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Archived: Clece Care Services Limited - Buckinghamshire Requires improvement

This service was previously registered at a different address - see old profile

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 2 December 2017

This inspection took place on 2, 3 and 4 October 2017. This was Clece Care Services Limited – Buckinghamshire’s first inspection since it registered with us in June 2016.

The service provides domiciliary care to people in their own homes. At the time of the inspection they were providing personal care to 137 people.

The service had a registered manager. They had been registered with the Commission since February 2017. 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.

During 2017 the provider had experienced difficulties with the delivery of the service. We were told by the registered manager and the operations manager this had been due to high levels of staff sickness which resulted in a shortage of staff. This had resulted in a high volume of late or missed calls to people. Recognising the risk this placed people at the provider had worked with the local authority to subcontract some of the care to other organisations until such time as they had sufficient staff numbers to manage the care safely.

Our inspection took place at a time when changes were being made which was having a positive benefit for people. Staffing numbers had increased and there was acknowledgement from a small number of people that improvements were being made in some areas. However overall, people felt they had been let down by the provider. Repeatedly throughout the inspection we were told about the missed and late calls and the impact this had for people. The provider acknowledged the situation and was working hard to improve the service for people.

Although people were still receiving late or missed calls the number had reduced to less than 1%. People and staff felt the scheduling of calls was partly the cause, as staff were not allocated travelling time. The registered manager told us this was being addressed and they were ensuring staff got breaks throughout the day. Not all staff were aware of this. We have made a recommendation about improving the numbers of staff available to support people.

Medicine records were not filled in accurately. Information related to the prescribed medicine was not comprehensive, and unexplained gaps were found on a number of Medicine Administration Record (MAR) charts. Checks carried out by the supervisors did not identify the concerns we found.

Due to a lack of clear documentation we were uncertain as to whether anyone receiving a service lacked the mental capacity to make decisions for themselves, even though some records implied they were not able to. Even though staff had received training they did not understand the Mental Capacity Act 2005 (MCA) or how this applied to the lives of people they cared for. We have made a recommendation about training for staff in this area.

Care plans and risk assessments were not robust in their content and this placed people at risk of receiving inappropriate or unsafe care. Care plans were not always person centred and there was minimal information about people’s preferences and how they wished to be cared for. We have made a recommendation about how care plans could be improved to include this information.

Recruitment systems were in place to ensure the risk of employing unsuitable staff was minimised.

People spoke positively about their relationship with some staff. They enjoyed their company and looked forward to their visits. Other people found some staff did not appear to know what was required of them, or their attitude was not professional. Staff had attended training and were receiving regular supervisions. Spot checks were carried out on their performance and where needed additional training was offered. Three monthly reviews were carried out with people to revise their c

Inspection areas

Safe

Requires improvement

Updated 2 December 2017

Some aspects of the service were not safe.

People were placed at risk of harm as carers were not always available to carry out care visits at the agreed time.

People�s medicine records did not demonstrate that medicines were administered safely and consistently.

Care plans and risk assessments did not always accurately describe the risks associated with people�s health needs. Care plans did not provide detailed information in relation to risks. This placed people at risk of receiving inappropriate care.

Effective

Requires improvement

Updated 2 December 2017

The service was not always effective

Records showed people had access to health care appointments when needed. This ensured people�s health needs were maintained.

Staff were unable to demonstrate a clear understanding of the requirements of the Mental Capacity Act 2005. There was no documentation in relation to mental capacity and decision making. We were told no one lacked mental capacity.

Where people required support with eating and drinking this was provided by staff who had received training in the area of food and nutrition.

Caring

Requires improvement

Updated 2 December 2017

The service was not always caring.

Staff demonstrated how they protected people�s privacy and dignity. They were able to give examples of how they showed respect to people.

Some people experienced poor communication from office staff when care visits were going to be late. This was being addressed by the registered manager.

Some people had engaged well with staff, enjoyed their company and looked forward to their visits.

Responsive

Requires improvement

Updated 2 December 2017

The service was not always responsive.

Care plans were not focussed on people�s preferences or how they wished care to be provided. Without this people had limited choice and control over the care provided.

People knew how to make a complaint, but did not always feel confident to do so. There was a mixed response from people about how well their complaint had been handled by the provider.

Well-led

Requires improvement

Updated 2 December 2017

The service was not always well-led.

A lack of quality monitoring in some areas such as medicines records and care records meant improvements had not been identified or implemented.

Some people did not feel the service was well managed as they had experienced late or missed call visits. This placed them at risk of harm.

The provider had failed to notify CQC about safeguarding concerns that had occurred in the service. This is not in line with regulatory requirements.