Cherish UK Ltd

Cherish UK is a domiciliary care service based in Standish, Wigan and provides personal care and support to people in their own homes.

People’s experience of using this service:

We carried out this inspection on 16,18 and 22 July 2019. At the time of the inspection there were approximately 230 people using the service across the Wigan areas of Atherton, Ashton, Golbourne and Lowton.

People were supported to access the local community and participate in activities of their choice. We saw a number of examples where the staff team had gone ‘above and beyond’ expectations of them to ensure people could continue to pursue their hobbies and interests.

People said they felt safe using the service, with staff demonstrating a good understanding about how to protect people from the risk of harm.

People received their medicines safely.

Staff were recruited safely, with appropriate checks carried out to ensure risks were minimised.

There were enough staff to care for people safely.

Accidents and incidents were monitored and any actions taken to prevent future re-occurrence were recorded.

People received the support they needed to eat and drink.

Appropriate systems were in place regarding the Mental Capacity At (2005).

People using the service and visiting relatives made positive comments about the care provided by Cherish UK. The feedback we received from people we spoke with was that staff were kind and caring towards people.

People said they felt treated with dignity and respect and staff promoted their independence as required.

Complaints were handled appropriately. Compliments were also recorded about the quality of service provided.

Audits and quality assurance systems were in place at both managerial and provider level.

The feedback we received about management and leadership was positive.

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 (published July 2018). The inspection was carried out in May 2018.

Why we inspected:

This was a routine comprehensive inspection and in line with our timescales to inspecting Requires Improvement rated services.

Follow up:

We will continue to monitor information and intelligence we receive about the service to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for Good rated services, however if information of concern is received, we may inspect sooner.

Cherish UK Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults, younger adults and adults with learning disabilities or autistic spectrum disorder. The service is a member of the local authorities ‘Ethical Community Services Framework’ and was awarded the contract for provision of care in Atherton, Golborne and Lowton. The service also provides support to people in other areas including Wigan and Leigh. At the time of inspection 297 people were using the service.

The service was last inspected in April 2017 when it was rated as good. At this inspection we identified six breaches in four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment (two parts), staffing (two parts), person-centred care and good governance. You can see what actions we told the provider to take in the full version of this report.

At the time of the inspection there was a registered manger in post. 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.

We received mixed views from people and their relatives in relation to feeling safe as a result of using the service. Some of the people we spoke with spoke positively about the care provided, whereas others commented on the staff being rushed and there being inconsistencies with carers.

We saw the service had safeguarding policies and procedures in place. Staff had all received training in safeguarding vulnerable adults and were able to demonstrate a good understanding of how to report both safeguarding and whistleblowing concerns. However we noted incidents had not been consistently reported to both the local authority and CQC.

We were aware the service had experienced issues with managing calls during the early part of the year, which had triggered the involvement of the local authority. Reviews of records and monitoring from February and March 2018 showed a number of calls had been missed or staff had attended the visit late. From speaking to people and their relatives, it was apparent some geographical areas had been more affected than others, as some people living in certain areas expressed no concerns with late or missed calls, whilst others in other areas reported feeling let down by the service.

Staff told us they had experienced problems with their rotas, both in terms of the feasibility of making the calls in a timely manner, and the lack of communication from office staff when these had been altered, which they stated was done ‘at short notice, often the night before or on the same day’. Again some staff had experienced more issues than others, which they attributed to the co-ordination of the calls.

We saw that robust recruitment procedures were in place to ensure staff working for the service met the required standards. This involved all staff having a DBS (Disclosure and Baring Service) check, at least two references and work history documented.

The service had systems in place for the management of medicines. However we received mixed feedback from the people we spoke with, with some having experienced no issues and receiving their medicines as required, whilst others reported their relatives had taken over this task, due to the service being inconsistent. Reviews of Medicine Administration Record (MAR) charts, showed these had not always been completed consistently and in line with company policy. Auditing of MAR charts had not taken place consistently until recently, which meant historical issues had not been identified timely.

Staff reported receiving the necessary level of training to carry out their role. We saw all staff completed an in depth induction programme, followed by a period of time shadowing experienced care staff, before being allowed to work independently with people who used the service. Staff told us ongoing and refresher training had improved over time and welcomed the practical sessions provided. However we found staff supervision had not been completed in line with the provider’s policy.

People spoke positively about the standard of care received and the caring nature of their ‘regular’ staff. They were reported to treat people with kindness, dignity and respect. Staff we contacted were knowledgeable about the importance of promoting people’s independence and people we spoke with confirmed they were encouraged by staff to do as much for themselves as possible.

We looked at 12 care files, which contained detailed and personalised information about people who used the service, including detailed guidance on the support people wished to receive during each visit. We saw that people or their representatives had been involved initially in planning the care provided, although reviews of care had not been completed consistently.

We received conflicting reports from people, relatives and staff in regards to the management of concerns and complaints. Whilst some people reported having nothing to complain about, or their concerns being addressed, others commented on not feeling listened to, not being happy with outcomes to their complaints or frustrated at having to continually raise the same issues.

The provider utilised a range of systems and processes to monitor the quality and safety of the service. However these had not identified some of the issues we identified during the inspection and we noted a number of audits had been completed retrospectively, due to not being done at the time. This meant issues from six to 12 months ago, were only just being identified.

Cherish UK Ltd is a large family managed domiciliary care organisation with branches in Wigan and Blackpool. The Wigan service is managed from an office in Standish Lower Ground. The service is a member of the local authorities ‘Ethical Community Services Framework’ and was awarded the contract for provision of care in Atherton, Golborne and Lowton. The service also provides support to people in other areas including Wigan and Warrington.

At the time of the inspection there was a registered manger in post. 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.

We saw there were systems and procedures in place to monitor the quality of the service. In line with ISO 9001 quality management systems, an audit was carried out internally by the Chairman following a monthly schedule. The service also completed weekly operational review meetings, which assessed the performance of the service over the last week based on a number of key performance indicators (KPI's).

We received mixed views from staff on the completion of staff meetings, with some stating these occurred and others having no knowledge of them ever being facilitated. We noted from looking at meeting minutes that some had taken place in 2016, although we did not see a formal schedule for the last 12 months, which would have ensured staff were aware of when meetings were due to be held. However we saw a schedule was in place for staff meetings in 2017, with these being planned for May and September. We were told staff would be notified of these meetings via email and they would also be added to their rotas.

All the people we spoke to told us they felt safe. We saw the service had suitable safeguarding policies and procedures in place. Staff had all received training in safeguarding vulnerable adults and were able to demonstrate a good understanding of how to report both safeguarding and whistleblowing concerns.

The service utilised a screening tool, reviewed on a monthly basis, to ensure sufficient staff were employed to meet people’s needs. All but one staff spoken to told us enough staff were employed to meet people’s needs. People using the service were largely positive about staffing levels. People reported some issues in the past with late and missed calls, but had noticed improvements over the last six months.

We saw that robust recruitment procedures were in place to ensure staff working for the service met the required standards. This involved all staff having a DBS (Disclosure and Baring Service) check, at least two references and work history documented.

Staff reported that they received an appropriate level of training to carry out their role. We saw all staff completed a comprehensive induction training programme, followed by a flexible period of time shadowing experienced care staff, before being able to work with people who used the service. We saw the service had systems in place to ensure that staff received regular refresher training to ensure their skills and knowledge remained up to date.

The service had systems in place to ensure safe medicines management. People we spoke with confirmed they received appropriate support to ensure medicines were taken when required and as prescribed. We saw the service carried out regular audits of Medicine Administration Record (MAR) charts to ensure medicines had been administered correctly.

People spoke positively about the standard of care received and the caring nature of the staff. Staff members were highly thought of and people told us they were treated kindly and with dignity and respect. Staff were knowledgeable about the importance of promoting people’s independence and people we spoke with confirmed they were encouraged by staff to do as much for themselves as possible.

We looked at 10 care files, which contained detailed and personalised information about people who used the service. The care plans also contained thorough risk assessments, which helped to ensure people’s safety was maintained. We saw that people or their representatives had been involved in planning the care provided and were asked for their feedback through completion of reviews and questionnaires.