04 September 2015
During a routine inspection
The inspection was announced and took place on 04 September 2015.
Carers with Care Limited is a domiciliary care agency that provides personal care to people in their own homes in the West Surrey area of Camberley, Frimley, Lightwater, Bagshott and Mytchett. People who receive a service include those living with frailty or memory loss due to the progression of age, mobility needs and health conditions such as diabetes. At times, services were also provided to people who were at the end of their life. At the time of this inspection the agency was providing a service to 59 people between the ages of 40 to 103. Visits ranged from half an hour to waking night services. The frequency of visits ranged from one visit per week to four visits per day depending on people’s individual needs.
During our inspection the manager was present. The manager had been in post since 03 August 2015. The manager informed us they had begun the application process to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Incidents were recorded by care workers but actions had not always been taken to ensure people were free from the risk of harm. There was no evidence that any of the incidents had been reported to the local authority safeguarding team or to CQC. Despite robust safeguarding procedures not having been followed everyone we spoke with said that they felt safe in the hands of Carers with Care Limited and the care workers who supported them.
Medicines records were not accurate and did not always demonstrate that people received the required support with their medicines.
Risk assessments included information about action to be taken to minimise the chance of harm occurring. Care workers that we spoke with were able to explain the procedures that should be followed in the event of an emergency or if a person was to have an accident.
People said that care workers generally arrived on time and if they were delayed for a significant amount of time then were contacted to inform them of the reason. People also said that they knew the care workers well and generally received a service from a group of known workers. They also said that if their care workers felt that it was necessary to stay for longer than their allotted time then they did so to ensure that people were safe and all tasks completed to their satisfaction.
The agency used an electronic software system for planning care workers rotas. This also matched care workers to people who received a service to ensure continuity of care.
Everyone that we spoke with that received a service from the agency said that they had never had missed visits and that on the rare occasion when a care worker had been more than five or ten minutes late someone had telephoned them beforehand to keep them informed. For example, one care worker had needed to stay with another person who received a service whilst an ambulance was called and the office phoned and explained. Recruitment checks were completed to ensure care workers were safe to support people.
People were supported by care workers who had the knowledge and skills required to meet their needs. Everyone that we spoke with said that care workers were well trained and were competent in their work. All staff that we spoke with said that they were fully supported by the manager. All new care workers completed an induction programme at the start of their employment. Training was provided during induction and then on an on-going basis.
People were supported at mealtimes to access food and drink of their choice. The support people received varied depending on people’s individual circumstances. Care workers were available to support people to access healthcare appointments if needed and liaised with health and social care professionals involved in their care if their health or support needs changed.
People confirmed that they had consented to the care they received. They told us that care workers checked with them that they were happy with support being provided on a regular basis. Mental capacity assessments were completed for people and their capacity to make decisions had been assumed by staff unless there was a professional assessment to show otherwise.
People had care plans in place for identified needs. Care workers understood the importance of promoting independence and this was reinforced in peoples care plans. People were supported to express their views and to be involved in making decisions about their care and support. People told us that the agency was responsive in changing the times of their visits and accommodating last minute additional appointments when needed.
Positive, caring relationships had been developed with people. Everyone that we spoke with, without exception told us they were treated with kindness and respect by the care workers who supported them. Care workers were respectful of people’s privacy and maintained their dignity.
Dignity and independence were reinforced as one of the main values of the agency within its statement of purpose and service user guide.
People using the service and their relatives told us they were aware of the formal complaint procedure and that they were confident that the manager would address concerns if they had any.
People using the service and their relatives said that the agency was well-led and provided a good service. Care workers were motivated and told us that they felt fully supported by the manager. They said that the manager was approachable and kept them informed of any changes to the service and that communication was very good.
Since being in post the manager had introduced quality monitoring systems that were linked to The Fundamental Standards and the domains of safe, effective, caring, responsive and well-led. Two audits had been completed and an action plan put in place to address areas where improvements had been identified.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.