Archived: Key Care & Support Limited

Key Care & Support Limited is a domiciliary care service, which provides support for both children and adults in the community, who require assistance with personal or nursing care. At the time of this inspection two adults were receiving personal care provided by Key Care & Support.

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

The provider had not ensured health care risks had been appropriately managed. Although staff understood where people required support to reduce the risk of avoidable harm, the care records did not contain explanations of the control measures to keep people safe. New staff had been recruited carefully and the consistency of staff teams helped to ensure people were safeguarded against abusive situations. Medicines were managed well and the staff team were trained in the prevention of cross infection.

People’s interests were documented within the care files and their likes and dislikes were recorded well. However, we recommend the provider obtains more detailed information about how people’s needs are to be best met before a package of care is arranged. The staff team were trained, but we recommend the provider makes improvements around end of life care and the formal supervision of staff.

People were not supported to have maximum choice and control of their lives, which was in their best interests. This was because care records we saw did not demonstrate the Mental Capacity Act was being followed or decisions were being made in people’s best interests. However, relatives told us staff supported people in the least restrictive way possible and the policies and systems in the service supported this practice.

Systems were in place for the management of complaints. People were treated with kindness by a caring staff team and their privacy and dignity was consistently respected. However, the provider had failed to ensure people’s care was properly planned and therefore person-centred care was not always being provided.

There was little oversight of the service and a robust system for assessing and monitoring the quality of service provided had not been established. Therefore, there were significant failings within the governance of the service, which resulted in the well-led domain being rated as Inadequate.

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

Why we inspected

This was a planned inspection based on the previous rating.

The last rating for this service was good (Published 6 December 2016). Since this rating was awarded the service has moved premises. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on our findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Key Care & Support Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, need for consent, person-centred care and good governance at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Key Care and Support is registered to provide personal care to people in their own homes. At the time of the inspection the service was providing personal care support for one person who was supported by one member of staff. The service was not actively seeking to increase the people it supported as it was concentrating on other areas of the business. The main area of work for Key Care and Support is the supply of agency staff to other organisations, for example NHS hospitals, care and residential homes.

The service had a registered manager in place. 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 not in the office during our inspection. We spoke with the care co-ordinator who was responsible for managing the one support package the service had.

The relative we spoke with said their loved one was safe supported by Key Care and Support. They currently employed their own personal assistants as well as having support from Key Care and Support. A review meeting was due to take place in the week following our inspection to review the care plans and potentially increase the support provided by the service. The care co-ordinator had plans in place for establishing a trained staff team, with additional staff trained to cover for annual leave and sickness, if this happened.

Staff had received training in safeguarding vulnerable adults and knew the correct action to take if they suspected any abuse had occurred. Staff said the care co-ordinator would listen to any concerns they raised.

Staff administered medicines safely via the percutaneous endoscopic gastrostomy (PEG) feeding tube ‘mickey’ button. Key Care and Support staff recorded all medicines administered and monitored food and fluid intake and used bowel charts. The care co-ordinator checked that the paperwork was correctly completed during the annual review. All paperwork remained at the person who used the service’s home. However the personal assistants did not complete the monitoring charts and daily logs. This was to be discussed at the forthcoming review meeting to agree clear instructions as to what was to be completed by whom so complete records were available if required.

The care plans in place were due to be reviewed. They were written in a person centred way and contained the preferences and choices of the person who used the service. Clearer guidelines were required for some tasks, for example when to support the person to turn over at night and the positioning required for some personal care tasks. Clear agreement of who was to complete what tasks was also to be agreed, for example who was to re-order the medicines.

Where external agencies such as the NHS provided equipment and guidelines for its use, these needed to be dated to clearly show they were current.

Risk assessments had been completed giving guidance to staff on how to mitigate the risks identified. These were updated annually.

Staff received annual refresher training including person centred care, fluids and nutrition, mental health, safeguarding vulnerable adults, basic life support and health and safety. Staff had also been trained in the use of the equipment provided and for PEG feeding. However these were not regularly refreshed unless the equipment changed. Observations of staff competency when using the equipment and administering medicines were not completed. The care co-ordinator said they would arrange for observations to be undertaken.

The person who used the service had capacity to make their own decisions. The care co-ordinator was aware of the requirements of the Mental Capacity Act (2005) if the service started to support people who did not have capacity to consent to their care and support.

A robust system of recruiting and training staff was in place. Staff completed mandatory training courses and any training required on the specific equipment the person who used the service used, for example a ventilator, PEG feed and cough assist machine .Staff would then complete two shifts shadowing an experienced member of staff before being placed on the rota.

Staff said they felt well supported by the care co-ordinator. They were in telephone contact at least monthly and more frequently if there were any issues or incidents. We were told the on call system was available out of office hours but only the care co-ordinator knew about the needs of the person who used the service. The staff member had supported the person who used the service for six years and knew them well. They therefore contacted the person’s family or other professional directly when required. This meant the staff had the skill, knowledge and support to provide effective support.

The care co-ordinator sought feedback from the person who used the service every three months. The feedback we saw was positive.

There was a system in place to record, investigate and learn from complaints. All issues to date with the service had been resolved informally. However we saw other parts of the agency had fully investigated the complaints made to them.

People we talked with who used Key Care and Support staff agency, had a high regard for the organisation and felt that staff were supported to be effective and safe workers. They told us: 'Key Care are very receptive and accommodating to the needs of the clients.'

And:

'From what I've experienced I've had no problems whatsoever. There is really good communication and they work with us well.'

People who worked for the agency told us: 'They have a good reputation amongst workers and the hospitals.'

And:

'We have all the training we need, everything you can think of, first aid, moving and handling, how to give injections or take bloods'everything.'

We found there were effective systems in place to ensure people were involved in planning their care and support.

People were protected because staff understood about infection control and preventing cross infection.

We found that a robust recruitment and selection process was used which meant the employment of good quality staff was promoted.

We found that when staff were supplied directly into people's homes, systems to check that assessments and care plans were up to date needed to be improved but quality monitoring that took place was effective because the provider listened to people and improvements made in response to what was said.