Archived: Care Connect

Updated 12 May 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 23rd of February and 14th March 2017 and was announced on both dates. We gave the service 48 hours’ notice so that the manager would be available to assist us with this inspection.

This inspection was carried out by an Adult Social Care Inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experienced assisted us by speaking with 7 people who used the service and 9 relatives by telephone to gain their experiences of using the service. In addition to this we received questionnaires from people who used the service. Comments from people are included within this report.

Before our visit, we reviewed all the information we had in relation to the service. This included notifications, comments, concerns and safeguarding information. Our visit involved looking at seven care plans and other records such as four staff recruitment files, training records, policies and procedures, medication systems and various audits relating to the quality of the service. We also observed care practice within the service.

We spoke with the Local Authority Commissioning Team. They have identified similar concerns to ones we had found in August 2016. A recent visit to the service by them had noted that there had been improvements within the provision of care by the agency.

Updated 12 May 2017

An announced inspection was undertaken on the 23rd of February and the 14th of March 2017.

Care Connect provides care and support to people living in their own homes in central Cheshire

Since our last visit in August 2016, the registered provider had employed a new manager. This person was in day to day control of the day to day management of the service and had yet to become registered with us. Our records confirmed that this person had commenced the registration process with us.

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.

At our last visit in August 2016, we identified breaches in Regulations 17 and 18 of the Care Quality Commission (Registration) Regulations 2009. The breach of Regulation 17 related to the fact that staff did not receive sufficient training and supervision to perform their role. The breach of Regulation 18 related to the fact that the registered provider had failed to inform us of significant incidents that adversely affected people who used the service.

On this inspection we saw that improvements had been made. Staff had received training suitable for their role and supervision of staff was received by all staff on a more regular basis. This meant that people who used the service could be confident that they were being supported by well trained and accountable staff.

On this visit we were also able to confirm that improvements had been made by the agency in notifying us of significant events. This was confirmed through looking at our own records and records maintained by the agency.

People told us that they felt safe although this related to when they were supported by regular care staff. On occasions, they felt less secure when supported by unfamiliar staff. Three people also told us that calls were missed on occasions with no information given as to why this had been the case. The registered provider had a system for monitoring any missed calls and had not been alerted to these occasions. There was no evidence that these had had an adverse impact on people. Other people had concerns about the levels of hygiene used by some staff with reports of them not using personal protective equipment (known as PPE) such as gloves and disposable aprons while assisting with personal care. Staff had revived training in infection control, policies were available devised by the registered provider and staff told us that sufficient supplies of PPE were available to them.

Staff had a good understanding of the types of abuse that could occur and how this could be reported. Staff had received training in safeguarding and this was confirmed through training records. Staff were also aware of how they could report concerns about the agency’s practice to external agencies such as the Local Authority or CQC.

Risk assessments were in place for each person highlighting the risks they faced for their environment as well as risks in providing support to them and the considerations staff needed to make to keep people safe. All risk assessments we saw were up to date and had been reviewed.

People told us that they received their medication when they needed it. Care plans indicated that where people were independent with managing their own medication, this was encouraged. Staff had received medication training and had had their competency to assist with medication assessed. Medication administration records (known as MARS) were retained by the office for auditing purposes.

A computerised system was in place for matching staff with people who required support. This enabled a rota to be produced for each member of staff. Staff were required to log in when they arrived at a person’s home and this was detected by the computer system.

Staff now received more consistent training. A training co-ordinator had been employed by the registered provider since our last visit. They gave us an account of how training needs had been identified through supervision, the new induction process that had been introduced and how training was updated. People who used the service had mixed views on how well trained staff were. Some felt that staff knew what they were doing whereas others commented that staff needed more training in infection control.

Staff had received training in the Mental Capacity Act 2015 and this was confirmed by staff and through training records. Staff were able to give an overview of how they assisted people to make choices relating to their support. Care plans included reference to the capacity of people to make decisions.

Staff had received training in food hygiene. The nutritional needs of people were outlined in care plans were applicable. People who used the service told us that staff were able to give them choices in what they ate while others said that staff needed more knowledge in preparing meals.

People considered staff to be generally caring yet indicated that it was their regular staff that provided a caring approach. They told us that when supported by unfamiliar staff they had felt rushed, or support had not been given to their satisfaction which sometimes made them feel unsafe. Staff gave us practical examples of how people’s privacy and dignity would be promoted.

Assessment information was gained by the registered provider prior to people receiving support from the service. This included assessments from Local Authorities who funded care as well as assessments undertaken by the agency. Assessments included all the main support needs of people which were then translated into a care plan. Care plans included a person centred approach providing an indication for staff on how to best support each person. People we told us they were aware they had a care plan in place. In one case, a person had difficulty in receiving a copy of a care plan despite requests and found that it was missing information on a health need they had.

A complaints procedure was in place as well as a more robust recording system when complaints were received. These outlined the nature of the complaint and responses made to address concerns. People told us that they knew how to make a complaint whereas others told us that they had not experienced a satisfactory response to concerns.

Staff told us that the management team were supportive and approachable. Following our inspection in August 2016, we asked the registered provider for an action plan as to how deficiencies in standards were to be addressed. We did not receive an action plan yet this visit noted that improvements had been made.

Three people told us that they were not always clear about who was managing the agency.

Audits were in place in respect of daily records and medication. These were extended to care plans and risk assessments. Our last visit had found that daily records were inconsistent yet this visit found that more robust action had been taken through team meetings and supervision to address any recording issues in daily notes.