Smithfield Health & Social Care Limited t/a Verilife

Smithfield Health & Social Care Limited t/a Verilife is a domiciliary care agency providing personal care to 135 people at the time of our inspection.

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

Risks to people were managed safely. People’s care records included risk assessments and risk management plans. The registered manager monitored them to ensure any areas for improvement were identified and discussed with staff. People were protected from the risk of infection. Staff had received training and were knowledgeable and supported people in a way that reduced the risk of the spread of infection. The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again. Staff completed accident and incidents records. These included actions staff took to respond to and minimise future risks.

Rating at last inspection

The last rating for this service was good (published 28 January 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about risk management and infection control. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Smithfield Health & Social Care Limited t/a Verilife is a domiciliary care agency providing personal care to 109 people at the time of our visit.

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.

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

People told us they felt safe with staff and there were robust risk assessments and plans in place to manage any risks people faced. There was a system to monitor and respond to any incidents, such as falls. People received their medicines from trained staff and care was delivered in a way that reduced the risk of the spread of infection.

People gave positive feedback about the competence of staff and said staff supported them in personalised ways to meet their nutritional needs. 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. Staff regularly worked with healthcare professionals and made referrals when people’s health changed.

People told us staff supported them in a way that was caring and considerate of their needs. Staff were knowledgeable about how to provide care in a way that was respectful and maintained people’s dignity. People were encouraged to maintain their independence.

People’s care was planned in a personalised and people told us they were involved in care planning. When things changed, reviews took place and care plans were updated. People knew how to complain and any complaints raised had been investigated and responded to appropriately.

Improvements had been made since our previous inspections and the provider had embedded systems to ensure improvements could be sustained. People’s views were sought and taken seriously and staff said they felt supported by management. There was a system to reward good practice amongst staff and the service regularly worked alongside others to deliver care.

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 Requires Improvement (published 29 December 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service had a registered manager 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.

We inspected Smithfield Health & Social Care Limited t/a Verilife, in January 2017 and found significant shortfalls. We found two breaches of the fundamental standards and regulations. Staff were not always deployed in a way that met people’s needs. Effective systems were not in place to monitor and address late visits and the provider was not taking sufficient action to improve the service.

We took enforcement action and issued a warning notice relating to 'Good Governance' and told the provider to meet the fundamental standards by 12 April 2017. We followed up on the warning notice and we inspected the service on 15, 16 and 21 August 2017. We found that the provider had made improvements to the systems used to assess and monitor the quality of the service; however further improvement was required in specific areas of quality assurance and call monitoring. The service was rated overall requires improvement at June 2017 and in August 2017 inspections.

At this inspection we received a mixed response from people, their relatives and staff about the management of the service. We found the provider had not always monitored and analysed short, early or late calls, to identify patterns and improve on the service. The provider had not acted to make sure that risk assessments included appropriate guidance for staff on how identified risks should be managed. Care plans we reviewed did not always reflect people’s current needs and had not been updated when their needs had changed. The provider had identified communication needs for people but had no guidance in their care plan for staff about how to meet them.

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

People and their relatives told us they felt safe. The provider had clear procedures to recognise and respond to abuse. All staff had completed safeguarding training. The service had a system to manage accidents and incidents and to reduce recurrences. People were protected from the risk of infection.

The service had enough staff to support people’s needs and had carried out satisfactory background checks for staff before they started working at the service. The service had an on-call system to make sure staff had support outside of office working hours.

Staff supported people to take their medicines safely. The provider had a policy and procedure which gave guidance to staff on their role in supporting people to manage their medicines safely.

The service provided an induction and training, and supported staff through regular supervision and spot checks to help them undertake their role.

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 consented to their care before it was delivered. The provider and staff understood their responsibilities within the Mental Capacity Act 2005. Some people lacked capacity to make important decisions about their care and the provider had documented best interest decisions, when decisions had been made on their behalf.

Staff supported people to eat and drink enough to meet their needs. People’s relatives coordinated their health care appointments and health care needs, and staff were available to support people to access healthcare appointments if needed. People’s personal information about their healthcare needs was recorded in their care records.

People and their relatives said staff were caring. People were supported to be as independent as possible. Staff involved people and their relatives where appropriate, in the assessment, planning and review of their care needs. People’s care records showed that they were involved in planning and subsequent reviews of their care. Staff showed an understanding of equality and diversity.

The service had a complaint policy and procedure in place. People knew how to make a complaint and told us they would do so if necessary. Each person had a care plan which contained information about people’s personal life and social history, their health and social care needs, allergies, family and friends, and contact details of health and social care professionals. The provider had systems and processes in place to support people with end of life care, in line with their wishes.

The registered manager held staff meetings, where staff shared learning and good practice so they understood what was expected of them at all levels. We observed staff were comfortable approaching the registered manager and their conversations were friendly and open.

People’s views were sought to improve on the quality of the service. The service had a positive culture, where people felt listened to and included in making decisions. The service worked effectively with health and social care professionals and commissioners. Feedback from a social care professional stated that the provider made improvements since the previous inspection in August 2017.

At our previous focussed inspection on 25 January 2017 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found staff were not always deployed in a way that met people’s needs. Effective systems were not in place to monitor and address late visits and the provider was not taking sufficient action to improve the service.

Following that inspection we took enforcement action issued a warning notice to the provider in relation to the quality monitoring at the service and told them to meet the fundamental standards by 12 April 2017. The provider sent us a report of improvements they had made.

At this inspection we found that the provider had made improvements in the systems used by the service to assess and monitor the quality of the care people received. In March 2017 the provider had appointed one more care coordinator in addition to the existing three. As a result of these interventions the service had made improvements, which included updating staff rostering to allow them sufficient travel time between calls, informed people when staff were running late to attend their scheduled calls and maintained a record to show what action was taken in this matter. The provider carried out an analysis of late call alerts routinely and have also recorded what action was taken to address. Through our discussions with staff and people using the service, we confirmed there had been no missed calls to people.

Although the provider had made improvements since the January 2017 inspection, at this inspection we identified some further improvement was required in specific areas. Five members of staff calls were arranged back to back with no travel time allowed in between visits. Another four members of staff did not have sufficient travel time allocated between calls. We further found, that some people either received late calls or early calls instead as per their scheduled call time. A member of staff told us that sometime people requested them to come early or late on some occasions and so they accommodate their request. However, there was no record to show that people had requested them to come early or late. Also, on some occasions staff have not spent the full allocated time at people’s home but spent less time. A member of staff told us that when they finished their allocated tasks, people asked them to leave their home. However, there was no record to show people have asked them to leave earlier than their scheduled visit times.

The above issues were a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

The registered manager held regular staff meetings, where staff shared learning and good practice so they understood what was expected of them at all levels.

The service worked effectively with health and social care professionals and commissioners. Feedback from a social care professional stated that the provider continued to make improvements and had been cooperative with safeguarding investigations.

People’s consent was sought before care was provided. However, we saw in people’s care records that five people were identified as not having capacity to make decisions in relation to their care. Although, the service had worked with their relatives, if appropriate, and the relevant health and social care professionals in making decisions for them in their best interests but had not maintained a record to reflect the same in line with the MCA, and this required improvement. There was no negative impact on people.

The service provided an induction and training, and supported staff through regular supervision and annual appraisal to help them undertake their role. The service had enough staff to support people and carried out satisfactory background checks of staff before they started working. The service had an on call system to make sure staff had support outside the office working hours. Staff felt supported by the provider.

The service had a registered manager 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.

Staff supported people with food preparation. People’s relatives coordinated health care appointments to meet people’s needs, and staff were available to support people to access health care appointments if needed.

The provider involved people about their care and support needs. Staff supported people in a way which was caring, respectful, and protected their privacy and dignity. Staff developed people’s care plans that were tailored to meet their individual needs. Care plans were reviewed regularly and were up to date.

The service had a clear policy and procedure for managing complaints. People knew how to complain and would do so if necessary. The service had maintained a complaints log, which showed when concerns had been raised senior staff investigated and responded in a timely manner to the complainant. The service sought the views of people who used the services.

The service had a registered manager 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.

We carried out an announced comprehensive inspection of this service on 30 November 2016 and the service was meeting all the requirements we inspected. After that inspection, we received concerns in relation to staff rotas being planned by the service with no allocated travel time. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report form our last comprehensive inspection, by selecting the ‘all reports’ link for Smithfield Health & Social Care Limited t/a Verilife on our website at www.cqc.org.uk.

At this inspection on 25 January 2017, we found that staff were not deployed in a way that met people’s needs. People and their relatives told us that staff were often late for visits. Two people we spoke with told us late visits had a negative impact on them, specifically when visits were two and a half hours later than agreed in their care package. The service did not provide staff with adequate travel time between visits. Rotas identified instances where visits were scheduled back to back. People were not always informed by the office when staff would be arriving late for their scheduled visit.

The service did not have robust systems in place to monitor and address late visits. The service used an electronic system to monitor visits and late and missed visits were highlighted on the system. The information about visits was difficult to interpret without further analysis. The service was not analysing this information to enable them to clearly understand the extent of late visits. After the last inspection on 30 November 2016, the provider sent us an action plan to address concerns identified in the inspection, including being late for visits. However, at this inspection we found back-to-back visits were still being scheduled and people continued to receive late visits.

People who raised complaints about staff lateness did not always have their complaints acknowledged in a timely manner. After this inspection, the provider sent us confirmation complaints had been acknowledged and were under investigation.

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

Smithfield Health & Social Care Limited t/a Verilife is a domiciliary care agency which provides personal care for people in their own home. They may be older adults, people living with dementia, people with a learning disability or children needing support.

On the day of this inspection there were 148 people using the service who had personal care needs.

A registered manager was in place at the time 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.

Relevant checks had been carried out for recruiting staff, however, systems for checking staff members right to work in the UK did not identify an issue that we found. After the inspection we were informed that the relevant agencies had been informed of the issue and an audit undertaken on all staff files which found all checks had been completed and were up to date.

An electronic monitoring was system used to monitor times people had visits and how long staff stayed to support people. This confirmed staffing arrangements were adequate to meet people’s needs. Systems were also in place, following a recent satisfaction survey, to ensure the areas where staff worked was divided equally to ensure timekeeping was improved and people were supported by the same care workers as much as possible.

Staff could explain how they would recognise and report abuse and received the appropriate training in safeguarding adults. Policies and procedures were in place for safeguarding adults and children.

Person centred risk assessments had been undertaken. Plans were put in place to minimise any risks identified for people and staff to ensure they were safe from harm.

The service trained staff to support people appropriately. Areas covered included basic food hygiene, health and safety in people’s homes, moving and handling, administration of medicine, and the Mental Capacity Act 2005 which included training on the Deprivation of Liberty Safeguards.

Staff received regular one to one supervision and annual appraisals. The content of supervision sessions recorded what was relevant to individuals’ roles.

The service had systems to assess and record whether people had the capacity to consent to care. Staff understood the importance of asking for consent before they supported people.

Staff were clear that treating people with dignity and respect was a fundamental expectation of the service. They had a good understanding of equality and diversity and understood the need to treat people as individuals.

Care plans were detailed and personal and provided good information for staff to follow.

A complaints policy and procedure was in place and structures were in place to address complaints effectively.

We heard from staff that the registered manager was supportive and her approach was positive and open.

Regular auditing and monitoring of the quality of care was taking place. This included spot-checks and observations on the care provided by staff to people.

The service undertook an annual survey in June 2016 we saw there had been an overall improvement in satisfaction. However, the satisfaction rate for time keeping had decreased slightly and actions were in place to address this. We saw evidence of analysis and where there had been concerns raised, actions had been identified to support improvements.

We found that people were asked for their consent before care was carried out and that care was planned and delivered in a way that met people's needs. People told us they felt safe with the care staff in their homes and we found staff were aware of how to manage an allegation of abuse. Not all the people we spoke with had received quality monitoring visits although we found the agency were taking steps to monitor the quality of the service.

Almost everyone we spoke with told us they found the care staff suitable, however we found that the agency had not carried out the appropriate pre-employment checks in every case, as they were required to do.