Archived: Community Care Direct

Community Care Direct is a home care provider which offers domiciliary care and support for people within their own homes. The service was providing support to 40 people at the time of the inspection.

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

At the last inspection in September 2020 we had found the provider in breach of regulation with regards to the governance and running of the service. At this inspection we found continued management issues and there was a lack of overall governance and monitoring systems. The provider remains in breach of regulation.

There remained a lack of clarity regarding the senior manager roles in terms of the running of the agency. Since the last inspection the registered manager had maintained safe standards of care as reported by people using the service. However, there had been no development with respect to auditing systems to monitor and ensure safe standards were maintained. The overall governance of the service was poor with a lack of updated records being maintained in staff training, care, medicines and assessing clinical risk.

People reported good support regarding the management of their medicines and told us they get their medicines on time. There were some anomalies with medication records and the auditing processes had not been carried out effectively and had not picked these up. Although staff underwent training, they were not being formally monitored in terms of their ongoing competency to administer medicines. These findings were similar to the last inspection. Following our feedback, the provider ensured all staff administering medications had been checked for competency.

The agency had move location since the last inspection and were in the process of staff recruitment. There was enough staff to carry out the care and support needed. Current staff had been recruited safely.

People's experience of using the service was mostly positive. People told us they received their care and support when required and at their preferred times. People and family members told us staff were helpful and kind.

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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 Requires improvement (published 16 December 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance and management of the service. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to a safeguarding concern received about the support and care for a person. We also had some concerns about the service being responsive to regulatory requirements such as timely submission of statutory notifications. The service was also in breach of regulations from the last inspection. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well led key question of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. 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 Care Concern (UK) on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to good governance at this inspection.

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

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.

Community Care Direct is a home care provider which offers domiciliary care and support for people within their own homes. The service was providing support to 31 people at the time of the inspection.

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

Leading up to the inspection the service has undergone a period of management change and disruption following the last registered manager leaving and the appointment of the current registered manager. Over this period, we received feedback which raised concern around the general management and running of the agency.

On inspection, some staff reported a lack of clarity regarding the senior manager roles in terms of the running of the agency. The recent history leading to the inspection and the staff feedback suggest this is the main barrier to progress.

Quality audits were carried out but needed further developing to help ensure continued monitoring and bring about improvements.

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People's experience of using the service was mostly positive. People received the care and support when required and at their preferred times. People said they received the same carers most of the time. People and family members told us staff were helpful and kind. Positive relationships had been developed between staff and people they supported. People said calls to their home were rarely missed and that staff usually arrived on time.

Although feedback about care delivery was positive, this was carried out by some staff working excess hours. Some staff reported low moral because of this. There was a realisation that more staff needed to be recruited. Current staff had been recruited safely.

People reported good support regarding the management of their medicines and told us they get their medicines on time. There were some anomalies with medication records and the auditing processes had not picked these up. Although staff underwent training, they were not being formally monitored in terms of their ongoing competency to administer medicines.

The new registered manager was a positive force in leading the service.

The service worked effectively with other professionals.

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 8 August 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the overall management of the agency and how this might affect standards of care. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. 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 Community Care Direct on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to the monitoring of quality and care at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

At the time of our inspection the service was providing packages of care to 18 people.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing]. It provides a service to older adults and younger disabled adults. Not everyone being supported by Community Care Direct received personal care. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks relating 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.

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.’

During our last inspection in June 2017, we found no breaches of any of the health and social care regulations however the service was rated as requires improvement. This was because the service had previously been rated as inadequate and placed in special measures and we wanted to ensure the service could sustain good practice.

Staff were recruited safely and checks were made on their character and suitability to work. Staff were only allowed to work once these checks came back as satisfactory.

Risks assessments were in place and were reviewed regularly. Risk assessments were suitably detailed and contained information with regards to the management ofrisk.

Medication was stored in people's own home and administered safely. Where staff were responsible for administering people's medication this was done by trained staff who had had their competency assessed.

Staff were provided with Personal Protective Equipment (PPE) such as gloves and aprons in accordance with the service's infection control procedure.

Staff were aware of safeguarding procedures and were able to describe the action they would take to ensure people were kept safe from harm. This included raising alerts to the registered manager, local authority safeguarding teams, the police, or whistleblowing.

Rotas showed that staff were assigned their care calls using an electric monitoring system (ECM). Staff were issued smart phones and were required to 'log' in and out of calls to ensure people were getting their allocated time. Records showed this system had been implemented since our last inspection.

The registered manager and the staff understood the principles of the Mental Capacity Act 2005 and associated legislation.

People were supported with eating and drinking and staff were aware of people’s dietary preferences.

Staff supported people to contact other healthcare professionals such as GP’s and District Nurses if they felt unwell.

Staff undertook training in accordance with the registered providers training policy. Staff told us they enjoyed the training. Training was a mixture of e-learning and practical training sessions. Staff spoken with confirmed they had regular supervision and appraisal.

Additional role specific training took place to help people manage their support needs. This training was overseen by a registered nurse who assessed staff competency once they had attended the training.

People we spoke with were complimentary about the caring nature of the staff and we received positive comments about the registered provider in general.

People told us that they were always kept informed and involved in their care.

We did not observe care being delivered, however, people told us staff were kind and caring in their approach.

Care plans contained detailed information about people, what their preferences were and how they liked their care to be conducted. Information in care plans was regularly reviewed and updated in line with people’s changing needs. This meant that the registered provider was responsive to people’s needs and preferences.

Complaints were investigated in line with the complaints procedure and responded to appropriately.

Audits took place which checked service provision and action plans were implemented to improve practice.

Feedback was gathered from people using the service and people told us they felt that the registered manager had responded to their comments.

Community Care Direct is a domiciliary care agency providing care to people with complex health needs in their own homes. At the time of the inspection Community Care Direct was providing care to 18 people and employed 36 staff.

Following an inspection in November 2015 the service was rated Inadequate and placed in special measures. Enforcement action was taken and we served a notice that restricted the service from accepting any new service users until the necessary improvements had been made. We inspected the service again in May 2016 and rated it Inadequate for a second time. At our inspection in November 2016 the service was rated as inadequate for a third time with persistent breaches of regulation. The service remained in special measures while the Commission considered its regulatory response.

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. At this inspection we found improvements in all areas and all previous breaches of regulations had been met. Because of the improvements the overall quality rating has been raised to ‘requires improvement’ and the service has been removed from special measures.

A registered manager was 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.

At the previous inspection we found that the service was in breach of regulation relating to safe care and treatment and in particular; the management of risk, safe management of medicines and the management of incidents and accidents.

We found that risk assessments had been significantly improved. Each record contained an environmental risk assessment as indicated in the provider’s action plan and other records were sufficiently detailed and showed evidence of regular review. The service was no longer in breach of regulation in this regard.

At the previous inspection we identified a concern with the clarity and consistency of records relating to the administration of medicines. As part of this inspection we checked a sample of Medication Administration Records (MAR’s) and saw that they were completed correctly.

At the last inspection we were provided with information to suggest that incident and accidents records had not been completed as required or that appropriate action had not been taken following incidents and accidents. We saw that records were completed in sufficient detail and had been analysed to look for patterns and trends which could help reduce risk in the future. The service was no longer in breach of regulation in this regard.

At our last inspection we found that the service was in breach of regulation because consent was not always considered in accordance with the principles of the Mental Capacity Act 2005 (MCA). At this inspection we saw the service was operating in accordance with the principles of the MCA and was no longer in breach of regulation relating to consent.

At the last inspection we found the service to be in breach of regulation because the quality of communication with staff was not consistent. This meant that people were at increased risk of calls being delayed or missed. As part of this inspection we checked paper-based and electronic communication records to ensure that they were complete. The records that we saw were significantly improved since the last inspection. Each communication was clear and resulted in an action where appropriate. The service was no longer in breach of regulation in this regard.

At the last inspection we received information of concern indicating that staff did not always stay for the duration of the scheduled call. During this inspection we spoke with people receiving care, staff and the registered manager. None of the people that we spoke with expressed concern that staff did not stay for the full duration of the call. We also looked at records to establish if care had been delivered in accordance with contractual requirements. People told us that staff were occasionally late, but we were told that communication regarding late calls had improved. The records that we saw supported this view.

The staff that we spoke with had received training in safeguarding and understood their responsibility to report concerns internally and externally as required. There had been no recent incidents which required a safeguarding referral. Staff were deployed in sufficient numbers to meet people’s needs and were recruited safely following a process which included individual interviews and shadow shifts.

We looked at records relating to staff training and support and spoke with staff. We saw that training which was appropriate to the needs of people using the service had been provided on a regular basis.

Following the previous inspection we made a recommendation regarding the Care Certificate. The registered manager confirmed that all staff were expected to complete the Care Certificate to demonstrate their competency. The records that we saw indicated that the process had been completed appropriately.

Following the previous inspection we made a recommendation because staff had not received formal supervision consistently. As part of this inspection we spoke with staff and checked supervision records. Staff told us that they had access to formal supervision at least twice per year, but they also confirmed that they could ask for additional supervision and support as required.

At the last inspection we made a recommendation because communication regarding people’s care was not always completed in a timely manner or to a sufficient standard. Both people using the service and staff told us that the timeliness and quality of communication had improved since the last inspection.

At our last inspection we found the service remained in breach of regulation relating to person-centred care. The records that we saw contained sufficiently detailed, person-centred information to support staff in the provision of care. We saw that the plans had been signed by the person or their nominated relative and had been subject to regular review.

During the previous inspection we saw that call times were regularly subject to change at short notice. During this inspection we saw that the situation had stabilised and showed signs of improvement following the introduction of the electronic planning system. The service was no longer in breach of regulation in this regard.

We checked records relating to receiving and acting on complaints. Since the last inspection records indicated that each complaint had been processed in a timely manner and had generated a written response.

At our last inspection we found the service was in breach of regulation regarding governance. The records we saw and the comments made by people using the service and staff clearly indicated that significant improvements had been made and sustained since the last inspection. The service was no longer in breach of regulation in this regard.

People and their relatives spoke positively about the attitude of staff and the quality of care that they provided. Staff understood the need to provide dignity in the provision of personal care and offered examples of how they achieved this in practice.

It was clear that the staff we spoke with were honest about the pressure that they experienced because some calls were short, but the majority of calls allowed sufficient time for staff to spend time speaking with people as well as providing care.

The staff that we spoke with were enthusiastic about their roles and were motivated to provide good quality care. Staff spoke positively about the quality of management, communication and the impact of the new electronic systems.

The registered manager and owner were able to describe a clear vision for the development of the service and were realistic about targets. They confirmed that any growth would be managed in a manner that did not compromise the improvements that they had made.

At the inspection in November 2015 the service was rated inadequate and placed in special measures with breaches of regulations 9, 10, 11, 12, 13, 16, 17, 18 and 19. At our next inspection in May 2016 the service was again rated as inadequate with continued breaches of regulations 9, 10, 11, 12, 16, 17, and 18. Following the inspection in November 2015 enforcement action was taken and we served a notice that restricted the service from accepting any new service users until the necessary improvements had been made. This restriction remained in place following the inspection in May 2016. We found that the agency had adhered to this legal requirement at the time of our inspection.

Community Care Direct is a domiciliary care agency providing care to people with complex health needs in their own homes. At the time of the inspection Community Care Direct was providing care to 26 people and employed 35 staff.

A registered manager was 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.

At the last inspection in May 2016, we asked the provider to take action to make improvements in relation to person-centred care, dignity and respect, need for consent, safe care and treatment, receiving and acting on complaints, good governance and staffing.

Actions in relation to receiving and acting on complaints, dignity and respect and staffing had been completed. Actions in relation to consent, person-centred care, safe care and treatment and good governance had not been completed and the service remained in breach of regulation in these areas.

We looked at five care records to evaluate risk assessment processes and documentation. We also looked at the guidance given to staff to safely manage risk. We saw that some risk assessments were not present in care records and other risk assessments were lacking detail.

Medicines were not administered and recorded in accordance with best-practice guidance. Some records were incomplete and did not provide staff with clear guidance. Other records were difficult to read. PRN (as required) medicines were not administered safely or in accordance with instructions.

Before the previous inspection we received information of concern relating to poor infection control practice and the distress that this had caused to a person using the service. The service was in breach of regulation in this regard. We checked training records and asked the registered manager what action had been taken to improve practice in this area. We saw that additional training had been provided to all staff, guidance had been circulated and spot checks completed. The service was no longer in breach of regulation in relation to infection control.

Incident and accidents records had not been completed as required and appropriate action had not been taken following incidents and accidents.

Consent was not reviewed when care needs had changed. For example, one person was identified as having fluctuating capacity because of a health condition. Concerns were raised about their capacity to give consent at the last inspection. We saw that this potential lack of capacity had not been addressed within the care plan or consent documents.

The quality of communication between care workers and the service was inconsistent. During this inspection we checked to see what progress had been made by looking at the communication books. We saw numerous examples where information was limited and there was no evidence of action taken as a result of information being shared.

The provider’s action plan for achieving compliance with the requirements for delivering person-centred care included a review of all care plans and the introduction of an electronic monitoring system. We looked at a sample of care plans and saw that some had been reviewed and transferred to a new, paper-based template. The template encouraged the recording of more person-centred information. However, we saw that not all care plans had been transferred. We also saw that some of the new templates did not contain any additional, person-centred information. The electronic system had not been implemented.

We saw that the staff rotas and call-times were subject to change at short notice. This meant that the service could not be certain that the care it provided was meeting people’s needs. Rotas were not normally shared with people receiving care meaning that they could not express a preference for particular care workers.

A number of actions resulting from the previous inspection had not been completed as indicated in the provider’s action plan. Quality audit processes were not extensive or robust. They had failed to identify areas of concern noted during this inspection and contained incorrect and misleading information.

At the previous inspection we found that the registered manager had made some improvements within the service. However, we found that the health, safety and welfare of people who used the service had still been compromised despite the improvements that had been made. People were still put at unnecessary risk of harm. At this inspection we saw that there had been further improvement, but the service remained in breach of regulation in a number of areas. For example, safe moving and handling procedures were not always followed.

At the last inspection we were concerned that the culture of the service was not open and transparent because we received conflicting information regarding the owner of the service being actively involved in the provision of care. During this inspection we received information from the registered manager and other staff which conflicted with the written evidence provided. We were concerned at various points during this inspection the registered manager was not providing effective leadership.

We looked at records relating to staff training and support and spoke with staff. We saw that training which was appropriate to the needs of people using the service had been provided on a regular basis. New staff were not trained in accordance with the requirements of the Care Certificate.

We have made a recommendation regarding this.

Staff told us that they felt well-supported and had access to informal support mechanisms, but the majority of staff had not received a formal supervision within the last six months.

We have made a recommendation regarding this.

Staff rotas were produced with less than 24 hours’ notice and were not shared with people using the service unless they made a specific request.

We have made a recommendation regarding this.

Since the last inspection records indicated that each complaint had been processed in a timely manner and had generated a written response. We saw that action had been taken as result of the complaints. For example, in one case the receipt of the complaint had led to disciplinary action being taken against a staff member. The service was no longer in breach of regulation in relation to complaints.

Staff were recruited following a process which included individual interviews and shadow shifts. Each offer of employment was made subject to the receipt of two satisfactory references and a Disclosure and Barring Service (DBS) check.

We saw that the service worked with healthcare professionals and changed the delivery of care when required to do so. However, we saw that care records did not always contain adequate detail regarding people’s healthcare needs.

We received mixed views from people regarding their involvement in decisions about their care. We were told that changes to times or staff were not always communicated to people using the service. We saw from the communication book that at least one person had called the service to ask which staff were coming. We also saw evidence that calls had been started late, but in each case the person had been contacted to let them know the care staff were running late. None of the people that we spoke with expressed concern regarding delays in their calls. The service was no longer in breach of regulation in this regard.

People spoke positively about the attitude and caring nature of the care workers.

The staff that we spoke with were enthusiastic about their roles and spoke positively about improvements that had been made in the service.

The overall rating for this provider is still ‘Inadequate’. This means that the service remains in ‘Special measures’. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

This provider is still in special measures. This inspection found that there was not enough improvement to take the provider out of special measures.

CQC is now considering the appropriate regulatory response to resolve the problems we found.

The agency provides care to people who have complex care needs such as palliative/end of life care, spinal injury and neurological conditions such as Parkinsons Disease and Multiple Sclerosis. At the time of our inspection there were 35 people using the service and 44 staff employed.

We found despite some improvements being made since our last inspection, such as an improved recording of messages in the communication book, we remained concerned that the service delivery was to suit the service and not the people receiving the service. We were also concerned that the registered manager had failed to demonstrate that they had actively listened to people and done everything possible to improve the care for people. People were still at risk of harm.

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.

We found a system in place whereby the registered manager was visiting people to review their care but we did not see a system of transferring that information in the care plans to ensure the information in the care plans was up to date. We found care plans were also not being reviewed when changes occurred. Therefore, we could not be sure the information was up to date. We found that although new processes had been implemented, the information was not always being recorded appropriately.

We found the service were still not reviewing people's mental capacity.

A new on-call system had been put in place since our last inspection and a more thorough recording system of any messages received however, it was not always clear what action had been taken.

Staff told us that they have an online system in place to complete training in addition to their classroom training. Staff we spoke with told us they had received supervision in the last six months.

The registered manager had implemented new policies such as the Quality Control/Assurance Audit Record and Policy and completed survey questionnaires with staff and people who use the service. Of those returned, we could not see any evidence of learning from the comments or answers being given. We also did not see any evidence of learning from complaints, safeguarding’s or accidents.

An incident logging system had been put in place however it was not robust enough to ensure information was being recorded appropriately.

There had been an improvement to staff rotas as staff were now receiving them a week in advance. However there was still not enough staff to ensure people were safe and their needs were met in a timely way.

We looked in staff recruitment files and found there were systems in place for recruiting staff. Some people we spoke with were unhappy with the delivery of care in relation to the timings and duration of their calls.

We viewed MARS (Medication Administration Record Sheets) sheets and they were being signed when medication was administered. However, we found for one person there were gaps on occasions where the person required prescribed creams to be applied.

Staff were able to tell us what they would do in the event that they were concerned about abuse and how they would report it. Safeguarding training was being provided and the registered manager was sending in Statutory Notifications when appropriate. However, we received information of concern from the Local Authority and from another source.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found '

Is the service safe?

We found that the provider had effective recruitment processes in place. We looked at four staff files which evidenced this.

Is the service effective?

Staff had received training which helped ensure people`s needs were met and kept them safe. We saw evidence new staff had received an induction and training to support them in their job.

Is the service caring?

This was a responsive inspection to concerning information and we did not look specifically at this area.

Is the service responsive?

This was a responsive inspection to concerning information and we did not look specifically at this area.

Is the service well led?

This was a responsive inspection to concerning information and we did not look specifically at this area.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived who used the services of the agency their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Environmental risk assessments were completed in respect of people's homes to enable the agency staff to support them safely.

People who used the services of the agency told us that they felt their rights and dignity were respected.

The Registered Manager told us the agency employed sufficient numbers of staff to support people in their own homes. Some people who used the services of the agency told us the staff phoned them to advise if they were going to be late arriving at their home. Others said they knew the staff were coming but sometimes it was not at the arranged time. The majority of people we had contact with told us they had not had a missed call from the agency staff.

The Registered Manager and the agency staff were aware of how to help protect the rights and welfare of the people in accordance with the Mental Capacity Act [2005]. Meetings were held with external health care professionals to support people with decisions needed. Safeguarding procedures were in place to help protect people from abuse.

We found people who used the services of the agency did not benefit from safe medicine administration. We have asked the provider to tell us how they will meet the requirements of the law in relation to planning and delivering care and ensuring the safe management of medicines for people who use the services of the agency.

The agency staff had a rota and this recorded the am and pm calls to people in their homes. The Registered Manager informed us the agency employed sufficient numbers of staff to provide care and support to people who used the services of the agency.

Is the service effective?

People who used the services told us at the time of the inspection they were satisfied with the care they received and their needs were being met by the agency staff. People's health and care needs had been assessed and a plan of care was in place. There was limited evidence of the care and support people needed and some of the care plans had not been reviewed regularly. It was therefore not possible to confirm that all people's needs were being met. We have asked the provider to tell us how they will meet the requirements of the law to ensure people receive effective and safe care.

Looking at staff training records, the agency's training plan and talking with staff, we found that staff training was not completed consistently and not all staff had received supervision. Not all staff had completed a number of mandatory [required] training courses: for example, safeguarding adults, moving and handling, food safety, food hygiene, first aid and medication management. We have asked the provider to tell us how they will meet the requirements of the law in respect of ensuring staff are properly supported to provide care and support to people who use the services of the agency.

Is the service caring?

People who used the services of the agency said the staff were kind and helpful. Discussions with the agency staff indicated they had a good knowledge about the people they provided care and support to. A person who used the services of the agency and a relative we spoke with told us the agency did their best to make sure the same staff carried out the visit. This they said was reassuring.

Is the service responsive?

People who used the services of the agency told us they were aware of how to contact the agency office 'out of hours'. Agency staff told us there was an 'on call' rota.

Input from external health care professionals was sought by the agency staff for people they supported and who needed specialist advice regarding their on-going care management.

People who used the services of the agency said they were aware of how to raise a complaint should they have concerns about the service provision. Complaints received had been investigated and completed in line with the agency's complaints policy.

Is the service well-led?

The agency carried out a number of audits on the service provision however these were not robust and effective. For example, there was no formal system in place to make sure the Registered Manager and the staff learned from events such as missed calls to people in their own home. Improvements were needed around staff training, staff supervision and updating care files. This meant that people were not benefiting from a service that was taking on board lessons learnt, minimising the risk of re-occurrence and making improvements where needed. We have asked the provider to tell us how they will meet the requirements of the law in relation to ensuring people are fully protected from risks and from receiving inappropriate and unsafe care and support.

Arrangements were in place for seeking the feedback of people who used the services of the agency. Feedback was gathered using questionnaires and the 2014 survey had been sent to 34 people in July 2014. No questionnaires had been returned as yet to provide feedback about the service provision.

You can see our judgements on the front page of this report.

The care plans we viewed provided details about the care and support each person required based on their individual assessments. Overall people spoke positively about the care they received. Comments included; 'The service is very reliable. There have been some staff changes recently which means you have to show new staff 'the ropes,' and 'Staff are very pleasant and I have confidence in them.'

We looked at the systems in place for managing medicines. The agency only provided people with support and assistance with their medicines where it was specified as part of their individual care needs and where the medication was prescribed by their GP.

Most people we spoke with said care workers usually came on time and stayed for the full length of their allocated call time. Staff we spoke with told us they attended specialist training to support people with specific health needs.

All care records were securely retained by the agency to maintain confidentiality. The Registered Manager was knowledgeable about the safe storage and destruction of care records and other confidential information.

People told us;

"I ask and they provide it is a great service"

"I have used them for years first for my wife and now for myself, I tell them what i want and they can provide. Darren comes out to see me everytime I want to change the package nothing is too much trouble"

"The girls really look after me and I trust them which is a big thing for elderly people"

Staff told us;

"I left to work somewhere else but came back, I now know what its like to feel supported and valued in my job"

"Even if you have personal problems the managers will try and help you, they really look after you."

"I enjoy caring for people it is rewarding and has led me to decide to start my nurse training"

"The most rewarding part of my job is knowing I have made a difference to someone and that they appreciate my efforts"