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Inspection carried out on 4 February 2019

During a routine inspection

About the service: Kivernell Care is a domiciliary care agency that provides personal care, live-in care, respite and domestic services to people in their own homes, some of whom were living with dementia or complex health needs. The service operates in the New Forest, Lymington, New Milton and Christchurch areas. There were 105 people using the service at the time of our inspection.

People’s experience of using this service:

• At our last inspection in May 2016 we rated the safe domain as ‘Good’. This inspection identified some areas where improvements were needed and the domain is now rated as ‘Requires Improvement’. Risk management strategies needed to be more robust. For example, records reflected that staff were giving one person foods that were not in line with their assessed dietary needs. Staff knew who to inform if they witnessed or had an allegation of abuse reported to them. They were confident the registered manager would act upon any concerns. There were sufficient numbers of care workers available to meet people’s needs. Recruitment practice was safe and overall medicines continued to be safely managed. Infection prevention and control processes were in place. Accidents and incidents were documented and monitored for trends.

• At our last inspection in May 2016 we rated the effective domain as ‘Requires Improvement’. This inspection found that improvements had been made and the domain is now rated as ‘Good’. Assessments of people's needs were comprehensive. People said staff were knowledgeable, competent and suitably skilled. Records were now being maintained of the training that staff had completed which allowed the registered manager to have better oversight of this, although we have made a recommendation that the registered manager review the current training programme to ensure it fully reflects the needs of people using the service and provides ongoing assurances about the competency of staff. Staff supported people to have access to sufficient food and drink of their choice. Staff recognised if peoples’ health or wellbeing was deteriorating and appropriately sought medical advice to address this. We have, however, made a recommendation that the registered manager make body maps available to staff to contemporaneously record bruising, marks or skin damage found as an aid to later assessing the cause of these or to monitor the healing process.

The completion of mental capacity assessments needed to be further embedded within the service. Action is being taken to address this.

• At our last inspection in May 2016 we rated the caring domain as ‘Outstanding’. Our inspection findings, and the feedback received, at this inspection now supported a rating of ‘Good’. Staff displayed a genuine desire to enhance people's wellbeing and understood it was a person's human right to have their choices respected and to be able to express their views. People confirmed that staff helped them to stay independent and were mindful of their privacy and dignity.

• People continued to receive care that was responsive to their needs. Care plans were person-centred. This, along with the fact that many people had good continuity of carers supported staff to develop meaningful relationships with people. Overall people were confident that any concerns or complaints would be listened to and acted upon. Staff understood the importance of working with other health and social care professionals to provide end of life care in a person-centred manner.

• The service continued to be well led. People, their relatives and staff were positive about the leadership of the service. There was a clear leadership and management structure in place and staff were clear about their role and responsibilities. Whilst some quality assurance checks were taking place, the management team had already identified that these would benefit from being strengthened and more clearly documented. Action is being taken to address this.

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Inspection carried out on 9 May 2016

During a routine inspection

This inspection took place on the 9 and 10 May 2016 and was announced. The provider was given 48 hours’ notice because the location is a domiciliary care service and so we needed to be sure key staff would be available at the office.

Kivernell Care is a domiciliary care agency that provides personal care, live-in care, respite and domestic services to people in their own homes, some of whom will be living with dementia or have complex health needs. The service operates in the New Forest, Lymington, New Milton and Christchurch areas. There were 190 people using the service at the time of our inspection. Approximately half of these had their care and support commissioned on their behalf by the local authority or the local clinical commissioning groups. The remaining people had arranged their care direct with Kivernell Care and were referred to by the service as private clients.

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.

Improvements were needed to ensure staff had all of the training relevant to their role. The registered manager told us they would be working with their training consultant to deliver training sessions over the next five weeks to address the gaps in training. We will check to see that this has been completed.

Improvements were underway which once embedded will help to ensure staff were acting in line with the requirements of the Mental Capacity Act (MCA) 2005.

Staff received regular supervision and an annual appraisal. This helped to ensure staff understood their role and responsibilities.

People’s preferences in relation to food and any special dietary requirements were recorded in their care plans and staff demonstrated an understanding of these. People were supported to maintain good health. There was evidence staff liaised with health and social care professionals involved in their care if their health or support needs changed.

People told us they felt safe when being supported by the care workers. Risk assessments were undertaken to assess any risks to people who received a service and to the care workers who supported them. Some of the risk assessments could be more detailed, but we were aware these were in the process of being updated to ensure they reflected people’s needs and risks more comprehensibly.

People told us they were happy with the support they received with their medicines. Care plans recorded the level of help people needed with their medicines. Staff were aware of how to support people safely with PRN or ‘as required medicines’ and kept appropriate records in relation to this.

Staff had received training in safeguarding adults and had a good understanding of the signs of abuse and neglect. Staff had clear guidance about what they must do if they suspected abuse was taking place.

There were sufficient numbers of care workers available to keep people safe. People told us they were cared for and supported by staff who were familiar with their needs.

People told us, without exception, they were supported by staff who were kind and caring. Staff displayed a genuine desire to enhance people's wellbeing and to developing positive relationships with the people they cared for.

Care staff understood the importance of promoting people's independence and supporting them to retain as much control as possible. People told us they were treated with respect and the support they received helped to maintain their dignity.

Peoples care and support was planned in partnership with them and their relatives and they told us they usually received support from a regular team of care workers who understood their needs. Most care plans contained detailed step by step i