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Reports


Inspection carried out on 6 September 2018

During a routine inspection

The inspection started on 6 September and ended on 11 September 2018. The registered manager was given two days’ notice of our inspection.

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.

Inspection carried out on 18 December 2017

During a routine inspection

Inspection site visit activity started on 18 December 2017 and ended on 10 January 2018. There have not been any published inspection ratings for this service, as it was previously registered and run by a different provider. Under the previous registration the service was rated requires improvement with two breaches of regulation in relation to good governance and fit and proper persons employed. Although this is a new registration, this information is relevant because the current nominated individual for the registered provider and registered manager was also a director of the previous company and was responsible for its operation throughout.

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.