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Inspection carried out on 12 November 2020

During an inspection looking at part of the service

About the service:

Care More is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the present time it provides a service for 110 people. Not everyone using the service receives personal care. The Care Quality Commission (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:

At the time of this inspection there was not a manager in place who was registered with the CQC . Also CQC had not received an application for a new registered manager that could be approved. The previous registered manager left the service at the end of March 2020. A management team was in place in the interim period.

People were protected from the risk of abuse. The service had safeguarding procedures in place that staff were well aware of. Staff received training on safeguarding people.

Comprehensive risk assessments and risk management strategies were in place as part of the assessment and support planning process. This meant risks to people and to staff were minimised.

There were robust recruitment practices in place and sufficient staff levels to meet people's needs.

The provider had reviewed their medicines policy and procedure and all staff received appropriate training. This meant people received their medicines safely and staff had clear guidance to follow, informed by models of best practice.

The provider ensured that all their staff received appropriate training and support to understand and to manage Covid 19. This included best practice for infection control and the use of PPE.

Staff also received appropriate guidance on how to support people with dementia to understand the pandemic and Covid 19. The provider made appropriate support services available to staff in order to support their mental wellbeing through the pandemic and if they became unwell and when they returned to work.

Accidents, incidents and risks were appropriately recorded and included details of preventive strategies used by the service to reduce the likelihood of events occurring in the future.

People all told us they thought the service was well led and that they were very happy with the support they received.

Staff told us the service was well led by the owner and the management team. They said they employed innovative ways of working to develop the service. There were effective systems in place to monitor the quality of the service provided to people which ensured good governance.

Technology was used effectively by the provider to ensure people were informed promptly about potentially missed or late calls.

The service had systems in place to notify the appropriate authorities where concerns were identified. The culture of the service was positive, open and person centred.

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 good (published 19 June 2018). At this inspection we rated the service as good.

Why we inspected: We carried out this inspection following a routine review of information we held about this service. Our intelligence indicated that there may be a higher level of risk at this service. As a result we undertook a focussed inspection to review the key questions of safe and well-led only. We applied the ratings limiter to well-led.

Follow up: We will continue to monitor information we receive about the service and we will re-inspect when we feel it is necessary.

Inspection carried out on 29 May 2018

During a routine inspection

The inspection took place on 29 May 2018 and was announced. The last inspection of this service was carried out on 11 August 2016. The service was meeting the regulations we looked at and was rated Good overall. At this inspection we found the service remained Good. The inspection was announced 48 hours in advance because we needed to ensure the provider or registered manager was available.

Kareplus Epsom is a service which is registered to provide personal care to adults in their own home. At the time of our inspection there were 89 people using this service.

The service had a registered manager. 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.

People told us they felt safe. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. Staff were aware of the whistleblowing procedures and knew how to use them.

The risks to people's safety and wellbeing were assessed and regularly reviewed. The provider had processes in place for the recording and investigation of incidents and accidents.

There were sufficient numbers of staff available to help meet people’s needs.

People were supported appropriately with the management of their medicines.

Staff completed training for good practice with food hygiene and infection control.

The provider met the requirements of the Mental Capacity Act 2005 (MCA) to help ensure people’s rights were protected. Some staff had received appropriate training, and had a good understanding of the MCA. People and their said staff sought their consent before providing care.

People were supported to access health care services as required in order to help them to stay healthy.

New technology was introduced since the last inspection that had started to reduce late and missed calls and improve accessibility for staff to up to date care plan information for people.

Staff had a caring approach to their work and understood the importance of treating people with dignity and respect. People were involved in their care and told us they were listened to.

People and relatives had developed positive relationships with care staff and management.

People's care record's reflected their individual preferences and gave staff clear guidance about how people's needs were met.

Complaints were responded to in an open and transparent way, in line with the provider’s policy.

There were effective systems to monitor and improve the service, which included systems to gather people's feedback about the service.

People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were given information about how to make a complaint and the people we spoke with knew how to go about making a complaint and were confident that they would be responded to appropriately by the provider. We saw evidence the registered manager responded to complaints received in a timely manner.

There was a positive culture within the staff team and staff spoke positively about their work. Staff were complimentary about the management team and how they were supported to carry out their work. The manager and other senior staff were committed to providing a good service for people. There were quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. People told us they were regularly asked for their views about the quality of the service they received.

Inspection carried out on 11 August 2016

During a routine inspection

This inspection took place on 11 August 2016 and was announced. This was the first inspection since registration in October 2015.

Kare Plus Epsom provides personal care as well as general support to people such as meal preparation, prompting medicines, laundry and general household support. The registered manager told us the service provided care to 44 adults at the time of this inspection.

At the time of the inspection, there was a registered manager. 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 said they received care and support from staff who knew what they were doing. We found they were adequately supported but there were shortfalls in staff receiving training to ensure their knowledge remained up to date. We found that there was a breach of regulation in relation to having trained staff to care for people. You can see what action we have told the provider to take at the back of this report.

People and the relatives we spoke with told us they felt safe with the service and support they received. Risks were assessed to help reduce potential problems with the provision of support and we found there was a good assessment and care planning process. This was carried out together with people which ensured that people's care was detailed and based on all their needs. People told us they found staff to be professional and caring. They said there were sufficient numbers of staff to meet their needs. We found there was a robust method for staff recruitment that helped to ensure people’s safety. People's medicines were administered, stored and documented appropriately and people were encouraged to self-administer their own medicines.

The provider met the requirements of the Mental Capacity Act 2005 (MCA) to help ensure people’s rights were protected. Some staff had received appropriate training, and had a good understanding of the MCA. People and their said staff sought their consent before providing care.

People were supported to have a varied and balanced diet and food that they enjoyed. They were enabled to eat and drink well and stay healthy.

People told us staff were caring and kind to them. They said staff treated them in a respectful and dignified manner and their privacy and dignity was respected. People told us they were assisted in a way to help them achieve maximum levels of independence for themselves.

People’s needs were assessed with their and their relative’s involvement to ensure that the service was responsive to their individual needs and staff encouraged and promoted people’s independence. Changes in a person’s needs were identified promptly and care plans revised.

People were provided with information about how to make a complaint and people told us they felt confident in making a complaint if they had any concerns.

There was an open management culture. The registered manager was approachable and together with staff shared the same vision and values which were embedded in practice.

There were effective systems in place to assess the quality of services being provided to people.

Staff understood their role and were motivated and inspired to develop and provide quality care.