Worth Valley Care Services Ltd

Worth Valley Care Services is a domiciliary care service that provides care and support for people in their own homes. At the time of our inspection 58 people received personal care. 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.

The service supported adults including people living with dementia, physical disabilities, mental health conditions, learning disabilities and autistic people.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. 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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People’s experience of using this service and what we found

Right Support: Risks to people were not always well managed. People’s care records needed to be more detailed and accurate to ensure staff provided the right support. People were happy with the care and support they received. People were supported by a regular team of staff who knew them well. This promoted continuity of care. Staff worked in partnership with people, relatives and health and social care professionals to provide good outcomes for people.

Right Care: Staff were not always recruited safely. People’s needs and preferences were not always thoroughly assessed. People’s care records did not contain the information staff required to deliver safe and personalised care. People told us they felt safe with staff and were complimentary of the care they received. People received consistent care from staff who knew them well. People and those important to them were involved in planning their care. Staff understood how to protect people from abuse. There were enough staff to meet people’s needs and deliver consistent care.

Right Culture: Quality assurance and monitoring systems needed to be improved. The provider needed to improve their audit processes to learn lessons, reduce risk and improve the quality of care people received. Improvements were required to ensure medicines and risks to people’s health and wellbeing were safely managed. The registered manager was passionate about the service and promoted an inclusive, open and person-centred culture. The care team listened and responded to people's views.

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

Rating at last inspection

The last rating for this service was good (published 31 July 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, 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. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

We saw no evidence that people using the service were harmed as a result of the risks identified. Following the inspection the provider sent us an action plan and assured us they would take action to mitigate the risks to people and ensure appropriate improvements were made. They also confirmed they were not taking new care packages to enable staff to focus on making the required improvements.

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

Enforcement

We have identified breaches in relation to safe care and treatment, good governance and staff recruitment.

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

Follow up

We will request an updated 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.

At our last inspection we rated the service good overall. However, the well led domain was rated as requires improvement because the registered provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because they were unable to demonstrate they had effective systems and processes in place to assess and monitor the quality and safety of the services provided.

During this inspection we found the registered provider had taken appropriate action to deal with this and they were no longer in breach of regulations. We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service remained safe and people were protected from the risk of abuse. People told us the care workers were discreet and respected their privacy.

People’s medicines were managed safety.

There were enough suitably trained staff available to ensure people received the right care and support at the right time. People told us the service was very reliable and flexible.

Risks to people’s safety and welfare were identified and managed. People’s care records included information about their likes and dislikes and staff knew people well. People told us the care workers were all kind and caring. They told us the registered manager and office staff were approachable and listened to them.

We found people were involved in planning how their care and support would be delivered. People told us they had no reason to complain about the service but said they would not hesitate to talk to the registered manager if they had any concerns.

The service worked with other health and social care professionals to make sure people received the right support.

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.

Everyone we spoke with told us they would recommend the service to friends and/or family. Two people said they had already recommended the service to friends. Similarly care workers told us they would recommend the service, both as a place to work and to anyone needing care at home.

The registered provider had systems in place to monitor and assess the quality and safety of the service. People were given the opportunity to share their views of the service. Feedback from people was used to improve the service.

Further information is in the detailed findings below.

The service had been last inspected in January 2014. The service was found to be compliant with all of the legal requirements inspected at that time.

Worth Valley Care Services is a domiciliary care agency located in Haworth, West Yorkshire, which provides care and support to people in their own homes. The service can provide a service to adults, older people, people living with dementia, people with physical disabilities and people with mental health conditions. On the day of our visit, 62 people were receiving a personal care service.

A registered manager was in place. 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 who used the service told us they felt safe with the care they received. We found there were appropriate systems in place to protect people from risk of harm.

Policies and procedures were in place regarding the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS).

People were provided with care and support by staff who had the appropriate knowledge and training to safely and effectively meet their needs. We saw the skill mix and staffing arrangements were sufficient for the current needs of the service.

Robust recruitment processes were in place and followed, with appropriate checks undertaken prior to staff working at the service. This included obtaining satisfactory references from the person’s previous employer as well as checks to show that staff were safe to work with vulnerable adults.

Staff told us they had opportunities for on-going development and the registered manager ensured that they received induction, supervision, spot checks, annual appraisals and training relevant to their role.

People we spoke with told us staff were kind, caring and respected their dignity and privacy. Staff were able to tell us about people who used the service, their care needs and how they treated people with dignity and respect.

We saw care and support was delivered in line with people's care plans and people had been consulted about the care and support required. Care records were person centred and updated to reflect people's changing needs.

Medicines management plans were in place where required and people were supported to access a wide range of healthcare professionals.

Where the service provided nutritional support, people's individual dislikes and needs were supported to enable people to consume a well balanced and healthy diet.

A complaints procedure was in place which enabled people to raise any concerns or complaints about the care or support they received.

People using the service, relatives, staff and healthcare professionals we spoke with were very positive about the registered manager. They said the registered manager was committed to providing the best service they could offer, was approachable and lead the service by example.

Relatives and staff said they had and would recommend the service to other people.

There was a lack of quality assurance monitoring systems in place that could monitor and identify any shortfalls in service provision.

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

Everyone we spoke with told us they were happy with the quality of care received. People said staff were caring, arrived at the correct time and carried out the required care tasks. Their comments included:

'Excellent, worth every penny. Very caring.'

'They work hard, I am very happy.'

'They meet my needs and really care for me, they even go the extra mile.'

Systems were in place to ensure valid consent was gained before care and support was provided.

People's needs were fully assessed on admission, so appropriate care and support was delivered.

Infection control procedures were in place to ensure staff took the necessary precautions when delivering care.

Staff told us they felt well supported by the provider and we found a range of training and development opportunities were available for staff.

The provider had systems in place to ensure it regularly monitored the quality of its service provision and sought the views of people who used the service.

We found people's needs were assessed and care and treatment was planned and delivered in line with a plan of care and support.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The provider had effective systems in place to regularly monitor the quality of care and which ensured that the health and welfare of people was protected.

We spoke with four people who used the service or their relatives. They all told us they had been involved in planning the care package and had consented to that care. We also spoke with three members of staff. They all told us the care was well organised.

Other comments included;

"The staff are fantastic."

"I am more than happy with the care I get."

"They offer an excellent service."

"I don't know what I would do without them."

"They do my washing up."

All four of the people we spoke with told us they felt safe being supported by Worth Valley Care Services Ltd.