Archived: Radis Community Care (Huntingdon)

Radis Community Care (Huntingdon) is a domiciliary care agency. The agency office is in Huntingdon. Care is provided to adults in their own houses and flats. At the time of our inspection there were 74 people receiving 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.

At our last inspection we found the provider to be in breach of regulations 12, 17 and 19 of the Health and Social Care Act (2008). Due to the improvements made since the last inspection the provider was no longer in breach of these regulations.

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

There had been good improvements made since our last inspection. People, relatives and the staff team were positive about their experiences at the service.

The provider had policies and procedures to ensure people were kept safe. The registered manager understood safeguarding and the importance of reporting any concerns.

Quality assurance audits were completed, any issues identified were reviewed and action plans completed to ensure improvements were made. The registered manager responded appropriately to incidents, complaints and concerns.

People told us they were happy with the care and support they received. Peoples care plans contained good guidance for staff, which included appropriate risk assessments that were reviewed every six months or when required.

Recruitment practices were robust and included appropriate checks by the provider. Staff received regular training which included infection control, they understood how to keep people safe and the importance of reporting any concerns. Staff understood their roles and felt supported by the registered manager.

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 requires improvement (published 30 April 2019).

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions in Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Radis Community Care (Huntingdon) is a domiciliary care agency. The agency office is in Huntingdon. Care is provided to adults in their own houses and flats in the Huntingdon, St Neots, Ramsey, Yaxley, and the surrounding areas. There were 123 adults receiving personal care at the time of our inspection.

People’s experience of using this service:

Staff had not always identified risks to people who used the service or put in place guidance on how to reduce risks where these were identified. Staff had not always updated people’s risk assessments to reflect their changing needs. The registered manager had not always investigated incidents that occurred.

The registered manager had not always carried out robust checks of staff to make sure they were suitable for their roles.

Governance systems and provider oversight were not sufficiently robust to have identified the issues we found in relation to the management of staff recruitment, medicines, assessment and care planning.

People were satisfied with the way staff supported them to take their prescribed medicines and they said they received these at the right times. However, staff did not always record that they had administered medicines that had been bought over the counter, rather than prescribed.

There were enough staff to ensure people’s needs were met safely and at the right time.

People were protected from avoidable harm by a staff team trained and confident to recognise and report any concerns. Staff followed the provider’s procedures to prevent the spread of infection and reduce the risk of cross contamination.

Staff knew the people they cared for well and understood, and met, their needs. Staff were trained and well supported to meet people’s assessed needs. Staff supported people to have enough to eat and drink. Staff supported people to access external healthcare services to help maintain their health and well-being.

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 were fully involved in making decisions about their care and support.

People and their relatives were involved in the setting up and review of their or their family member’s individual support and care plans. However, some people’s care plans lacked guidance for staff in how to provide people’s care and had not been updated when people’s needs changed.

Staff were kind, caring and friendly. Staff respected and promoted people’s privacy, dignity and independence.

Staff worked in partnership with other professionals to ensure that people received care that met their needs.

People’s suggestions and complaints were listened to, investigated, and acted upon to reduce the risk of recurrence. The registered manager sought feedback from people about the quality of the service provided.

We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment, fit and proper persons employed, and good governance. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Rating at last inspection: Good (report published 17 August 2016). At this inspection the rating went down to requires improvement.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service. We will return to re-inspect in line with our inspection timescales for services rated requires improvement.

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

There was a registered manager in place during this 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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager had an understanding that people being supported by the service who lacked the mental capacity to make day-to-day decisions should have an application to the Court of Protection made on their behalf. The majority of staff were able to demonstrate a sufficiently robust understanding of the MCA. This meant that any decisions made on people's behalf by some staff would be in their best interest and as least restrictive as possible.

People had care records in place which documented people’s support and care needs and assessed risks. Plans are put in place to minimise people’s identified risks and to assist people safely whilst supporting their independence. However, people did not have risk assessments or care plans for all of their identified risks.

People’s care records included how people wished to be supported, and what was important to them and their identified goals. These records and reviews of these, recorded that people and/or their appropriate relatives had been involved in this process.

Arrangements were in place to ensure that people’s medicines were administered safely. Records regarding the administration of people’s prescribed medicines were kept. These showed that improvements were needed by staff around the accurate recording of people’s medicine administration were being actioned by senior staff and the registered manager.

People’s nutritional and hydration needs were met. People, who required this support, were assisted to contact and access a range of external healthcare professionals to maintain their health and well-being.

People who used the service and their relatives said that staff respected their choices about how they/their family member would like to be supported. People were supported by staff in a kind and respectful way. Staff promoted people’s privacy and dignity.

There was a sufficient number of staff to provide people with safe support and care. Some people experienced care calls that were later than the agreed time and this was not their preference as this made them anxious.

Staff understood their responsibility to report any suspicions of harm or poor care practice. There were pre-employment essential checks in place to ensure that all new staff were deemed safe and suitable to work with the people they supported.

Staff were trained to provide care and support which met people’s individual needs. The standard of staff members’ work performance was reviewed during supervisions, competencies checks and appraisals to make sure that staff were competent and confident to provide the agreed care and support.

The registered manager sought feedback about the quality of the service provided from people who used the service and their relatives. Staff meetings took place and staff were encouraged to raise any concerns or suggestions that they may have had. Quality monitoring processes to identify areas of improvement required within the service were in place.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found-

Is the service caring?

Observations we made during our inspection demonstrated to us that people were provided with respectful and reliable support from care staff in a consistent manner. Four out of 12 people we spoke with told us that sometimes they were not informed that their carer was to be late. People were able to make choices about their care needs in an individualised way. Staff told us that the manager's door was always open and that if they ever had any concerns about people's care that they could raise these and be confident that changes would be made where this was practicable.

Is the service responsive?

Before people started to use the service their personal care and support needs were assessed to ensure that the provider was able to reliably meet these needs. This also included people's individual choices and preferences as to how they liked to be supported. We observed that people could make changes to their support and had been involved in reviews of their support. We saw that reviews were in place to update people's care and support needs. Where the provider conducted quality assurance surveys we saw that actions had been implemented to make changes according to people's most up to date needs.

Is the service safe?

Improvements to people's health risk assessments regarding people's individual activities had been reviewed and updated since our inspection in 2013. Staff training in mandatory subjects and also specialist care meant that measures were in place to minimise the risks to people's health. Staff member's understanding of their roles and responsibilities in identifying and reporting any potential abuse meant people were safely cared for. People we spoke with confirmed to us that they always, "felt safe" with staff. Staff were kept up to date with safeguarding training and the associated reporting procedures. Checks on staff and their care practices ensured that people were only assisted with their mobility by the appropriate number of staff.

Is the service effective?

We found that care workers were knowledgeable about people's individual care and support needs. Observations we made during our inspection confirmed that the care staff provided consistent support when assisting people with personal care and support. Care records we viewed demonstrated that people had made choices on the time they wanted their care, what care they needed and how they wanted this to be provided. Monitoring of people's health by trained staff ensured that people's care was effective.

Is the service well led?

The care agency was effectively led by a registered manager. Staff confirmed to us that that they felt well supported and were provided with regular training. This included how to help people with their mobility. Observations made during our inspection showed that staff responded to people's care and support needs in a respectful way. Health and safety checks had been completed in people's homes to ensure that were in place to monitor services provided. Quality assurance surveys were carried out to gather opinions from people using the service, relatives and staff to identify, as far as practicable, if improvements could be made to the service. Improvements and changes made since our inspection in 2013 showed us that the service was well led.

We found that the provider was compliant with the regulations in all the areas we assessed. If you wish to see the evidence supporting our summary please read the full

report.

People we spoke with said the agency dealt with any issues very quickly and one person said: "They dealt with it straight away and that was very reassuring". Another person said they had asked for certain staff not to visit and the request had been dealt with and those staff did not provide the care again.

Staff had completed appropriate training so that people were kept safe and their needs were met.

People we spoke with were aware of the complaints process and knew how to contact the office at all times.

People that we spoke with were positive about the care and support they received from care staff and commented that, 'The care staff are cheerful and very helpful.' People told us that they received care and support in a respectful and dignified manner. Some people we spoke with did raise concerns over the lateness of care staff for care visits

There was evidence of peoples' involvement in the reviewing and planning of their care and support. Care and support was appropriately assessed and each care visit was documented with guidelines for staff for the care and support the person required.

However, improvements to the reviewing of some care planning documentation were needed.

Staff were trained in administration of medication and were aware of their responsibilities when recording medication that they had given or prompted people to take. The agency had effective recruitment procedures in place to ensure that only people who were suitable to work with vulnerable adults were employed.

Complaints were responded to but some people felt that improvements in communication with the staff in the office needed to be made