Archived: Clece Care Services Limited - Buckinghamshire

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 care and the staff performance. This took the form of face to face reviews and alternate telephone reviews.

People received support with their health needs, and where required support with food and drink.

Some people told us they did not always receive a positive response when they tried to communicate with the office staff regarding the timings of calls. Others found the staff supportive and responsive to their requests for help. They told us they felt carers listened to them and responded to their needs.

Although audits were carried out to identify areas the service needed to improve, they had not identified the areas we found during our inspection. This did not enable the registered manager to have a clear oversight of the service.

There was a mixed response from people and staff as to whether the service was well managed; this was influenced by people’s experience of the service.

The provider had failed to comply with the legal requirement to notify us of safeguarding concerns that had been raised with the service. This was discussed with the registered manager who was unaware of this requirement. They assured us this would not happen again in the future.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.