Archived: Kare Plus Guilford

Kare Plus Guildford provides care to people that live in their own homes. Services are provided to older people, people with mental health needs, physical and learning disabilities and sensory impairment. 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. There were seven people receiving a personal care at the time of our inspection.

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

The risk assessments for people were in place, however more detailed guidance was required for staff. Improvements were also required around how staff recorded on people’s medicines charts.

People told us they felt safe with the care staff. There were sufficient numbers of staff to provide care. There were systems in place to monitor whether staff were late for a call or if they had not turned up for a call.

Staff were aware of the care people needed and care plans contained information around people’s preferences. Staff also communicated the needs of people through care notes and meetings. People were asked their consent before any care was delivered. Healthcare professionals were consulted in relation to the care delivery.

Staff received appropriate training and supervision to ensure safe and effective care was delivered. People told us staff were caring and considerate towards them. Staff maintained good relationships with people and people were treated in a dignified and respectful way. People told us staff supported their independence.

There were systems in place to review the quality of the care including audits, surveys and spot checks. Where shortfalls had been identified, actions were taken to address this. People, relatives and staff were very complimentary about the management of the service.

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 Inadequate (published 19 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection there had been significant improvements however the provider was still in breach of one regulation. The service no longer remains in special measures.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider made improvements. However, there were areas around the management of risk and medicines where further improvement is needed. Please see the Safe, and Well Led sections of this full report. The provider gave assurances that these shortfall will be addressed. You can see what action we have asked the provider to take at the end of this full report

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kare Plus Guildford provides care to people that live in their own homes. Services are provided to older people, people with mental health issues, physical and learning disabilities and sensory impairment. There were 12 people receiving a regulated activity at the time of our inspection.

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

People were not always being protected from the risk of abuse as the provider had not always investigated allegations of abuse or reported them appropriately. Risk assessments were not always in place in people’s care plans. Those risk assessments that were in place were generic and not specific to the person.

Although there were improvements around the management of the service, systems were not always in place to ensure smooth delivery of care. The provider failed to follow their own policies that related to safeguarding people and ensuring that staff were attending meetings where required. Staff fed back the management of the service had improved.

People were not always contacted by the office with when staff were going to arrive late for the call. Where complaints were made around lateness of calls these were not always recorded or responded to. We have recommendations to include the provider considering how people are contacted when staff are going to be late and about the recording of all complaints. There were other complaints that were investigated and responded to appropriately.

There were sufficient staff to attend calls and there had been no missed calls. Staff were adhering to good infection control. Staff had received updated training and were being supervised in their role.

Care plans contained information around people’s wishes around care routines. Staff were aware of the care that people needed. Staff also communicated the needs of people through care notes and meetings. People were asked their consent before any care was delivered. Health care professionals were consulted in relation to the care delivery.

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.

People were treated by staff in a caring and respectful way. Staff ensured that people were supported to remain independent. Staff had developed good relationships with people and supported them to follow their interests.

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

Previous Inspection

The last rating for this service was Inadequate (Report published 26 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection although there had been some improvements the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. Prior to the inspection we received concerns that related to safeguarding incidents not being investigated or reported by the provider.

We have found evidence that the provider needs to make improvements. Please see the Safe, Caring and Well Led sections of this full report. The provider has given assurances that the safeguarding incidents that were not reported are now being investigated and have been reported to the Local Authority and CQC.

Enforcement

We have identified breaches in relation to safeguarding people from abuse, risks relating to people’s care including the management of medicine and the lack of following procedures and policies. 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.

Since the last inspection we recognised that the provider had failed to notify the CQC of reportable incidents. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

We asked the provider to mitigate the risks in relation to ensuing that safeguarding incidents are reported and investigated.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

Kare Plus Guildford is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older and younger people some of whom may be living with dementia or have a learning or physical disability. At the time of our inspection the service provided a regulated activity to 36 people.

Rating at last inspection

At our last inspection we rated the service Good. This latest inspection was partly prompted by an incident which had a serious impact on a person using the service and this indicated potential concerns about the management of risk in the service. While we did not look at the circumstances of the specific incident, which may be subject to criminal investigation, we did look at associated risks. The Local Authority also made us aware of ongoing concerns that related to staff not attending calls to people using the service.

The registered manager was not available on the day of the inspection. 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. Instead we were supported by the provider.

People’s medicines were not being managed in a safe way which put people at risk. Staff were not trained or assessed as safe to administer medicines to people. Accidents and incidents were not always reported and actions were not always taken to reduce reoccurrence of them. Good infection control was not always being followed by staff and assessments of the risks associated with people were not always assessed. Where people were at risk of malnutrition or dehydration there were sufficient processes in place to monitor this.

The provider had not ensured that there was sufficient organisation of the staff rotas and we found that staff were at times late for calls of failed to attend calls. The provider, registered manager and staff were not following procedures that related to safeguarding people from the risk of abuse or neglect. The recruitment of staff was not robust which put people at risk.

Staff were not sufficiently trained or supervised to ensure that they were competent to carry out their role. There was a lack of understand of the Mental Capacity Act and its principles. Where people’s capacity was in doubt there was no assessments undertaken by the registered manager. Prior to people receiving care there was a lack of assessments of their needs. Where advice was needed to be obtained to support people, health care professionals were not always being contacted. Appropriate systems were not in place to ensure that staff were communicating changes in people’s needs.

People’s care was not provided in a consistent way. People were not always sure who would be attending their call and told us that this caused them anxiety. People were not always involved in their care planning. Where they asked for staff to attend the call at a particular time this was often not adhered to. Care plans lacked information about people’s backgrounds, interests and things that were important to them. Where people were being cared for at the end of their lives there was no care planning in place around this.

Care plans lacked detailed and guidance for staff. There were times where staff were delivering care without having any information about the person’s needs. Where there was a change to people’s care their care plans were not updated to reflect this. Where people and relatives complained about their care, this was not recorded and insufficient actions were taking place to address their complaints.

People, relatives and staff felt the service was poorly managed. Appropriate steps had not been taken to ensure that staff were attending calls or whether they were staying for the full length of the call. There were no systems in place to assess the quality of the care being provided. The provider was not following their own processes in relation to the care provision. Staff told us that they did not feel valued or supported.

Notifications that are required to be sent to the CQC were not always being done. This included incidents of safeguarding.

There were people and relatives that told us that they felt safe with staff at the service and felt that staff were aware of the risks associated with their care. Relatives did say that there were staff that were aware of their family members health needs and contacted them if they were concerned.

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

This inspection took place on the 6 October 2017 and was announced. We gave 48 hours’ notice of the inspection to ensure that staff would be available in the office, as this is our methodology for inspecting domiciliary care agencies.

A registered manager was 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 registered manager assisted us with our inspection.

People told us they were cared for by staff who were kind and caring. They said they arrived on time, stayed the full time and carried out care for them in the way they wished it.

People and their relatives told us they felt safe with staff from Kare Plus. Staff had a clear understanding of the different types of abuse and the procedures to be followed if they had witnessed or suspected abuse had taken place. The registered provider had followed safe recruitment processes to ensure they only employed suitable staff.

Risks to people were identified and actions taken to help people stay safe. In the event of an accident the agency followed this up.

If an emergency occurred at the office or there were adverse weather conditions, people’s care would not be interrupted as there were procedures in place. There was an on-call system for assistance outside of normal working hours.

Staff had received training and supervisions that helped them to perform their duties. They also received spot checks from the registered manager whilst they were working with people. The registered manager understood the Mental Capacity Act 2005 (MCA) and we found that people’s consent was sought before the agency provided care to them. People received information on what care the agency could provide to them prior to accepting the care. Staff received induction training when they commenced working at the agency. Mandatory training and other training specific to the roles of staff was also provided.

There were enough staff to ensure that people’s assessed needs could be met and all visits could be undertaken in a timely manner. Management of medicines was undertaken in a safe way and recording of such was completed to show people had received the medicines they required.

Person centred care plans were in place for people and included information about how people preferred their care to be provided. Guidance for staff was detailed and there was evidence people were involved in their care plan.

People’s nutritional needs were met by staff who would cook meals for those who required this type of support. Healthcare professionals were involved in people’s care and staff liaised with them as and when required.

People were supported by staff to remain as independent as they were able. People were encouraged to do things they would normally do such as washing themselves. Where people wished to go to specific events or activities, staff supported them to do this. Such as one person who staff supported to go on holiday.

Quality assurance audits were carried out to help ensure the quality of the care the agency provided met the needs of people. People and staff were involved in the running of the agency and staff told us they felt supported and valued. There was a complaints procedure in place and we found that management responded to complaints promptly. Records were held securely and confidentially. The registered manager was knowledgeable about the service and was able to assist us with the inspection. It was evident they had a good relationship with staff as we saw staff coming in to the office and speaking with them.