-register and there was an acting manager who was in the process of registering with CQC.

People were protected from the risk of abuse but were susceptible to the risk from avoidable harm. For example key safe number s had been emailed to unsecure email addresses. Risks were not assessed comprehensively and where hazards had been identified these had not been mitigated fully. Medicines were not effectively being managed as the recording sheets used did not contain information about each medicines and prescribing instructions. In addition this information was not contained on any other part of the care plan.

Recruitment procedures were not consistently being followed and staff had not always had the correct pre-employment checks prior to working with people.

People had access to healthcare professionals but they were at risk of not having their health needs met as information was not consistently updated. For example one person had important changes to how staff should support them to eat and drink but these had not been included in the care plan three months after the changes had been made.

Consent had not consistently been sought and the principles of the Mental Capacity Act 2005 (MCA) had not consistently been complied with. Two people were being supported with the use of bed rails but the registered provider had not considered whether the use of bed rails was restrictive. Care plans did not always have consent forms signed by people or their representatives.

Care plans were not consistently person centred and did not always contain the person’s ‘voice’ or their input. One person’s care plan had failed to mention a diagnosis of mental health problems and how best to support the person in this area.

Quality monitoring systems were not effective in identifying shortfalls in the service and the current system had not been reviewed on a monthly basis as per the system requirements.

The staff were kind and caring and treated people with dignity and respect. Caring relationships were seen throughout the day of our inspection. Staff knew the people they cared for well. People spoke positively about the care and support they received from staff members.

People receive adequate food and drink and where necessary the registered provider uses food and fluid charts to monitor how much people are consuming. However, some records were not always complete and some plans lacked detail about people’s food preferences. We have made a recommendation about this in our report.

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