Cera - Staffordshire and Stoke

Cera - Staffordshire and Stoke is a domiciliary care agency providing personal care to people living in their own homes. The service provides support to people with dementia, learning disabilities or have autistic spectrum disorder, mental health issues, physical disabilities, sensory impairment, older people and younger adults. At the time of our inspection there were 185 people using 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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support:

People were supported to have maximum choice and control of their lives. Staff knew people well and understood how they were to be supported in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not always support this practice.

People’s care plans and risk assessments did not always identify how to support them with their individual needs. However, people were supported by staff who knew them well to be able to support them with their needs and to have choice and control in their lives.

Right Care:

Some improvements were needed to people’s care plans and although plans were person centred, these were not always updated in a timely way and not all health risks were assessed and planned for. People and relatives told us they felt safe with their carers. Staff had received mandatory training to be effective in their roles in supporting people.

Right Culture:

People and staff told us they had experienced communication issues with the office staff and issues reported to them were not always acted on. The registered manager had already identified this and was putting measures in place to address it. Some people and relatives told us care calls were sometimes late, and this had caused upset. The registered manager was responsive to our feedback about a potential safeguarding issue and took some immediate action to ensure people were made safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (17 March 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to safeguarding and call times. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cera – Staffordshire and Stoke on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding, staffing and governance and oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cera - Staffordshire and Stoke is a Domiciliary Care Agency (DCA) registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported approximately 212 people with personal care in their own homes.

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

Whilst there had been improvements since the last inspection some of the quality assurance systems were not always effective. Audits which took place with the medication records did not always identify areas where improvement was needed.

People told us they felt safe. Staff had received training in how to safeguard people. People had their risks assessed and their needs understood by staff.

People were supported by safely recruited staff, who had the skills and knowledge to provide effective support. There were enough staff available to provide consistent care and to meet people's needs. People were protected from the risk of cross infection as staff followed the additional guidance in place due to the COVID-19 pandemic.

People and staff were given opportunities to share their views about the service, and people felt able to contact the office to raise concerns.

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 under a different location name ‘Mears Care’ which was requires improvement (published 11 February 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This was the first inspection under the new provider, and we found improvements had been made therefore, the provider was no longer in breach of regulations. The service remains rated requires improvement.

Why we inspected

Our intelligence and monitoring systems highlighted to us that the service was high risk. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. However, we have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Cera - Staffordshire and Stoke on our website at www.cqc.org.uk

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.

Mears Care Stoke is a Domiciliary Care Agency (DCA) registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported approximately 291 people with personal care in their own homes.

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

Medicines were not always managed safely by the service. Medicine administration record (MAR) had not always been signed to confirm that medicines had been given. Daily notes then did not confirm if they had been administered. The registered manager had a process when staff identified that a MAR chart had not been signed. However, we found that staff were not following this process.

Risks to people were not made clear to staff. People’s files contained information from professionals relating to their physical health condition, however there was no guidance in people’s care file to advise of this and staff were unaware of the risks.

Care files did not contain risk assessments for equipment in people’s homes or regarding their health condition. We consistently found in people’s ‘Equipment maintenance information’ that this had not been completed to advise staff what equipment people used in their homes.

Capacity assessments, where appropriate, did not detail the support people required from staff, and areas which they lack capacity.

Staff received the providers mandatory training. However, staff did not always receive training on people’s specific physical or mental health needs that they worked with.

People's care files were not always personalised to their needs and information was minimal to guide care staff on specific needs.

People’s needs, and choices were not always taken into account. People’s care files did not identify how their medical condition impacted on their lives.

Quality assurance processes in place were not effective. Audits carried out did not identify areas found during the inspection with people’s care files and MAR Charts. Care records were not accurate and up to date.

People felt the service was on time for their calls. Staff told us they felt there were enough staff to meet people’s needs.

People's views on how the service was run and the support they received was regularly sought.

The registered manager understood their Duty of Candour, to be open and honest when things went wrong.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

(The last rating for this service was good (01 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches. Regulation 12 the registered person failed to ensure risks relating to the safety, health and welfare of people using the service were assessed and managed safely and the registered person failed to ensure the proper and safe management of medicines. Regulation 17 the registered person had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We requested an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mears Care Stoke are registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported approximately 206 people in their own homes.

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.

Staff and the registered manager understood their responsibilities to keep people safe from harm where abuse may be suspected.

People's risks were assessed and followed. Staff knew people's needs and carried out support in a safe way.

There was a system in place to monitor incidents and accidents and actions had been taken to mitigate the risks and ensure that people were protected from the risk of further occurrences.

There were enough suitably qualified staff available to meet people's assessed needs. The provider had an effective recruitment system in place to ensure staff were suitable to provide support to vulnerable people.

We found that people's medicines were managed and monitored in a way that kept people safe from harm.

Staff received training which was updated regularly to ensure they had the knowledge and skills required to meet people's needs effectively.

People consented to their care and where they were unable to consent mental capacity assessments and decisions had been made in the person’s best interests had in line with the Mental Capacity Act 2005 (MCA). Staff showed they understood and applied the requirements of the MCA. This meant people’s rights were protected as the provider was appropriately applying the principles of the MCA.

People were supported to eat and drink sufficient amounts and were offered choices. Staff understood people's nutritional needs and preferences when they supported people with their diet.

People were supported to access health professionals when required and referrals for advice were sought by the registered manager, which ensured people's health and wellbeing was maintained.

People received care that was caring and compassionate and they were enabled to make choices about their care. People's dignity was maintained when they received support from staff.

People were supported by a consistent team of staff who knew their needs and preferences well. People were involved in the planning and review of their care, which was planned and carried out in a way that met their preferences.

People told us they knew how to complain and the provider had an effective system in place to investigate and respond to complaints.

People and staff felt able to approach the registered manager and staff felt supported to carry out their role.

Feedback was sought from people and staff, which was acted on by the registered manager to make improvements to service delivery.

Effective systems were in place to assess, monitor and manage the service. The registered manager was committed to making improvements to the quality of the service and the provider had an overview of the service provided.