We carried out a review of the data available to us about White River Homecare on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about White River Homecare, you can give feedback on this service.
White River is a domiciliary care agency. It provides personal care to people living in their own homes in and around the St Austell area. On the day of the inspection the service was supporting 48 people with a range of health and social care needs, including people with a physical disability, sensory impairment or people living with dementia. Support was tailored according to people's assessed needs within the context of people's individual preferences and lifestyles to help people to live and maintain independent lives and remain in their homes.
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
Recruitment systems had improved to ensure all staff had the necessary checks in place before starting to work for the agency.
Medicines were being managed safely following a review of how they should be recorded.
Changes to the service’s governance systems had ensured records were robust and peoples needs were being effectively recorded and managed.
Risks to people's health and safety were assessed and records showed these were being managed effectively.
Staff had access to a range of training which supported them in their role.
People told us they were confident concerns were always listened to and acted upon if necessary by management team.
Lessons were learned from incidents and accidents, by reflecting on them and putting systems in place to mitigate any further issues. Managers and staff were consistently open and transparent when things went wrong and kept records to demonstrate this.
People were supported to have maximum choice and control of their lives and 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 and update
The last rating for this service was Requires improvement (published 2 February 2019) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
White River Homecare is a community service that provides care and support to adults of all ages, in their own homes, in the St Austell and surrounding area. This includes people with physical disabilities and dementia care needs. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and give support with meals, shopping and housework.
At the time of our inspection 38 people were receiving a personal care service. These services were funded either privately, through Cornwall Council or NHS funding.
There was a registered manager in post who was responsible for the day-to-day running of the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service’s last comprehensive inspection was 10 May 2016 when there was a breach of the regulations relating to medicines administration. We then carried out a focused inspection on the 17 January 2017 to check on the action taken by the provider to meet the requirements of the regulations. At this focused inspection we found that improvements had been made in the training of staff in medicines management and the medicines policy had been improved and the service was found to be compliant with the regulations.
We carried out this announced comprehensive inspection on 2 January 2019. We told the provider two days before that we would be coming. This is in line with our methodology for inspecting domiciliary care providers and was to ensure that someone would be available in the office at the time of our visit.
People and their relatives told us they felt safe using the service. Staff had received training in how to recognise and report abuse. Staff were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. The service was flexible and responded to people’s changing needs.
People told us, “I like our daily conversations regarding family & friends, the weather,” “Carers will ask me is there anything they can do for me or what do I need doing today. I do tell them when I want a drink and what to eat on each visit” and “My carers are well trained and seem to know their job. They are helpful and useful.”
People received care from staff who knew them well, and had the knowledge and skills to meet their needs. People and their relatives spoke well of staff, comments included, “We mostly have the same staff, they are a good bunch.”
Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were kind and compassionate and treated people with dignity and respect.
The management had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.
Staff told us there was good communication with the management of the service. Staff told us, “I think this company does listen to your suggestions even if they are not always followed through for whatever reason” and “I do discuss things with the office if I think there is a problem.”
There were some quality assurance systems in place which were not always effective and therefore opportunities for improvement were not always identified and addressed. Where the provider had identified areas that required improvement, actions had been promptly taken to improve the quality of the service provided.
Care records were regularly reviewed to ensure staff met their needs. However, the care plans were not always updated to provide accurate up to date direction and guidance for staff. This meant some care plans provided out of date information. Staff recorded when they supported people with their medicines in the daily notes. However, there was not a robust process for staff to record, on specific medicine documentation, when they had given medicines that are required occasionally, such as Paracetamol.
The service had a process for recruiting new staff. Some checks were done before they commenced working alone, such as a DBS check. However, some staff had been allowed to start working alone with people in their own homes before the service had received any references from their previous employers. This meant staff were not always recruited safely, and people were not always protected from staff who may not be suitable to work alone with them.
We found breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.
This report only covers our findings in relation to the question ‘is the service safe?’. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for White River Homecare on our website at www.cqc.org.uk
White River Domiciliary Care Agency (DCA) provides personal care and support to people living in their own homes in and around the St Austell area of Cornwall. At the time of our inspection White River DCA was providing support for up to forty three people.
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.
There was a training matrix held in the office of all staff training including training for medicines. The registered manager held a record of this training undertaken by staff and when they were due for updates. This meant that the service had a robust process with which to monitor the training needs of all staff.
The registered manager had introduced a revised consent form which took into account people’s consent for staff to prompt or administer medicines. Where a person had been deemed as lacking capacity there was acknowledgement of the person’s ‘best interest’ being taken into account with the person’s representative.
The service’s policy for the management of medicines had been updated. This reflected the safe and effective procedures when providing care and support with medicines in a person’s own home. This meant staff had clear guidelines to prompt or administer medicines safely.
At this focused inspection we found the registered provider had taken effective action to meet the requirements of the regulations and the breach had been met.
This inspection took place on 10 May 2016 and was announced. This meant we gave the provider short notice of our intended visit to ensure someone would be available in the office to meet us. The service was previously inspected in June 2015 when it was found to have failed to have complied with some of the requirements of the regulations. Recruitment procedures were not established to effectively ensure people employed by the agency were of good character or had the necessary competence to carry out their role. People were not protected because risks were not being adequately assessed or action taken to mitigate risk. The level of information in care plans was inconsistent meaning staff may not be responsive to meet people’s assessed needs, There was a limited auditing system which meant the monitoring of the service was not effective. At this inspection we found improvements had been made in these areas and the service was now meeting the relevant requirements’.
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.
Medicine procedures and guidance did not ensure staff had clear guidelines in respect of their responsibility to prompt medicine or administer medicine to people. Where medicines had been administered by staff they had not always been recorded which was not safe practice.
People told us they felt safe and their care needs were met. The way staff were deployed meant they had time to meet people’s needs and provide a flexible service. People and their relatives told us they knew their care workers and had a good relationship with the managers if there were any issues with their care and support. Relatives told us, “We couldn’t manage without them. It gives me peace of mind” and “I rely on their support very much. They go over and above.”
People told us they felt safe and secure when receiving care. People received consistent support from care workers who knew them well. People told us, “(Staff member) comes at the right time and is wonderful. We have time to have a good chat when (staff name) is helping me” and “I get a very good service from the agency and it’s important that we know who is coming into the house. There are not many changes made and we usually get told about them”.
People’s care plans were detailed, personalised and provided staff with sufficient information to enable them to meet people’s care needs. The care plans had been agreed between the service and the person or their representative. The care plans we reviewed were up to date and accurately reflected each person’s individual needs and wishes. The service’s risk assessment procedures had been developed to include all areas of support while providing appropriate protection.
Staff received training and were knowledgeable about their roles and responsibilities. People said they were generally satisfied with the way staff supported them and understood how to meet their specific care needs. One person said, “Staff know what to do but sometimes I might have to prompt a new member of staff.” Another person told us, “I have every confidence in the girls. They clearly know what they are doing”. Training records showed staff had been provided with all the necessary training which was refreshed regularly. Staff told us they had ‘lots of training” and found the training to be beneficial to their role.
Staff told us they were supported by the registered manager and the on- call arrangements provided people and staff with appropriate support when the service was closed. Staff received regular supervisions and annual performance appraisals. In addition ‘spot checks’ by managers were used regularly to confirm each member of staff was providing appropriate standards of care and support.
Recruitment systems had been reviewed and developed to ensure staff were suitable and safe to support people in their own homes. Necessary pre-employment checks had been completed. Staff received a full induction to understand their role and to ensure they had the skills to meet people’s specific needs. This helped ensure people received care and support from staff who were competent and well matched to the role.
Audit systems had been reviewed and developed to effectively monitor and manage how care and support was being delivered to people. Auditing procedures took account of accidents and incidents, as well as concerns and complaints. These systems acted as early indicators of themes or trends which might affect individuals using the service or staff supporting people. People’s views were sought formally and their comments analysed in order to determine the level of satisfaction with the service.
We identified a breach of the regulations. You can see what action we have told the provider to take at the back of the full version of the report.
White River Homecare provides personal care to people who live in their own homes in St Austell and the surrounding areas. At the time of our inspection the service was providing care and support to 42 predominantly elderly people.
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.
People told us they felt safe when being provided with care and support by White River Homecare staff. However we found not all aspects of the service were safe. Recruitment processes were not robust and references from staff members last employers were not routinely followed up. We found Disclosure and Barring Service (DBS) checks had highlighted a concern regarding one care workers previous employment. Although we saw evidence the management team had considered this risk we were not satisfied appropriate safeguards had been put in place to help ensure people were fully protected. Where risks had been identified following an assessment of people’s needs staff were not always provided with specific guidance on how to minimise the risk. Environmental risk assessments had not been completed in order to protect staff from risks while working in the community. This was not in line with the services policy on lone working.
There were sufficient numbers of staff to deliver the commissioned care. People told us care workers were rarely late. If they were held up the office would contact people to let them know of the delay and the likely time of arrival.
Staff told us they enjoyed their work and were well supported by the management team. Supervision was held regularly although these meetings were not adequately recorded. Staff underwent an induction and training was refreshed regularly. There were systems in place to help ensure all staff were kept up to date with any changes in people’s needs.
People were supported by care staff who had a good understanding of their needs. Staff were friendly in their approach, unhurried and adapted how they delivered care in line with people’s individual preferences. Where people had established a rapport with a particular member of staff or expressed a preference efforts were made to try and ensure that care worker supported them regularly. No-one had needed to make a complaint about the service they received. We saw thank you cards and compliments had been received.
Care plans were inconsistent in the depth of information they contained. While some contained comprehensive information in respect of people’s routines and described how they wanted care and support to be delivered others were brief and lacked detail. The provider and registered manager said they would review all care plans to bring them up to the same standard.
There was no robust system in place for regularly auditing the various aspects of the service. Recording systems were inadequate.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.