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Vera Care Limited Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 October 2018

This inspection took place on 28 August 2018, the inspection was announced.

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, older people, people with learning disabilities and autistic spectrum disorder, people with a mental illness and people who have a physical disability.

CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. There was one person receiving support with their personal care when we inspected.

At the last inspection on 26 July 2017 we rated the service Requires Improvement overall. We found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that medicines were suitably administered and recorded. The provider failed to establish and operate systems to assess, monitor and improve the quality and safety of the services provided. We also made recommendations. We recommended that the provider reviewed and amended recruitment records. We recommended that the provider reviewed systems and processes for recording and monitoring accidents and incidents. We recommended that the provider reviewed the systems they have in place in relation to reviewing and amending risk assessments. The provider submitted an action plan on 22 September 2017. This showed they had met Regulation 17 by 20 September 2017 and had met Regulation 12 by 15 September 2017.

There was no 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. The registered manager had deregistered on 22 August 2018, a manager was in post who planned to become the registered manager.

The person receiving care told us they received safe, effective, caring, responsive and well led care. They had nothing but positive feedback about the service they received.

The provider had followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles. The manager who was the only member of staff had attended training relevant to people's needs. The manager had received one to one supervision meetings and regular spot checks to ensure that they were putting their training into practice.

Individualised risk assessments were in place. However, the manager had not risk assessed catheter care. This meant risks in relation to infection control and monitoring the catheter had not been identified and mitigated. We spoke with the manager who provided the person their care and were confident that they knew how to work with the person effectively, who to contact and what to do if the catheter stopped working effectively. Managing risks to people's health was an area for improvement.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Systems were in place to enable the manager to assess, monitor and improve the quality and safety of the service. These systems were not fully robust as they had not identified the areas for improvement we found during the inspection.

People were supported and helped to maintain their health and to access health services. Timely action had been taken when people's health changed. There had been only one accidents and incident that had occurred. This had been handled effectively, there had been no lessons to learn from the incident.

Staff had received medicines training. Medicines had been recorded adequately. Medicines records were audited regularly. However, people were in receipt of as and when required (PRN) medicines had no PRN protocols in place to detail how they communicated pain, why they needed the medicine and what the maximum dosages were. This was an area for improvement.

People's care plans were clear for staff about how they should meet people’s care and support needs.

Essential information about people such as their life history, likes, dislikes and preferences were included. Care plans had been reviewed and amended regularly to ensure they reflected each person's current need or specific healthcare needs.

People knew who to complain to if they needed to. The complaints procedure was available in the office and in people had copies within their handbooks in their homes. People had opportunities to feedback about the service they received.

People were protected from abuse or the risk of abuse. The manager was aware of their roles and responsibilities in relation to safeguarding people.

People received effective support to prepare and cook meals and drinks to meet their nutritional and hydration needs.

There were suitable numbers of staff on shift to meet people's needs. People received consistent support from staff they knew well. People told us that staff were kind and caring. Staff treated people with dignity and respect.

People's information was treated confidentially. People's paper records were stored securely in locked filing cabinets.

Inspection areas

Safe

Requires improvement

Updated 17 October 2018

The service was not consistently safe.

Potential risks to people’s health and welfare had been assessed but there was not always detailed guidance for staff to follow to mitigate risk. Accidents and incidents had been dealt with effectively.

Medicines had been safely administered but people who were in receipt of as and when required (PRN) medicines had no protocols in place to detail how they communicated pain, why they needed the medicine and what the maximum dosages were.

There were enough staff deployed to meet people’s needs. The provider had followed safe recruitment practices.

Staff knew what they should do to identify and raise safeguarding concerns.

Staff used personal protective equipment to safeguard themselves and people from the risks of cross infection.

Effective

Good

Updated 17 October 2018

The service was effective.

The manager had completed training to help them meet people's assessed needs.

The manager had a good understanding of the Mental Capacity Act 2005 and how to support people to make decisions. People’s choices and decisions were respected.

People received medical assistance from healthcare professionals when they needed it.

People had appropriate support when required to ensure their nutrition and hydration needs were well met.

Caring

Good

Updated 17 October 2018

The service was caring.

People told us they found the staff caring, friendly and helpful.

Staff were careful to protect people's privacy and dignity and a person told us they were treated with dignity and respect.

People's information was treated confidentially.

Responsive

Good

Updated 17 October 2018

The service was responsive.

Care plans were in place, these were person centred and clearly detailed what care and support staff needed to provide. Care plans had been reviewed and amended when necessary.

The manager planned to discuss people’s end of life wishes and preferences with people if this was appropriate. The service did not provide care and support at the current time to people at the end of their life.

People knew how to complain. Complaints procedures were detailed in each person’s handbook and guide to the service. There had not been any complaints.

Well-led

Requires improvement

Updated 17 October 2018

The service was not consistently well led.

Systems to monitor the quality of the service were in place. However, these were not robust.

Systems were in place to enable people and their relatives to provide feedback.

Policies and procedures were in place, including whistleblowing procedures.

The provider had displayed a copy of their rating in the office and on their website.

The manager was keen to sign up to conferences and events in the local area to help them learn and evolve.