Eldercare

Eldercare is a domiciliary care service providing regulated activity of personal care. At the time of the inspection 18 people received the service in their own homes. The service is registered to provide support to people who misuse drugs and alcohol, people with an eating disorder, and people with dementia, mental health, learning disabilities or autistic spectrum disorder.

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 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 care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support: People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were safely recruited in line with the provider's policy and legislative requirements. Staff received supervision and appraisal along with spot checks to ensure they followed best practice guidance.

People received initial assessments of their needs with care plans in place to manage known risks.

Regular reviews ensured information remained relevant and up to date as an accessible point of reference for staff. For example, policies and procedures had been updated to ensure the safe and secure management associated with people’s finances, where this was required.

Right care: Care was person-centred and promoted people's dignity, privacy, and human rights;

Staff were respectful, caring and understanding around people’s emotional and physical needs.

Where people were assessed as requiring support to take their medicines this was completed by suitably skilled staff with information available for staff to follow to do this safely. Guidance to support staff in ensuring people received other medicines when they required them, for example, pain relief, and application of prescribed creams was available and will benefit from a required review to ensure guidance remained clear and always followed best practice protocols.

Right culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive, and empowered lives; The culture of the service was open and empowered individuals to express their views and be in control of their lives with the support of staff. People felt confident to approach staff and management and that their suggestions were listened to.

People were involved in planning their care and support and delivered following a robust assessment of needs to ensure people’s wishes, preferences, and any personal characteristics were recorded and supported.

A range of quality assurance checks including regular audits were completed to manage and improve the service and to maintain compliance with required regulations.

Staff followed latest guidance to maintain effective infection prevention and control and had good access to any required protective equipment which helped to reduce the spread of any infections.

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

Rating at last inspection and update

The last rating for this service was was Good (published 30 October 2018).

Recommendations

We have made a recommendation for the provider to review information to manage ‘as and when required’ medicines to ensure the implementation of best practice protocols and guidance for staff to follow.

Why we inspected

The inspection was prompted in part by a CQC notification of allegations of financial abuse against a person in receipt of regulated activity. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk associated with supporting people where their money was involved.

We undertook a focused inspection to review the key questions of safe and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eldercare on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eldercare 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, some of whom may be living with dementia. At the time of inspection 29 older people used the service. One of the directors, who was also the registered manager, was present throughout the inspection.

At our last inspection the provider was found to be in breach of four regulations. These were Regulation 12 Safe care and treatment, Regulation 18 Staffing, Regulation 19 Fit and proper persons employed and Regulation 17 Good governance.

We asked the provider to take action to make improvements to their quality monitoring systems and processes and ensure they kept complete, accurate and contemporaneous records to ensure they complied with Regulation 17 Good governance. This action has been completed.

Following the last inspection, we met with the provider to asked what they would do and by when to improve the key questions; Is the service Safe? Is the service Effective? Is the service Caring? Is the service Responsive? Is the service Well-led? to at least good.

Risk assessments had been improved to ensure they captured all risks relating to each individual. They had been reviewed an updated when changes in people’s need occurred.

Safe recruitment processes were now in place and had been followed. Pre-employment checks had been completed and an induction process followed.

Medicines had been managed safely. Staff had been provided with appropriate training and observations to assess staff competencies within this area had been conducted. Medicine administration records were now collected and audited on a monthly basis to ensure any areas of concern were identified and actioned as soon as possible.

Safeguarding training had been provided and staff we spoke with knew how to raise concerns. They were confident the management team would deal with any concerns raised appropriately.

There were enough staff available to meet people’s needs and attend planned care visits. People were supported by a consistent team of staff and pre-admission assessments had been completed to ensure the service could meet people’s needs before a package of care was accepted.

A comprehensive training plan was in place to ensure staff had the skills and knowledge to fulfil their roles. An extensive range of training had been provided since the last inspection. Regular one to one supervisions and appraisals had taken place. Staff told us they felt supported.

People were supported to access health professionals when needed and to maintain a healthy balanced diet of their choice.

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. People had signed their care plans to consent to the support they were receiving.

People’s independence was promoted by staff. Care plans had been further developed to ensure they contained person-centred information and provided clear guidance of the level of support that people required. These had been regularly reviewed to ensure they remained up to date.

People’s end of life wishes had been discussed and recorded. Advanced care plans provided staff with information about aspects of the person’s life that was important to them.

Complaints had been recorded and responded to in accordance with the provider’s policy and procedure. A concerns log had also been introduced to ensure informal concerns raised were addressed accordingly.

Effective quality assurance processes were now in place which were used to highlight any shortfalls in the service. Record showed that when shortfalls had been identified, action had been taken to address concerns.

Feedback from people had been sought on a regular basis to encourage continuous improvement. People told us they could contact the service at any time and were confident any feedback they provided would be listened to.

Following the last inspection, the provider had reviewed their management structure and implemented changes. People, relatives and staff spoke positively of the new management team, their performance and improvements made to the service provided.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Eldercare 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 people, some of whom are living with dementia. The service provides care and support to people living in Malton and surrounding areas. At the time of our inspection, there were 36 people using the service.

At the time of our inspection, the service had a registered manager. They had been the registered manager since August 2016. 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 this inspection, we found risk assessments were in place but not for all of the areas relevant to each person. Information contained in them was limited and did not provide sufficient details to enable staff to manage risks effectively. Medicines had not been administered as prescribed and staff had not received relevant training. Accidents and incidents had not been recorded accurately or monitored by the registered manager. People and staff told us they did not feel their confidentiality was respected.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 -Safe care and treatment.

Staff recruitment processes had not been followed. Applications did not contain full employment history, any gaps in employment had not been explored, interviews had not been recorded and references did not contain dates to evidence they had been received prior to employment commencing.

This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 - Fit and proper persons employed.

Staff had not received training to ensure they had the skills and knowledge they needed to provide care and support to people. Regular supervisions and appraisals had not been conducted by management and staff told us they did not feel supported within their role.

This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 - Staffing.

Audits had not been completed to monitor and improve the quality of the service. Thorough, up to date records were not kept. Throughout the inspection we found a number of concerns that the registered manager was not aware of. We found people were at risk of harm because the registered provider and registered manager did not have systems or processes in place to ensure compliance with regulations.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 - Good governance .

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

Training records showed that not all staff had up to date safeguarding training. However, the staff we spoke with were able to described the different types of abuse and action they would take if they suspected abuse was taking place.

People consented to care and support from staff by verbally agreeing to it. Some care plan evidenced people had been involved in planning their care as signatures were present, but this was not consistent for everyone.

Care plans contained details of people’s nutritional preferences. However, we found that where fluid monitoring charts were in place for people who were at risk of dehydration, these were not always completed accurately to state the amount of fluid that had been given. There was evidence of working relationships with other professionals to maintain and promote people’s health. However, guidance provided had not always been followed.

People we spoke with told us that they were well cared for by staff and had no complaints with regards to their approach. All the people we spoke with said they felt staff treated them with dignity and respect.

Care plans did not always contain enough information to meet individual’s support needs and had not always been reviewed in a timely manner. Complaints had not always been fully recorded to evidence they had been responded to appropriately.

Regular staff meeting had taken place. However, staff told us the management team were not supportive or approachable. People who used the service had been asked to provide feedback.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.