Archived: Carby Community Care

This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection, 31 people were using the service.

People’s experience of using this service

People’s experience of using the service varied. Those who were regularly attended by experienced or enthusiastic newer care workers spoke highly of them and we received exceptional or very good feedback about named members of staff. Others commented on the high turnover of staff and lack of skill in staff. Comments we received included, “They are absolutely wonderful, so helpful” and “Some staff do the minimum and get away with it.”

Staff training arrangements had been impacted by the Covid-19 restrictions, and since then not all inductions and refresher training had been completed. The service had begun to use online and video training but there were still significant deficits which potentially put people at risk. For example, people were being supported with their medicines by staff who had not been recently trained in the management of medicines or had their competency suitably assessed.

Medicines records were not always being correctly kept. People’s medicines assessments did not always contain all the information required to keep them safe. Audits of these records failed to identify many of the issues we found. Appropriate action had been taken where issues had been identified.

People told us their care workers usually arrived as expected but this was not always consistent. It was a common belief among people and their relatives that the service was short staffed.

The service was not keeping effective records of quality issues, complaints, safeguarding alerts and incidents. The manager described areas of improvement being looked into at the time of inspection, but these were not formally documented in an ongoing improvement plan.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 15 July 2019) and we found a breach of the regulations relating to management of medicines.

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

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion 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 Carby Community Care Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the safe management of medicines and the governance of the service 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 for 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.

Carby Community Care is a domiciliary care agency that provides personal care to people living in their own homes. It provides a service to older people and younger adults with disabilities. At the time of our inspection they were supporting 67 people. 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:

People and their relatives told us they felt safe and spoke highly of their regular care workers. People told us, “The carers are very good, very caring” and “I couldn't wish for a better carer”. However, medicines were not always managed safely and audits did not identify serious issues with medicine administration records.

People were looked after by staff who understood their safeguarding role and responsibilities. The manager dealt appropriately with safeguarding concerns.

Most of the people we spoke with were being visited around their preferred time by regular care workers, but some of those also said the service was unreliable when their usual staff were not available. People and staff told us the office did not communicate changes in the service well. A person told us, “They should be more efficient.” Rotas issued to staff did not always reflect the real order in which staff visited people.

The provider was making significant progress in improving some aspects of the service, such as the safe provision of visits that required two care workers to attend and in the prompt recruitment of a new manager and other staff. The morale of care workers was variable, although new staff gave positive feedback about their recruitment and training. The practice of fining care staff for absence and errors in medicines recording presented potential risk to people.

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.

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 31 August 2017).

Why we inspected:

The inspection was prompted in part due to concerns received about unsafe medicines management, recruitment, call times, visits that required two care workers only being attended by one, staff morale and the governance of the service. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

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.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led 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 Carby Community Care on our website at www.cqc.org.uk.

Enforcement:

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, specifically around the management of medicines. Please see the action we have told the provider to take at the end of the report.

Follow up:

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 our last inspection in July 2015 the service was rated as 'Good’. At this inspection we found the service remained Good.

The service had a registered manager in post at the time of the 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.

The provider continued to deliver care to people safely. People’s risks were assessed and staff were trained to protect people from abuse and avoidable harm. There were enough staff available to meet people’s needs safely and staff were recruited through a safe and robust process. People received their medicines as prescribed and staff followed good hygiene practices.

Staff continued to be trained and supervised to meet people’s needs effectively. People consented to the care they received and were supported to have their assessed nutritional needs met. Staff ensured that people had timely access to healthcare services.

People told us they were supported by kind and caring staff who respected their privacy and promoted their dignity. Positive relationships existed between people and staff.

The service remained responsive to people’s individually assessed needs. People’s care records were accurate and updated and reflected changes in people’s needs. People’s preferences for how they received their care and support were respected and people were encouraged to share their opinions about the care they received from staff.

The service continued to be well-led. There was a registered manager in post and they promoted an open culture within the organisation. There were robust quality assurance processes and partnership working with other organisations was evident.