The Care Quality Commission
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Archived: West Sussex Domiciliary Care Service

Overall: Requires improvement read more about inspection ratings

Prescott House, Upper St Johns Road, Burgess Hill, West Sussex, RH15 8HB (01293) 850493

Provided and run by:
Family Mosaic Housing

Important: The provider of this service changed. See old profile
Important: The provider of this service changed. See new profile

All Inspections

9 August 2016

During a routine inspection

This inspection took place on 9 August 2016 and was announced. Family Mosaic West Sussex Domiciliary Care Service provides personal care and support for older people living in their own flat within one of six extra care housing schemes in West Sussex. Extra Care housing is designed to support older people to remain as independent as possible. Extra Care facilities may include communal areas, restaurant facilities and a shop. Sometimes organised activities are available. At the time of the inspection Family Mosaic were supporting 148 people.

On the day of the inspection a registered manager was not 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. The registered manager’s role was being temporarily covered by the head of care and in this report we will refer to them as the person in charge.

At the last inspection in November 2015 we identified a number of areas of practice that needed to improve including, not always having sufficient staff to meet people’s needs and not following safe recruitment procedures. People did not always have continuity of staff to provide their care at the agreed time. Quality assurance systems were not consistently maintained to monitor and improve standards of service delivery. At this inspection on 9 August 2016 we checked to see what improvements had been made. We found that a number of improvements had been made, but there were continued concerns regarding governance arrangements and this was a breach of the regulations. You can see what action we told the provider to take at the end of the full report.

Quality assurance systems were in place, however they were not always effective in driving improvements in service. An auditing system was in place to monitor administration of medicines. Although gaps in recording had been identified and investigated, it was not clear what actions had been taken as a result to prevent further mistakes. Accidents and incidents were logged and sent to the person in charge who had oversight of all the extra care schemes. An accident had occurred and this had been logged and appropriate actions taken at the time. However, it was not clear what changes had been made following this to reduce the risk of further occurrences. This meant that the quality assurance system was not always effective and this was identified as a breach of the regulations.

People’s care plans were not well personalised and were not always updated to reflect changes in people’s needs. This meant that there was a risk that people may receive inconsistent or inappropriate care. This was identified as an area of practice in need of improvement. The person in charge was aware that care plans required updating and told us that this was work in progress.

Recruitment procedures were robust and ensured that staff were appropriate to work with people. People told us they were happy with the care provided by Family Mosaic and that the staff were kind and caring. Their comments included, “They are good as gold, some of them are absolutely brilliant, they are very caring,” and “I like all of them, I like to have a laugh with them, we get on well.” Staff knew the people they were caring for well and said that they had received the training and support they needed to care for them.

Staff had a firm understanding of how to manage risks to people and their responsibilities with regard to keeping people safe. Staff understood safeguarding procedures and were aware of the provider’s whistleblowing policy. People told us they felt safe and that there were enough staff on duty to support them. One person said, “That’s the point of living here, you have your own place, but you have the help on hand when you need it.” People told us they knew how to complain about the service if they needed to. The provider kept a complaints log and responded to people’s complaints within appropriate timescales.

People received their care visits on time and staff stayed for the duration that they expected. Staff told us they had time to cover all the calls without rushing and that they could spend time with people. People told us they received the support they needed with food and drink and that staff helped them to access health care services when they needed to. One person said, “If I am unwell the carers phone the doctor to come and see me.” Visiting health care professional spoke highly of the care staff and told us that they were knowledgeable about the people they were caring for, and proactive in seeking medical support when needed. People told us that staff had time to spend with them and that they enjoyed the activities that were on offer.

Staff spoke highly of the person in charge, one staff member said “I have never had such a good manager.” People also spoke highly of the care team managers, their comments included, “They are very efficient, kind and helpful,” and “They are very approachable.”

Staff were aware of the vision and values of the service and spoke of supporting people’s independence and providing excellent care. The person in charge was working through a clear action plan to develop the service and had completed many of the outcomes that were identified. People told us that they were happy with the service provided.

25 November 2015

During a routine inspection

This inspection took place on 25 November 2015 and was announced.

Family Mosaic West Sussex Domiciliary Care Service provides personal care and support for older people living in their own flat within one of six extra care housing schemes in West Sussex. Extra care housing has been designed with the needs of frailer older people in mind and could include communal restaurant facilities and organised activities. At the time of our inspection around 130 people were receiving a service.

On the day of our inspection, 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.

This was the first inspection of the service since the new provider had taken over the running of the service and was registered with the CQC. Senior staff told us this had been a difficult period with a number of staff changes within the service. Each extra care housing scheme should have had a care manager to provide day to day management cover and to support the registered manager. There had been difficulties in recruiting to these posts. There had been a number of changes in care staff, and although there had been an ongoing recruitment programme to employ new care staff there had been difficulty in recruiting the required number of care staff. There had been particular difficulties within three of the extra care housing teams and senior staff had action plans in place that they were working to address issues highlighted. We received some feedback from staff that there had not always been sufficient staff to meet peoples care needs. One person told us, “They come on time, and treat you well. They are often short-staffed, sometimes there’s only two on, other people need more than that to care for them.” People told us that the staffing difficulties had at times led to some missed calls, staff appearing to be rushed and the duration and punctuality of calls had also been affected. One person told us, “Some girls are a bit brusque – one did say ‘I’ve got to go early – I’ve got lots to do today’; but most of them are very good to me; my little angels.” Another person told us about their care worker, “She’d come at 8.45 and left by 9.00am, and said ‘I’ve got to go – I’ve got another six to do.” Rotas were minimal and did not accurately detail the times for the calls. This meant that there was not an accurate record of the visit times and duration for staff to follow and could have led to inconsistency in the provision of the service. This was an area in need of improvement.

Not all the care staff had been through a thorough recruitment process and a full employment history had not always been provided to inform the recruitment process. This was an area in need of improvement.

Quality assurance processes were not fully in place to audit and quality assure the care provided. The provider’s quality assurance policies and procedures detailing the timescales and frequency that quality assurance should take place were still being developed. Where quality assurance audits had been completed these had not all been maintained or fully embedded in the running of the service. This meant there was limited information available as to how the service was improving following feedback received. This was an area in need of improvement.

Policies and procedures were in place for the management of medicines, care staff had received training to ensure the safe administration of medicines. However, there was limited quality assurance of the system which meant any issues were not picked up promptly and addressed. This was an area in need of improvement.

Care staff received an induction, and training to ensure they could meet people’s care needs. Care staff had supervision in one to one meetings and staff meetings, in order for them to discuss their role and share any information or concerns and for senior staff to discuss their work performance. However, individual supervision meetings were not always regular. T his was an area in need of improvement.

People and their relatives told us that they or their relative felt safe with the staff that supported them. One person told us, “Yes, of course I feel safe with all the lovely girls. They are so kind.” The needs and choices of people had been clearly documented in their care and support plans. Risk assessments were in place to ensure people were safe within their own home and when they received care and support. There was a review process in place, but it was not possible to fully evidence this was completed as this was a new service. Where people were unable to participate in the drawing up and review of their care plan, senior staff told us they would liaise with health and social care professionals to consider the person’s capacity under the Mental Capacity Act 2005 (MCA). Care staff had a good understanding of the need for people to consent to their care and treatment.

People and their relatives told us they were supported by kind and caring staff. One person told us, “They [the carers] are all very good. There is one thing wrong: they aren’t paid enough. The carers really do care. I’d give them a gold star.” People knew how to raise concerns or complaints if they needed to.