Archived: CORCARE

Corcare is a domiciliary care agency. It provides personal care to predominantly older people living in their own homes throughout Cornwall. The service was set up to provide home care support for people living in rural areas not covered by other care agencies. At the time of our inspection the service was providing support to approximately 72 people.

People’s experience of using this service

People and their relatives told us they received a reliable service, had agreed the times of their visits and were kept informed of any changes. People felt safe using the service and staff treated them in a caring and respectful manner. Comments included, “You can’t fault their care”, “I have faith in Corcare and feel safe with them” and “We are very satisfied with the service.”

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.

Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. Care plans were personalised to the individual and recorded details about each person’s specific needs and wishes. These were kept under regular review and updated as people’s needs changed.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

The service’s rotas were well organised and there were enough staff available to provide all planned care visits. A mobile phone call monitoring application was used to ensure all visits were provided and to share information securely with staff. No one reported having experienced a missed care visit.

The service had been working with the Royal Cornwall Hospital Trust by taking additional packages to help with the increased number of hospital discharges, to assist with winter pressures. During the winter of 2018/19 the service had been provided with agency staff to create additional capacity. At the last inspection we found the way this additional work was being managed had impacted on the service’s overall performance and reliability.

At this inspection we found the service was in the process of managing another group of agency workers to increase the service‘s capacity to accept hospital discharges. We found lessons had been learnt from the previous project and this additional work was being well managed by a dedicated team.

Staff were recruited safely and they received regular supervision and support from management. New staff completed an induction which involved training and a period of shadowing more experienced staff. Training was regularly updated so staff were aware of any changes in working practices.

There was a positive culture in the service and management and staff were committed to ensuring people received a good service. Staff told us they were well supported and had a good working relationship with each other and the management team.

People, their relatives and staff told us management were approachable and they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service.

There were clear processes for management to check the quality of all aspects of the service. The provider had a defined organisational management structure and there was regular oversight and input from senior management.

The full details can be found on our website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (report published 14 March 2019) and there was a breach of regulations. 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 intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Corcare is a domiciliary care agency. It provides personal care to predominantly older people living in their own homes throughout Cornwall. The service was set up to provide home care support for people living in rural areas not covered by other care agencies. At the time of our inspection the service was providing support to approximately 70 people. The service provides short visits at key times of the day to support people with specific tasks to enable people to continue to live in their own homes.

People told us, “I’d tell anyone they won’t go far wrong if they can get on the list for them” and “My daughter has been so pleased that she has recommended the Service to other people in the village on several occasions.”

For the last two years the service had been working closely with hospital staff as part of the “Hospital System Response Team” pilot project. This project aimed to improve patient flows through the Royal Cornwall Hospital Trust by facilitating timely discharges to home care services. The close working relationships developed during this project enabled the service to accept packages of care and provide initial care visits based on information provided by hospital staff. This meant people could be discharged earlier and the service was often able to provide initial care visits on the same day they were requested.

This project had been significantly expanded in December 2018 in an attempt to manage expected winter pressures. Corcare was provided with nine additional agency staff each day. This was intended to provide the service with additional capacity to enable more people to be discharged home from hospital. However, this had impacted on the service’s overall performance and reliability.

Issues in how people’s details and needs were communicated to the new agency staff had significantly increased the risk of information being miss transcribed and un-necessarily increased the risk that planned visits would be missed. Team leaders told us, “A lot of time is used explaining rotas to [agency] staff because they cannot access our system” and “The impact is on the team leaders they have been spending huge amount of time sharing information with [agency staff] who do not know the area. It has caused an awful lot of extra work and frustration from our customers.”

The majority of the agency staff used were based outside Cornwall and some were traveling significant distances from “beyond Bristol” to complete 12 hours care shifts. This meant they had very limited knowledge of local geography and that traffic issues on the main roads into the southwest impacted on the timing of people’s care visits. During our inspection one agency staff member was over an hour late to their first visit as a result of travel disruption on route to Cornwall. Agency staff told us, “Mostly I am on time but if something happens on the road you can run late” and, “You sometimes run late where it is a rural area and the postcode does not work. The most difficult bit is just finding the houses in this area.”

Since December 2018, three visits had been missed, there had been an increase in the number of visits provided more than 30 minutes late and, people were not being supported by staff they knew well. People told us, “They are late more often than not, especially all the new carers who can’t find the house”, “I am getting all new carers these days, from Wales and Birmingham and everywhere so they don’t know me like the old carers used to” and, “They are always late. I think it’s because of all the new carers who are not local and don’t know their way around.” One person’s relative commented, “I am the main carer for [my relative] and I get [my relative] up and on the commode in time for their visit. They are late most days and I am concerned when they are late about [my relative] getting pressure marks while waiting.” This meant the service was not providing person centred care and was in breach of the requirements of the regulations.

The service’s quality assurance systems were effective had identified this decline in performance and the had been registered manager and team leaders recognised this was a significant issue. Their comments included, “[The agency staff] have to use Sat Nav as they don’t know the area and that has led to a lot of late visits”, “We have had quite a lot of missed visits” and “I don’t think there have been many missed visits but there have been many late visits.” At the time of our inspection the registered manager and provider’s nominated individual were in the process of developing plans to meet people’s ongoing needs at the end of the three month period of agency staff support.

People told us they felt safe while receiving support and that all of their staff were kind and compassionate. All staff had completed safeguarding training and understood their role in protecting people from abuse and avoidable harm. All Accident and incidents had been recorded and investigated to identify any learning and establish how similar events could be avoided in future.

Staff were well trained and sufficiently skilled to meet people needs. However, a number of staff raised issue with the quality on online training provided recently and we have recommended the service seeks advice on how this training cold be made more engaging and beneficial.

The service’s recruitment practices were safe. All necessary pre-employment checks had been completed to ensure new staff were suitable for employment in the care sector. There were sufficient numbers of staff available to provide all planned care visits.

People’s care plans were developed from information provided by professionals combined with feedback from staff following initial care visits. People and their relatives had been involved in both the development and review of care plans and they told us, “We have been through my whole care plan and checked it was accurate.” We found people’s care plans were detailed, informative and up to date. Staff told us, “The care plans are very good.”

Staff and the registered manager had a good understanding of Mental Capacity Act 2005(MCA). Staff told us they always sought permission before providing support and people’s care plans included information for staff on how to support people to make decisions about how their care was provided. Daily records showed people were able to decline aspects of planned care and people told us, “The carers are very flexible and can adjust the way they do things for me to meet changes in the way I’m feeling.”

The service was led by a registered manager who was based in the service full time. The manager was supported by five team leaders and two administrators whose roles and responsibilities were well defined. Staff were well motivated and spoke positively of the service’s leadership. Their comments included,” You are always made to feel part of the team”, “The managers are really switched on” and “I find the [registered manager] really good. Very supportive. She always asks how you are doing, she does not just go through the motions.” People, relatives and professionals were also complementary of Corcare’s leadership and told us, “The staff in the office are approachable and professional”, “They are well managed, professional, friendly and easy to deal with” and, “The service is very well managed.”

The service had appropriate systems in place to ensure all complaints were investigated and resolved. Questionnaires were used to directly gather people’s feedback on the services performance and we saw responses prior to the introduction of the use of agency staff had been complimentary.

There are two different services registered to provide personal care, to people in their own homes, from this location. These are St Austell STEPS (Short Term Enablement and Planning Service) and CORCARE, which provides on-going long-term care packages.

The STEPS service provides care visits for periods of up to six weeks in the St Austell and surrounding areas. The aim of the service is to re-enable people to maximise and re-gain their independence, within their own home, after a period of illness and/or hospital stay. The service provides support to adults of all ages. On the days of the inspection the service was providing personal care to 33 people and employed 23 staff. Referrals for packages of care were made to the service by health and social care professionals. These included; hospital discharge teams, physiotherapists and occupational therapists.

The CORCARE service provides on-going care packages across the county of Cornwall. The service provides care and support to adults of all ages. 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 support with meals. On the days of the inspection the service was providing personal care to 67 people and employed 30 staff. Referrals for packages of care were made to the service from Cornwall Council’s brokerage team and were mostly taken from the ‘unmet needs list’. This list comprised of people who, usually because they lived in difficult to reach locations, had not been provided with their assessed care package through the usual contracting processes.

There were two registered managers in post. One was responsible for the day-to-day running of the STEPS service and the other for the day-to-day running of CORCARE. 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 and associated Regulations about how the service is run.

People and their relatives told us they felt safe using both services, commenting, “[Persons’ name] is comfortable with all the staff”, “I trust the staff and because of that I have let go of caring for [the person]” and “Excellent service, can’t fault it.” People told us staff were kind, caring and compassionate; whilst being respectful of their privacy and dignity. Comments from people and their relatives included, “Staff are cheerful and very helpful”, “[Persons’ name] is very happy with all the staff” and “Fantastic, nice and helpful girls.”

People received care, as much as possible, from the same care worker or team of care workers. Rotas were planned in such a way as to minimise changes of staff. People told us they had regular staff and the times of their visits were agreed with them. Everyone told us the service was reliable, visits were never missed and they were kept informed of any changes to the time of their visits. People said, “I am amazed how staff keep to the times” and “If they are going to be late they ring me.”

Staff were recruited safely, which meant they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. All 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. Staff received appropriate training and supervision. New staff received an induction, which incorporated the care certificate. There were sufficient numbers of suitably qualified staff available to meet the needs of people who used the service.

Staff were knowledgeable about the people they cared for and responded appropriately as people’s needs changed. The registered managers ensured staff received appropriate training and supervision. New staff received an induction, which incorporated the care certificate. Staff spoke passionately about the people they supported and were clearly motivated to provide an individualised service in line with people’s needs and goals. Comments from staff included, “I enjoy the job very much” and “I think people who use the service are safe and received good care.”

People told us they were involved in decisions about their care and were aware of their care plans. Care plans provided staff with clear direction and guidance about how to meet people’s individual needs and goals. In the STEPS service care plans were reviewed weekly to evaluate the progress people were making against their overall goals and agree the next steps for the following week. In the CORCARE service care plans were reviewed monthly, or as people’s needs changed. Any risks in relation to people’s care and support were identified and appropriately managed.

Both services worked successfully with healthcare services to ensure people’s health care needs were met. The services had supported people to access services from a variety of healthcare professionals including GPs, occupational therapists and district nurses to provide additional support when required. Care records demonstrated staff shared information effectively with professionals and involved them appropriately. One healthcare professional told us, “Staff are very good about reporting any concerns and asking for advice.”

The management, of both services, 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.

There was a positive culture in both services, the management teams provided strong leadership and led by example. Both registered managers had clear visions and values about how they wished their service to be provided and these values were shared with their staff team. Staff told us the management of both teams were very supportive and readily available if they had any concerns. Staff told us, “The team leaders of CORCARE are very supportive”, “They [CORCARE] are they best organisation I have worked for and the best rotas I have ever had”, “Any concerns we raise in the STEPS team are addressed” and “They [management of STEPS] take notice of what you say.”

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. People and their families told us the management teams were very approachable and they were included in decisions about the running of the service. People had details of how to raise a complaint if they needed to but felt that issues would usually be resolved informally. Comments from people included, “I would recommend the STEPS service to anyone” and “I would say the CORCARE service is well managed.”