CSK Support 24 Ltd

CKS support 24 is a large domiciliary care service, providing personal care for people living within their own homes. At the time of the inspection there were 112 people using the service. At this inspection the service provided care for older people and people living with dementia.

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

We found that people did not receive consistent care call times. Calls times were different for people on a daily basis. People told us this left them unsure on what time carers will come and how long carers will stay for.

There was no clear management oversight in place for when the registered manager was absent.

The provider had an on-call system. This is an emergency contact line to be used during out of office hours. However, we found that the on-call system was not effective. Staff did not use the protocol in place and gained contact with the manager outside of the protocol.

We found staff were trained and skilled and demonstrated an understanding of people’s care needs. However, we did identify a gap in the training provided, this being around end-of-life care.

The provider had a system in place to monitor and respond to complaints received. The registered manager showed where they had learnt for the future.

Staff had regular supervision. We also saw that staff received regular team meetings, these included communicating current information and involving staff around any changes or improvements to the care provided.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not support anyone with a learning disability or an autistic person.

Rating at last inspection

The last rating for this service was good, this was published January 2019.

.

Why we inspected

We received concerns in relation to when people received their care, staff training, consistency of staff and the governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have found breaches in relation to the governance of the service at this inspection.

Please see the action we have told the provider to take at the end of the full version of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Our last inspection of CSK Support 24 Ltd took place in September 2017 and was a fully comprehensive inspection. At this inspection the service was rated overall as requiring improvement. This was because people did not always receive a reliable and consistent service and staff did not always follow risk assessments in people’s homes. At this inspection we found that the required improvements had been made and sustained by the service.

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, younger disabled adults, and children. At the time of our inspection 42 people were receiving a personal care service from the provider and there were not any services being received by children.

Not everyone using CSK Support 24 Ltd receives a regulated activity; the Care Quality Commission only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

There was 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.

People felt safe when supported by staff from the service. The registered manager understood their responsibilities to keep people safe. Staff were knowledgeable about safeguarding and whistle blowing policies. Safeguarding issues were investigated and the relevant policies and procedures were updated where this was necessary.

People had risks to their wellbeing assessed and staff were provided with information on how to support people safely. People and their relatives were involved in developing and reviewing support plans. People’s choices, independence and freedom was respected in the risk assessment process and by staff delivering care. Risk assessments were updated as part of the review process.

People were protected by staff recruitment practices, which were effective and safe and reduced the risk of unsuitable staff being employed by the service. Staffing levels were constantly reviewed to ensure people’s needs were safely met. People had a regular group of staff, where possible, and that their staff were generally on time and stayed the full allocated time.

Most people managed their own medications. The administration of medication was well recorded and staff were trained in giving people medicines.

People’s needs were met by staff that received ongoing training, and had the knowledge and skills to meet people’s needs. Staff inductions included time with people, to get to know their needs and preferences, prior to delivering the service.

People received kindness and good care from staff who people said had a caring nature. Staff respected people and promoted their dignity throughout the services they provided. Staff knew and understood their responsibilities to keep people’s information in confidence. There was a low level of staff turnover resulting in people having continuity of staffing.

People had opportunities to express their views, directly to the registered manager, on the services they received. The registered manager knew how to identify where advocacy services may be required and how to arrange them. Most people we spoke to felt that generally the management team addressed their concerns.

Any complaints people raised were investigated and actions were taken based on any outcomes identified. The registered manager communicated outcomes of people’s complaints to them, throughout the process.

The registered manager had an effective presence in the service and monitored the day to day culture of the service by regularly speaking with the people receiving the service and supporting the staff that delivered it. Most people had met the registered manager.

The registered manager effectively analysed various quality assurance indicators and we could see that this process was used to improve outcomes for people.

The provider had notified us about events that they were required to by law and had on display the previous care quality commission rating of the service.

CSK Support 24 Ltd provided personal care and support to 38 people that lived in their own homes.

There was a registered manager in post, but she was on leave during our inspection. The registered manager is also the provider for this service. 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 and associated Regulations about how the service is run.

At a comprehensive inspection in July and August 2016 we found the provider was not meeting the law in respect of the recruitment of staff, and the governance of the service. This is because effective systems were not in place to assess, manage and monitor risks. We also found at the July and August 2016 inspection the provider needed to make improvements to ensure people’s preferences were taken into account about the gender of the staff that provided their care. Improvements were also required to ensure people received a reliable and consistent service. We carried out a focused inspection in March 2017 and found the provider had made improvements which meant they were meeting the law.

At this inspection in September 2017 we found some improvements had been made to ensure people’s preferences were met, but further improvements were needed to ensure people received a reliable and consistent service.

Recruitment practices continued to ensure people were supported by suitable staff. People did not always receive a reliable and consistent service, as some people had experienced late calls. Risk assessments were undertaken to assess and reduce any risks to people, but feedback we received from people and relatives indicated staff were not always following these assessments. People told us they administered their own medicines and staff provided minimal support. People’s records did not clearly specify the level of support each person required from staff.

Records showed that staff had received training but we received some feedback from people telling us more in-depth training was needed. Staff felt supported in their roles and confirmed they had access to regular supervision. Staff were aware of the procedures in place to safeguard people from abuse.

People were involved in deciding how they wanted their care to be delivered and were supported in line with the Mental Capacity Act 2005. People’s preferences were taken into account to ensure their dignity was maintained. People and relatives made positive comments about the staff that supported them describing them as kind, caring and gentle.

People and relatives knew a complaints procedure was in place and they told us they did not always feel concerns were responded to promptly. Records showed that all complaints had been investigated and outcomes and actions were recorded. Systems were in place to gain feedback from people using the service and this feedback was used to identify improvements that needed to be made in the service.

Improvements had been made and sustained to assess and monitor the service provided. Action was being taken to address the shortfalls in the service to improve the service provided to people. This was in relation to the consistency of the times people received their care, and the delay in the office and on-call phones being answered. A new electronic recording system had been introduced and some people did not like this and preferred written notes to be completed. The provider agreed to take action to consult people and their relatives about this.

We undertook a focused follow up inspection on 09 March 2017. The inspection was unannounced. We undertook this focused inspection to check that they had followed their action plan and to confirm that they now meet the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for CSK Support 24 Limited on our website at www.cqc.org.uk.

CSK Support 24 Ltd are registered to provide personal care and support to people that live in their own homes. People who used the service had a range of support needs. At the time of our inspection 24 people used the service.

There was a registered manager in post. 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.

The provider had taken action and the legal requirements had been met.

Improvements had been made to ensure the recruitment procedures were robust. The provider ensured that staff provided all the appropriate documentary evidence so that they could carry out the necessary checks of their fitness to work with people using the service. Systems were in place to audit and monitor the recruitment practices.

The provider had made sufficient improvements to monitor the quality of the service provided. This included monitoring the call times people received their service, auditing of care records, and medicine records. Communication had been improved to ensure people could contact the office staff and out of hours duty person when they needed to. Care records had been updated to ensure staff had the information they needed to deliver support in accordance with people’s preferences.

There was a registered manager in post and she was present during our inspection. The registered manager is also the provider for this service. 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 and associated Regulations about how the service is run.

Recruitment procedures were not robust to ensure all of the required information was obtained before people commenced employment.

People did not always receive a reliable and consistent service, as some people had experienced late and missed calls.

Medicine records were completed by the staff to confirm people received their medicines. However the records did not state the name of the medicines people were prescribed and which were administered by the staff.

Risk assessments and care plans had been developed with the involvement of people. However the content of these could be improved to make them more specific to the needs of the people.

Although staff had received training we received feedback from people and relatives that this could be improved. We found that the registered manager had started to undertake spot checks to monitor staff member’s performance.

Staff told us they gained people’s permission before providing their support.

People did not always receive support in accordance with their preferences to ensure their dignity was maintained.

A complaints procedure was in place which people and relatives knew about and had used.

Feedback was sought from people and relatives about the service provided.

Quality assurance systems were not effective and had not identified the shortfalls we found during this inspection.

You can see what action we told the provider to take at the back of the full version of the report