Flexecare Preston

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults.

At the last inspection on 04 September 2017, we rated the service as requires improvement. This was because we found a breach of legal requirements. The registered manager did not ensure people's needs were properly assessed before a package of care was arranged. Not all support plans were detailed and held person-centred information. We further made recommendations about safe recruitment; sufficient risk management records; documenting of consent; review of their complaints policy; service user guidance information; and effective quality assurance auditing.

During this inspection, we saw the provider had made improvements to recordkeeping and their care planning systems. They recognised assessing people before taking on packages of care maximised the potential for the service to meet their needs. We found care planning was detailed and followed a person-centred approach. When we discussed this with staff, we found they had a good level of awareness. One staff member commented, “I always ask myself, ‘how would I want to be treated?’ I have that bond and it hurts me if something goes wrong or if a service user is hurting.” People and their relatives were complementary about the responsiveness of care delivery. A relative told us, “I am so happy about the care [my relative] receives that I would have no hesitation recommending it to anyone else.”

When we discussed safety with people and relatives, we were told this was consistently maintained by H & S Direct Solutions. One relative commented, “At every twist and turn they’ve been wonderful.” Staff we spoke with demonstrated a good level of awareness about protecting people from poor practice or abuse.

The management team now followed safe recruitment procedures to ensure staff were suitable to work with vulnerable adults. We saw staffing levels matched each person’s requirements to maintain continuity of care. A relative told us, “All the carers know [my relative’s] routines and the communication is very good. It reassures us that she is safe and happy.”

We found care records included risk assessments that detailed each person’s independence level, risk factors, control measures and action to support them. All records were signed by people who used the service and staff to ensure their understanding of protocols to mitigate risk. The registered manager reviewed accidents and incidents and had systems to reduce risks to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. We discussed the principles of the MCA and consent with staff and found they had a good awareness. A staff member said, “It’s not taking over and about always taking their consent.”

We saw information made available to people about raising concerns had been improved. Those we spoke with told us they found the provider being responsive to their minor complaints. One relative said, “We experienced them as being very flexible and respectful. They did precisely what we asked them for in response.”

The registered manager had made required changes to their service user guide to provide correct details to people about the support they received. Additionally, new audits were implemented with measurable outcomes and actions taken to mitigate risk to people and staff. We saw examples of the registered manager addressing identified concerns to maintain everyone’s welfare.

We observed, where applicable, staff administered people’s medication in their own homes safely. They signed records on completion of procedures to evidence each person had taken their medicines. The management team provided training to ensure they had good levels of awareness.

When we discussed staff effectiveness with people they said they were well trained and skilled. Staff files we looked at evidenced they had guidance to carry out their duties confidently and competently. One staff member said, “It’s good training that helps me to do my job effectively.”

Care documentation included an evaluation of associated risks and measures to reduce the potential of malnutrition. People and their relatives confirmed they could choose what they wanted to eat and had ample meal portions.

We found H & S Direct Solutions had a strong focus on meeting people’s diverse and cultural needs. Those who used the service and their relatives told us the management team checked whether staff respected their customs and traditions. Care records evidenced people and their relatives were fully included in their support planning.

We saw staff were respectful when they interacted with people and consistently maintained their privacy and dignity. A relative stated, “[The staff member’s] a lovely girl. She knows how to talk with us. It’s not patronising and she chats on our level. She understands what it likes to get old.”

The service worked in partnership with other organisations to ensure they followed good practice and people in their care were safe. When we discussed the leadership of H & S Direct Solutions, we received complementary comments from staff, people who used the service and their relatives.

On 4 September 2017 we visited the agency office and the homes of some people who lived in the community and who used the services. On 5 September 2017 we made some telephone calls to others who also used the service.

H & S Direct Solutions (Flexecare) provides people who live in the community with a domiciliary care service. It is registered to provide personal care for older people and younger adults, people who have a physical disability or sensory impairment and those living with dementia or mental health issues.

The agency office is located on the outskirts of Preston city centre. It is within easy reach of surrounding towns of Chorley and Leyland. Public transport links are nearby and some car parking spaces are available.

The manager of this location was on duty at the time of our inspection. She was in the process of applying for registration with the Care Quality Commission. 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 of the Health and Social Care Act and associated regulations about how the service is run.

The agency had gathered information about people’s needs from community professionals, who had been involved in their care and support, prior to a package of care being arranged. However, the needs assessments conducted by the agency lacked detail, clear guidance for staff and person centred information. Therefore they did not accurately reflect what specific care and support was needed for people. The support plans varied in their quality. Some contained good person centred information, but others were very brief and were not always inclusive of people’s needs. We found that records were not always fully completed and details provided were sometimes contradictory.

This was a breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that mental capacity assessments had been routinely conducted for all those whose care records we saw, despite it being clear that they did not always lack the capacity to make decisions. Consent forms had been signed, but these did not provide person centred information, as the options not relevant to individuals had not been deleted from the form and therefore the information provided was misleading. We made a recommendation about this.

A system for assessing, monitoring and improving the quality of service provided had been developed. Risk assessments had been introduced in relation to people's health care needs and the safety of the environments in which people lived.

However, areas identified as being at high risk had not been reviewed for several weeks and the support plans we saw were not linked to these areas of risk. Advice had not always been sought from community professionals for people who needed additional support with their health care needs, due to a specific risk. The Personal Emergency Evacuation Procedures [PEEPs] we saw did not clearly identify how people should be assisted to vacate their homes in the event of an emergency and the hazard checklists did not make reference to electrical safety, such as plugs or sockets. The fire risk assessment, developed by the manager of the service referred to Shropshire Fire and Rescue Service and not Lancashire Fire and Rescue Service. Therefore, risk management systems did not reflect local guidance on how to manage risks. We made a recommendation about this.

We found that recruitment practices could have been better, so that at least one professional reference was obtained on behalf of each new employee and where this was not possible then a clear written explanation be provided, as to why professional references were unobtainable and the measure taken by the service to ensure staff were safe to work with vulnerable people. We made a recommendation about this.

Records showed that regular formal supervision and annual appraisals for staff had been introduced.

When asked to describe their care workers, people who used the service and their relatives told us that they were respectful, kind and caring. We were told that people felt safe using the service and that they usually received the same agency staff to provide care and support, which promoted continuity of care. This helped people to develop a trusting relationship with their care workers. We found that people were treated in a kind and caring manner, with their privacy, dignity and independence being promoted.

Records showed that people's views about the quality of service provided had been sought in the form of surveys, the results of which had been analysed and produced as an overall summary for easy reference.

A business continuity plan had been developed, which outlined action to be taken in the event of any environmental emergency, which could affect the operation of the agency.

Medicines and complaints were being well managed and systems were in place for reporting safeguarding incidents. The staff team were well supported by the senior staff of the agency, through the provision of information, induction programmes and a wide range of training modules. Staff members we spoke with had a good understanding of the people in their care and were able to discuss their needs well.