Archived: Housing & Care 21 - Kingsway

Housing & Care 21 (Blackburn branch) is based at Kingsway and is registered to provide a domiciliary care and reablement service to people living in their own homes in Blackburn with Darwen and East Lancashire. The service is also the designated care provider for four extra care housing schemes located in East Lancashire. The service user group mainly consists of older adults although the provider is registered to deliver a service to adults over the age of 18. At the time of our inspection there were a total of 274 people using the service.

When we undertook the inspection the service did not have a registered manager in place. 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 previous registered manager had left the service in January 2016. The regional operations manager had taken over the responsibility for managing the Blackburn Branch until a permanent replacement was appointed. Their application to the Care Quality Commission to add the Blackburn branch to their registration was approved on 11 May 2016. The service therefore had a registered manager in place from that date.

Improvements needed to be made to the way medicines were managed in the service. One person told us they had not been given their medicines as prescribed on the day prior to the inspection. Risk assessments we reviewed had not all been updated to take into account the updated medicines management policy for the service. This meant there was a risk staff would not be aware of the support people required to ensure they received their medicines as prescribed.

Staff had been safely recruited. Staff had received training in safeguarding adults. They were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy in place in the service and were confident that they would be listened to if they were to raise any concerns.

People who used the service told us they had no concerns about their safety when staff were supporting them. They told us staff were kind and caring and would always undertake any tasks requested of them. However, three people also told us that staff sometimes appeared rushed and did not have the time to chat with them.

Risk assessments for physical and mental health needs as well as any environmental risks helped protect the health and welfare of people who used the service. Arrangements were in place to help ensure the prevention and control of infection.

Support plans contained sufficient information to guide staff on how support should be provided. Staff completed a record of each visit they made. A system was in place to ensure support plans were regularly reviewed and updated. This helped to ensure they fully reflected people’s needs.

Where necessary people who used the service received support from staff to ensure their health and nutritional needs were met.

There was a comprehensive induction programme in place which included training in safeguarding, moving and handling, safe handling of medicines, nutrition and hydration and health and safety. Following the award of the reablement contract for East Lancashire all staff had also received training in the principles of this approach to supporting people to regain their independence after their discharge from hospital. Staff were also required to complete at least 21 hours shadowing more experienced staff before they were allowed to work independently in people’s homes.

Staff received regular supervision. Regular staff meetings also took place which were used as a forum to discuss service issues. The meetings also enabled staff to put forward suggestions as to how the service might be improved.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). Staff were able to tell us how they supported people to make their own decision. The managers in the service were aware of the process to follow should a person lack the capacity to consent to their care.

Although most people told us they received the care they needed, a small number of people told us they were not always consulted about changes to their care. One person told us staff had not responded to concerns they had raised regarding how their care was delivered. We were provided with evidence to show that action had been taken immediately following this inspection to rectify this matter.

There was a complaints procedure in place. We were told that all serious complaints were logged and monitored centrally by the provider. Any lessons learned from these complaints were shared with the relevant service. We noted that more minor complaints were documented at the registered office. However we saw that staff had not fully documented the action they had taken in response to one complaint received. This meant there was a risk the service would not be able to identify where improvements could be made.

Staff told us that they enjoyed working in the service. They told us communication and leadership within the service had improved following changes to the management in the branch. The service had a range of policies and procedures in place to help guide staff on good practice.

All the staff and managers we spoke with during the inspection demonstrated a commitment to providing high quality care. They were able to tell us of the areas where they felt improvements could be made in the service and the actions which had been taken to address any shortfalls identified through quality monitoring processes.

Below is a summary of what we found. The summary is based on our observations during the inspection, a review of records, discussions with eight people who used the service and four relatives. We also spoke with the registered manager and six members of staff.

Is the service safe?

All the people we spoke with who used the service told us they felt safe when receiving care and support.

Most people we spoke with who used the service told us they were very happy with the care and support they received. However, three people told us they did not always receive the consistent care they wanted due to changes of staff.

People's care records mostly contained the information required to enable staff to provide safe and appropriate care. However risk assessments could be improved to include more detailed information about the action staff should take to manage any identified risks.

Appropriate arrangements were in place to support the safe administration of medicines.

Is the service effective?

An assessment was completed before people started to use the service to ensure their individual needs could be met. People were involved in the development of their support plans.

Staff told us they knew people well and were able to deliver effective support which promoted independence and choice. One staff member told us, 'I always offer people choices about what they want me to help them with'.

Is the service caring?

People who used the service and their relatives were mainly positive about the staff who supported them. Comments people made included, 'They [staff] don't just do what they have to do and disappear. They are really caring', 'The carers are absolutely fabulous' and 'Staff are very nice but I would like the same one to come every time'.

People's care records showed that their preferences, likes and dislikes had been documented. However, one relative told us their family member had expressed the wish to only have a male carer but that this was not provided at weekends. The registered manager told us this was due to the fact that there were insufficient numbers of male staff to provide care at weekends, although they were in the process of recruiting one additional male carer.

Is the service responsive?

Systems were in place to review the care provided to people who used the service. However, we found improvements could be made to ensure all reviews were undertaken in a timely manner.

The provider had a clear procedure in place with regards to responding to any complaints and concerns made.

Is the service well led?

The service had a manager who was registered with the Care Quality Commission and was qualified to undertake the role.

We saw there were systems in place to monitor and evaluate the quality of the service provided.

Staff told us they felt well supported both by senior staff and their colleagues. We saw staff had access to training relevant to their role. However two staff told us they felt they needed additional training in specialised medical techniques such as the use of nebulisers. The registered manager told us they would take urgent action to ensure this training was provided to the relevant staff.

We found there were processes in place to obtain agreement from people or their representatives about how identified needs should be met.

We reviewed the care records held for five people who used the service. We saw support plans were personalised and based on an assessment of people's needs.

People we spoke with told us they received appropriate support to take their prescribed medication. However we found improvements needed to be made to help ensure medicines were always administered safely.

We saw evidence there were effective recruitment procedures in place. These should help ensure people who used the service were protected from unsuitable staff.

The provider had appropriate systems in place to monitor the quality of service provision. We found people's views had been taken into account in the way the service was provided.

We asked people to tell us what it was like to receive services from this home care agency with particular regard to how people's dignity was upheld how they can make choices about their care and how their safety was maintained.

People who spoke with us felt care workers treated them with dignity and respect. They also told us care staff respected their decisions in relation to day-to-day tasks. All the people agreed the care staff met their individual needs and that the care workers

were friendly and the agency was providing a good quality of care.

Continuity of the care workers attending their homes was important to them and all of the people we spoke with confirmed that they always or nearly always had the same carers.

One person said: "They are fabulous and treat me really well". Another person told us: "I have nothing but praise for the staff and managers of the agency, They are always on time and I never feel rushed or a burden."