Elite Careplus Ltd

Care Plus Elite Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. People had a wide range of needs. At the time of the inspection it provided a service for 33 people. 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:

People using the service and their relatives told us communications with the office were good. They said they were informed if staff were going to be late or if the person’s care needs changed.

People told us they felt safe and were protected from the risk of abuse. The service had appropriate safeguarding procedures. Staff told us they received regular appropriate training in person and they knew how to safeguard people from abuse and the processes that should be followed where concerns arose.

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.

There were appropriate policies and procedures in place to ensure people received their medicines safely. Appropriate training was available for staff on the safe administration of medicines. This together with appropriate supervision and monitoring meant when required people received their medicines, this was carried out safely and staff had clear guidance to follow.

The provider had ensured that appropriate training and supervision was available for staff. Most of the training staff received was classroom based. Staff told us this was more effective than other forms of IT based training. Training packages included understanding and how to manage best practice for infection control and the use of PPE.

There were systems in place to ensure that 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.

Together with referral information, assessments of need were carried out and these informed people’s support plans which were reviewed and updated as people's needs changed.

People told us they were well supported by staff. They were supported to eat and drink according to their dietary requirements taking into consideration people's preferences.

People told us they received good quality care from kind and caring staff. They said their care was delivered by regular staff and this provided the consistency and continuity they needed. They told us they were treated with dignity and respect. They told us staff had the right skills to deliver appropriate care and support.

Staff were able to communicate with people well.

People and their relatives said the registered manager welcomed feedback and they said complaints were dealt with swiftly and professionally. People told us they thought the service was well led and that they were very happy with the support they received.

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 22 January 2018).

Why we inspected:

This inspection was prompted because the service had not received a comprehensive inspection since January 2018.

Follow up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Elite Careplus Ltd is a service which is registered to provide personal care to adults in their own home. At the time of our inspection there were 48 people using this service.

The registered manager remained in post. 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.

At this inspection we found the provider had taken sufficient action to address the breaches of regulation identified at our previous inspection. We also saw the provider had taken sufficient action to improve their rating to ‘good’ for the key questions ‘safe’, ‘effective’, ‘caring’, responsive’ and ‘well led’. However we found the provider was still rated as ‘requires improvement’ for the key question ‘caring’.

Following the last inspection the provider undertook a review of the way new staff were recruited and of the procedures to do with the safe administration by staff of medicines to people. At this inspection we found the provider made significant improvements in both these areas. The new recruitment procedures were robust and ‘fit for purpose’ as were the procedures operated by staff for the safe administration of medicines. This showed the provider had taken appropriate steps to protect people from the risks previously identified.

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.

The risks to people's safety and wellbeing were assessed and regularly reviewed. People were supported to manage their own safety and remain as independent as they could be. The provider had processes in place for the recording and investigation of incidents and accidents.

Staff followed good practice in order to prevent and control the risk of infections.

People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

People who were cared for and supported by regular staff said they were happy with their support and that staff knew them well. People told us staff who were not regular were not always aware of the care and support people they visited needed. People also told us there were occasions when these staff seemed cold and distant in their approach to people. Regular staff treated people with dignity and respect. People's views were actively sought and they were involved in making decisions about their care and support.

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 registered manager was 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.

Elite Careplus Ltd provides a domiciliary care service and a recruitment agency to supply nurses to care homes. The domiciliary care service provides personal care to 15 people living in their own homes in the Sutton area. This service includes assistance with bathing, dressing, eating and medicines, home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties. We only looked at the service for people receiving personal care during this inspection as this is the service that is regulated by CQC.

The service had a registered manager. A registered manager is a person who has registered with the 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 found the recruitment processes were not safe. Not all the checks made before a person started to work for Elite Careplus had been completed. Specifically, criminal records checks were not in place for all staff and nor had the provider obtained two references from people’s former employers before they started working for the agency. Without these checks the provider could not be assured that people would be kept safe by the people they employed.

Medicines were not administered safely. Medicines administration records [MAR] were not completed correctly. Staff had not always signed MAR charts correctly to evidence they had administered the person’s medicines. The recording errors we saw could mean people did not receive their medicines as prescribed by their GP. We judged these concerns to be serious enough we reported them to the local authority as a safeguarding alert.

We found the support plans we looked at were not as comprehensive as they could be. They did not describe who the person was, the daily support they needed and how they would like to receive that support. None of the support plans we looked at had been signed by the person receiving the support or their representative to show they had agreed to these. Elite Careplus matched a person to staff by staff availability only and did not consider the person’s support needs, background history, cultural or religious needs. This meant there were risks that a person and the assigned staff were not compatible, which could adversely impact the delivery of care and support to the person.

Care files and staff records were not stored securely. We found care files and staff records were kept in a lockable cupboard but we also found other files containing personal information of staff or people who used the service on the floor of the office in a large cardboard box.

The registered manager had not submitted to CQC the notifications of relevant events and changes as they are required to do by law. The provider did not have effective quality monitoring systems in place so as to identify the issues we found during our inspection. Monthly audits the provider conducted were not effective. Systems to monitor and improve the quality of the service were not effective in gaining the views of people or staff, to help monitor and improve the quality of the service delivered.

Despite our findings above we received positive comments from people using the service and their relatives. Comments included “I have the best carer, she does any job needed and is always smiling” and “Staff are very good, really caring, always full of life and speak so kindly to me.”

We found the service had taken steps to help ensure staff were aware of how to safeguard adults at risk. All the people and relatives we spoke with said they felt safe with the service they received. We saw people had individual risk assessments in their support plans.

Staff told us they felt well supported by the registered manager and office staff and had appropriate training to carry out their roles. Staff files we looked at contained numerous current certificates of training courses completed. Staff we spoke with and records we looked at showed some staff did not receive formal supervision on a regular basis but were able to speak with the manager at any time. Staff were satisfied with the level of supervision they received.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. The service had up to date policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and consent. These policies and procedures gave staff instructions and guidance about their duties in relation to the MCA and consent.

We did see that the notes recorded by staff at each visit were descriptive and informative. People and relatives we spoke with felt that their privacy and dignity were maintained by staff when personal care was being given. The provider had a complaints policy that people and relatives we spoke with understood.

We found staff were positive in their attitude and were committed to the support and care of people. The registered manager told us they encouraged a positive and open culture by being supportive to staff and by making themselves approachable.

We found five breaches of the Health and Social Care (Regulated Activities) Regulations 2014 in relation to staff recruitment, safe care and treatment, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.