Kivernell Care Ltd

Kivernell Care is a domiciliary care agency providing personal care to people. Not everyone who used the service received personal care. 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 were supported by staff who had completed training in safeguarding and who followed risk assessments and care plans to safely care for them. Most staff had been safely recruited and the provider has addressed concerns found in some recruitment records. The provider only took on new care packages when staffing was in place to do so and people appreciated having small teams of staff to support them as they could form relationships with them.

Medicines were safely managed and staff were trained in how to support with medicines. Personal protective equipment (PPE) was provided and used according to current guidelines. Accidents were reviewed and learning shared.

Comprehensive assessments informed care plans which staff followed so they provided care as per peoples wishes. Care records held detailed information about health conditions to aide staff in working with other agencies.

Staff completed a range of mandatory training when commencing in role and shadowed more experienced staff as part of their induction.

The manager was updating Mental Capacity Act 2005 assessments and ensuring there were relevant best interest decisions in place.

There was a positive culture in the service and staff were complimentary of the new manager believing them to be fair to all. Staff knew they could approach the manager or outside agencies should they have concerns about poor practice.

Audits had not been completed for some months when we inspected however these were in process of being done to provide better oversight for the leadership team. The manager had introduced additional audits and monitoring.

The provider was aware of peoples protected characteristics and made adjustments as needed.

There was some confusion within the management team as to who was responsible for decision making. The manager had reintroduced staff meetings and quality assurance questionnaires were regularly issued to people and relatives

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 good (published 1 March 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service and, in part, due to concerns raised in relation to governance, application of the Mental Capacity Act 2005 and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led to examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kivernell Care on our website at www.cqc.org.uk.

Follow up

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

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.

• More information is in the detailed Findings below.

Rating at last inspection:

• Good (The date last report published was 9 June 2016)

Why we inspected:

• This was a planned inspection based on the rating at the last inspection in May 2016. The service remains Good.

Follow up:

• Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated 'Good'.

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 instructions for care staff to follow. Where complaints had been made, we were able to see these had been investigated and resolved to people’s satisfaction.

People and their relatives spoke positively about the registered manager. People felt the service was well led and organised and this helped to ensure they received effective care and support. Staff said the registered manager was approachable and supportive.

There were systems in place to assess and monitor the quality of the service and drive improvements.