Archived: Care Advance Limited

Care Advanced Limited is a small domiciliary care agency in Colyton, that provides support and personal care for people in their own homes in the surrounding area. This includes older people with physical needs, some of whom are living with dementia. The inspection took place on the 15 and 17 July 2015 and was announced, this was the first inspection since the service registered with the Care Quality Commission in 2013. At the time of our visit, the agency provided around 60 hours of care for seven people and employed one member of staff.

The company has two directors, one of whom manages the service and provides care. At the time of the visit, there was no registered manager at the service, they left in June 2015 and deregistered in July. The current manager was planning to apply to the Care Quality Commission to become the 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.

Staff did not have a full understanding of the requirements of the Mental Capacity Act (MCA) 2005 in relation to consent and had not completed any training on this. Although people’s initial assessment included asking questions about their memory and cognition, the agency did not undertake a first stage test of mental capacity for people who appeared to lack capacity. This meant it was not clear whether those people had the ability to make decisions and give consent about their care and treatment. Where people lacked capacity, it was unclear from the care records who needed to be consulted and involved in any ‘best interest’ decisions made about the person.

Following our visit, the provider contacted us to outline the steps being taken to address this, which included the introduction of a mental capacity assessment tool and staff training. Staff sought people’s consent for their day to day care, offered people choices and supported them to make day to day decisions for themselves, wherever possible.

Before the service commenced, people were consulted and involved in an initial assessment and discussion about their care needs. Support for people included personal care such as washing and dressing, helping with preparation of meals and prompting to eat and drink, and to take their medicines.

People said they felt safe and trusted the staff who visited them to provide their care. They confirmed the agency were reliable and they had not experienced any missed visits. Staff arrived on time and stayed for the required period. The manager confirmed they had enough staff to support the people they cared for and were in the process of recruiting additional staff before taking on any new people. Risk assessments were undertaken, which identified individual and environmental risks and how to reduce them. Accidents and incidents were reported with actions taken in response, for example by contacting the GP to visit the person.

People were protected because staff had received safeguarding training, knew about the signs of abuse and were confident that any concerns reported would be responded to. The agency had a robust recruitment process and undertook background checks to make sure staff were suitable to work in care.

People were supported to take their prescribed medicines in a safe way. People were protected from cross infection risks due to high standards of cleanliness and hygiene. Staff washed their hands before and after providing care and wore aprons and gloves when providing personal care.

People gave us positive feedback about the skills and knowledge of the care workers who knew how to meet their needs. Staff received induction training when they first came to work in the service and completed a range of training which included medicines management, safeguarding, health and safety and practical moving and handling training. Training was also arranged to support people’s individual care needs, for example, in relation to their diabetes. Staff received on-going support through regular supervision and spot checks and said the manager was accessible for advice and support. Staff had annual appraisals during which they received feedback on their performance and identified further training and development needs.

The agency supported people to keep as healthy as possible. Staff worked in partnership with local health and social care professionals who confirmed staff contacted them appropriately and followed their advice. The agency supported some people who were at an increased risk of malnutrition or dehydration, and had detailed care plans about how to support them with eating and drinking.

People described positive caring relationships with the staff that supported them and treated them with dignity and respect. Staff described how they protected people’s privacy when providing personal care such as by closing doors and curtains and making sure the person was covered with a towel. Staff knew people they were caring for well, their preferences and how they liked to be supported. They helped each person to maintain their independence by supporting the person to do what they could for themselves and only assisting when needed. People were supported to express their views and be actively involved in decisions about their care. They confirmed staff consulted them, and carried out their wishes and preferences.

Staff knew people well, their circumstances and family history, and about their needs. They demonstrated they understood the principles of individualised, person centred care through talking to us about how they met people’s care and support needs. People’s care records included what aspects of their care people could do for themselves and what they needed staff support with. Care records were regularly updated as people’s needs changed.

People knew how to complain and raise concerns, each person had the mobile number of the manager and knew how to contact the agency’s office. They said they wouldn’t hesitate to speak to the manager if they had any problems.

Written policies and procedures were in place about managing complaints details about how people could contact the ombudsman if they were dissatisfied about how the provider had dealt with their complaint. The agency had not received any complaints since registration.

The provider promoted a positive culture and an individual service tailored to people’s needs. Their vision and values were outlined in their customer information booklet and on their website. This included being family oriented, friendly, offering person centred care and making sure people were supported to remain as independent as possible.

There were effective systems in place for monitoring staff performance through training, supervision and appraisals. Accidents and incidents were reported and had evidence of action taken to reduce the risk of recurrence.

People and relatives feedback was sought and showed they were very satisfied with the service provided. Latest survey results demonstrated high levels of satisfaction with the service provided.

The agency had a range of other quality monitoring systems in place. This included a computer based rostering system, self-assessment audits of CQC standards, policies and procedures and a staff handbook which sets expectations of staff in their work. Care and staff records were securely stored at the agency’s office and were kept up to date.

We identified one breach of the regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.