Courage Limited

Updated 27 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 27 March 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because it is small and the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in the office to support us with our inspection.

The inspection was undertaken by one inspector. Before our inspection we reviewed information we held about the service including statutory notifications that had been submitted. Statutory notifications include information about important events which the provider is required to send us.

We also reviewed the provider information return (PIR) submitted to us 06 July 2017 prior to the previous inspection of this service. (We did not ask the provider to submit updated information prior to this inspection.) This is information that the provider is required to send to us, which gives us some key information about the service and tells us what the service does well and any improvements they plan to make.

Inspection activity started on 27 March 2018 and ended on 04 April 2018. We visited the office location on 27 March 2018 to meet with the registered manager and nominated individual to review care records and documents central to people's health and well-being. These included care records relating to two people, recruitment records for two staff members, staff training records and quality audits.

Subsequent to the visit to the office location we spoke with two people who used the service and relatives of three people who used the service by telephone to obtain their feedback on how people were supported to live their lives. We also spoke with three staff members to confirm the training and support they received.

Updated 27 April 2018

The inspection took place on 27 March 2018 and was announced.

This service is a domiciliary care agency, it provides personal care to people living in their own homes in the community. Courage Limited is registered to provide a service for people living with dementia, older people, people living with physical disabilities, sensory impairments and learning disabilities.

Not everyone using Courage Limited receives a regulated activity; 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. At the time of this inspection Courage Limited supported seven people with personal care.

When we last inspected Courage Limited in August 2017 we found breaches of regulations 11, 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to maintain robust governance of the service, record keeping was poor, management of medicines was not safe, risks to people’s safety and wellbeing were not appropriately assessed or managed, staff lacked training, their competencies were not assessed and there was a lack of engagement and involvement of people who used the service. This was the first time the service had been rated as ‘Requires Improvement’.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led to at least good.

The service had 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.

The registered manager had made significant improvements to how the service operated since the previous inspection in August 2017. However there were some areas that needed further development and embedding into daily practice. A training plan had been developed for the staff team however, this needed to be further developed so the registered manager could assure themselves that people’s needs were met safely. Record keeping had improved, however some further development was needed to promote a personalised service in terms of details included in care plans and risk assessments. People told us that they felt the service was well managed. Staff told us that they were confident of support should they need it out of office hours. The registered manager had a system of routine audits and checks to help drive the quality of the service provision forward. The registered manager kept themselves up to date with changes in the care sector and changes in legislation by being a member of care provider associations and communications from CQC.

Recruitment processes had been made more robust since the previous inspection and there were enough staff available to meet people’s needs safely. Risks to people’s safety and wellbeing were assessed and mitigated where possible. Staff had received training to enable them to support people to transfer safely by means of a mechanical hoist and their competency to do so was assessed. Staff had attended training to enable them to protect vulnerable people from abuse. People received their medicines from staff who had been trained to administer them safely. People felt safe using the services of Courage Limited. The registered manager had arrangements in place to manage and monitor infection control practices.

The staff team had the basic knowledge and skills necessary to meet people's personal care needs and promote their health and wellbeing. Staff received support and supervision from the management team to help them provide people with effective care. The service worked in line with the principles of the Mental Capacity Act 2005. People were supported to access healthcare professionals promptly when needed.

People told us the staff team were kind and caring. People were encouraged to make choices about their care and staff helped to support people’s independence and wellbeing. People or their relatives, where appropriate, had been involved in making decisions about their care. People were positive about the relationships they had formed with staff and the care they received. People told us that staff were respectful and protected and maintained their privacy and dignity when delivering care and support. Records were stored securely in a locked office and staff understood the importance of respecting confidential information.

Staff provided individualised care for people. People's care needs and preferences had been assessed and were being met whilst staff encouraged and promoted their independence. The service was responsive to people’s changing needs and wishes. People’s opinions were gathered about the care and support they were provided with. People received their care and support from a stable staff team. People told us they had not made a complaint but would know to call and speak to the registered manager if they did.