Blueberry Care

KARE Plus Cheshire is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of this inspection 68 people were receiving care and support from the service.

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

Overall people and relatives were complimentary and positive about the support they received. Improvements had been made to aspects of the service since the last inspection.

Since the last inspection, improvements had been made to records in relation to medicines. These were administered and managed safely.

Risks to people were assessed and regularly reviewed and this had improved since the last inspection. Staff understood the actions needed to minimise the risk of avoidable harm. Risk management plans would benefit from including further details about actions being taken. Staff had undertaken safeguarding training and understood their role in identifying and reporting any concerns of potential abuse. Where necessary appropriate action had been taken.

People received care that was responsive to their individual needs. Staff were familiar with people and knew their likes and preferences well. People told us staff were kind and caring in their approach.

There were sufficient numbers of trained, experienced staff to meet people's needs. The service was recruiting staff on an ongoing basis. The provider had invested in an electronic scheduling system to manage and monitor care calls more effectively. Safer recruitment practices were followed, and appropriate checks completed to ensure that only suitable staff were employed.

Staff received an induction and on-going training and support that enabled them to carry out their roles positively and effectively. People had access to healthcare services and were involved in decisions about their care. Staff worked closely with other agencies and health professionals to support people effectively.

Care plans were being updated and included person centred information. In some cases, we found further information was needed to reflect changes to people’s needs. This was being addressed.

Since the last inspection staff had received training and clearly understood The Mental Capacity Act 2005 (MCA). New documentation had been introduced to support staff to comply with the MCA. 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.

Governance systems and oversight of the service had improved and were effective. Issues were identified, and actions taken to address any shortfalls where necessary.

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 August 2018) and there was a breach of regulation. 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.

We previously carried out an announced inspection at the service on 22 and 23 March 2017, where we identified shortfalls to the care provision and the service was rated as Requires Improvement. We identified two breaches of the relevant regulations relating to good governance and the failure to submit statutory notifications. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-led to at least good. At this inspection we found that improvements had been made in some areas, however further work was still required. We found that the registered provider was no longer in breach of regulations relating to notifications. However, they remained in breach of regulations relating to good governance.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to people living with dementia, learning disabilities or autistic spectrum disorder as well as physical disability and sensory impairment.

Not everyone using Kare plus Cheshire receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; such as help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection there were 59 people receiving personal care.

There was a registered manager at the service. 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.

Since the last inspection, action had been taken to try to improve the recording of information relating to the management of medicines. However, shortfalls remained and we found that information relating to medications was insufficient. There were gaps in the guidance for staff around the administration of PRN (as and when required) medicines and topical creams. The registered manager had started to take action to address these concerns during the inspection.

Sufficient numbers of staff were deployed to provide people's care and support. However, we found that occasionally people received late visits or staff did not stay the full allocated time. We saw that travelling time was not included in staff schedules, which could impact on the timeliness of visits. The registered manager assured us that she would review the organisation of schedules.

Risk assessments had been carried out; however, the assessments had not always included all relevant information or been updated in line with people's changing needs. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the service.

The provider had taken some action to address issues raised at the last inspection regarding compliance with The Mental Capacity Act 2005 (MCA). However, we found there continued to be gaps in staff understanding of the MCA and mental capacity assessments were not always available when people were unable to consent to their care. We made a recommendation in relation to compliance with the MCA.

Improvements had been made to the training arrangements and a new provider had been sourced. Staff were positive about the support they received. We saw that staff received supervision and field observations were also undertaken.

An initial assessment of people's support needs was undertaken for all new referrals. The management team under took visits to people to discuss their care needs. People's nutritional needs were met as required.

People were positive about the approach and attitude of staff. They told us that overall, they received support from regular staff who knew them and their needs well. We found that people’s dignity and privacy was respected and promoted by the service. People's diverse needs were considered by the service.

People received personalised care and each person had a care plan. There were occasional gaps in information about people’s support needs. People told us that their wishes and choices were respected. We saw that people's communication needs were considered.

There was a complaints procedure and people had access to this information through a service user guide. People knew how to complain and felt able to raise any concerns should they need to.

A new registered manager commenced with the service in December 2017. There had been some unexpected events over the past few months, which had significantly impacted on the staff team, but they had worked hard to ensure that the service continued without disruption to people.

Quality monitoring audits were not fully effective in identifying areas of improvement and sufficient action was not always taken in response to audits and inspections.

Staff told us they felt supported by the management team and systems to improve communication were being embedded. Most people told us they had not yet met the registered manager.

The registered manager had ensured that statutory notifications were submitted as legally required.

We identified one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the second time the service has been rated as ‘Requires Improvement’. You can see what action we told the provider to take at the back of the full version of the report.

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.

This was the service’s first inspection since it was registered. At this inspection we identified 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.

The service was not consistently safe. Risk assessments sometimes lacked detail or were blank. Some people had support needs which had not been taken into account in the risk assessments, such as equipment used for mobilising and help to keep skin healthy.

Medicines were not always managed safely. People who required support with their medicines did not always have records of medicines being administered and there was information missing from some medicine records so there was a risk of staff not giving medicines as prescribed. There were also no protocols in place for medicine that were ‘as and when required’ (PRN) so this put people at risk of not having their medicines when they needed them.

Mental capacity assessments were not being carried out so it was not possible to determine how the service was protecting people in line with the Mental Capacity Act 2005. By not assessing capacity the service was verifying whether representatives with Lasting Power of Attorney had the right to make decisions on behalf of people. People and staff confirmed that people were supported to make their own decisions and consent was gained before staff gave support. Therefore not all of the principles of the Mental Capacity Act 2005 (MCA 2005) were being consistently followed.

The service was not consistently well-led as some audits had not always identified that there were omissions in documentation, such as medication administration records, missing risk assessments and missing information about the support some people needed. Improvements had been planned in some cases; however these had not yet been completed.

The service had not always notified the CQC about significant events that they are required to send us by law.

Staff did not always feel the online training was sufficient and felt that more face to face training would be more beneficial. Despite their feelings on training, staff felt supported in their role as they had supervisions and felt they could ask questions when necessary.

People told us they felt safe. People were also protected by the risks of potential abuse as staff knew what abuse was, how to recognise it and how to report suspicions of abuse. People and staff told us they felt there were enough staff and most people felt they had regular staff. We found staff were recruited safely.

People had access to other health professionals. Both people and other health professionals told us the service worked with them.

Most people we spoke to could prepare their own food or were supported by relatives to make their meals throughout the day. Of those who were supported by staff, they felt staff did this well and were encouraging.

People and relatives all told us they found the staff to be caring and that they treated them with dignity and respect. Staff offered explanations when needed and people were encouraged to retain their independence.

People told us they felt involved in writing their care plans and that they got to know the staff who supported them. People told us they were asked for their opinion about the care and we saw evidence of this. People knew how to complain and those who had complained had received a response and were satisfied with the outcome.

People and relatives all told us how supportive the registered manager was. Staff also felt supported in their role and felt they could go to the registered manager if they needed to.