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CCK Support Ltd Requires improvement

This service was previously registered at a different address - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 10 November 2017

The inspection took place on 20 and 22 September 2017and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection to make sure people we needed to speak with were available.

The service provided care and support to adults with a variety of needs living in their own homes. This included people living with dementia and physical disabilities. At the time of the inspection the agency provided personal care for ten people. They also provided support for other people with their shopping and activities but this type of support is not regulated by the Care Quality Commission (CQC).

The service is run by three registered managers. 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.

This was the first inspection of the service as they had moved locations and appointed two registered managers in April 2017. The registered managers had not identified the shortfalls found at this inspection. The audits in place had not ensured that the quality of the service was checked to assess the care being provided.

Policies and procedures had not been updated in line with current practice and legislation.

Although feedback about the service had been gathered from people and staff, other stakeholders such as health care professionals had not been sent a quality survey. The results of the surveys for people and staff had been analysed but this overview had not been distributed to ensure people were aware of the outcome.

Medicines were not being managed or administered safely. In some cases medicines could not be accounted for and some medicines were being left out for people to take after the staff had left their homes without full risk assessments in place to ensure this practice was safe. Medicine records were not clear to confirm that people were receiving their prescribed medicines. The medicine policy did not have full guidance for staff to follow.

Not all risks associated with people’s care had been identified, therefore guidance about how to manage risks and keep people safe were not in place. Staff were able to tell us how they moved people safely but this guidance was not in the care plans. Some people had medical conditions such as diabetes, and the care plans did not detail what signs and symptoms would indicate that their condition had become unstable. There was a risk that staff may not recognise the signs if a person was becoming unwell and when to seek medical advice.

People and relatives told us they felt safe whilst being supported by the staff, however the safeguarding policy was not up to date and although staff had received training on how to keep people safe, this had not been updated. Staff did not have a good understanding of how to report safeguarding concerns to the local authority safeguarding team.

Staff training was being provided but in some cases training had not been updated so that staff were aware of the latest guidelines and legislation. Staff had received medicines training however; senior staff had not observed staff practice to ensure they had the skills and competencies to administer medicines safely. Staff were not receiving regular supervision in line with the company policy.

Staff completed a full induction, which included shadowing experienced staff so they were aware of people’s needs and routines. Staff told us that they checked equipment such as hoists to ensure they had been serviced and were safe to use.

People said the staff asked for their consent when they supported them with their care. However people’s mental capacity had not been assessed to ensure that staff had an understanding of how this impacted on people’s daily lives.

People told us that the staff were reliable and they received their care from regular staff. They told us that each member of staff was introduced to them before providing their care. This gave them more confidence as they knew who was coming each day. There was sufficient staff on duty to cover the calls. Staffing levels were kept under review and there was ongoing recruitment to ensure there were sufficient staff to cover the calls. Staff recruitment required additional monitoring to ensure that all staff had two references including one from their previous employer.

Some care plans lacked detail to show that people received personalised care in line with their wishes. Although people were being supported to access health care professionals such as doctors or occupational therapists there was a lack of detail to guide staff how to support people with their catheter care or medical conditions such as diabetes. Staff reported any health concerns to the office staff who ensured appropriate action was taken so that people received the help they needed.

People told us there were supported with their meals and staff always gave them a choice. They talked about how staff left drinks and snacks out for them to eat later. People said the staff were kind and caring. Staff treated people with dignity and respect whilst encouraging them to remain as independent as possible. Staff told us how they supported people to access the community, such as dropping them off at social activities of their choice.

People told us that they would contact the office if they needed to raise any concerns. They told us that they did not have any complaints but were confident the office staff would sort things out if they raised any issues.

People and staff were aware of the out of hour’s telephone number and staff confirmed that staff on call always responded if they needed further guidance or support.

The registered managers both provided direct care at times and worked alongside care staff completing the calls. Although spot checks had not been completed since April this year, they told us how they observed staff practice during this time, however there were no formal records to confirm this.

People and staff told us the service was well organised and there was an open positive culture in the service. Staff understood the visions and values of the service, such as treating people as individuals with dignity and respect. .

We found breaches 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 end of this report.

Inspection areas

Safe

Requires improvement

Updated 10 November 2017

The service was not always safe.

People’s medicines were not being managed safely and there were shortfalls in the recording on medicine records. The medicine policy did not have full guidance for staff to follow.

Not all risks associated with people’s care had been identified. There was a lack of guidance for staff to follow to show how risks were being managed to keep people safe.

People told us they felt safe and trusted their care staff. However, the safeguarding policy was out of date and safeguarding training had not been updated. The management team also lacked the knowledge of how to process a safeguarding referral with the local authority.

Staff recruitment required additional monitoring to ensure that all staff had two references including one from their previous employer.

People’s needs were met by sufficient numbers of staff and regular staff provided people’s care and support.

Effective

Requires improvement

Updated 10 November 2017

The service was not always effective.

People received care and support from trained staff, however not all staff training had been updated. Although staff told us they had received an annual appraisal and supervision, the frequency of the supervision was not in line with company policy.

Although staff supported people to make decisions about their care, people’s mental capacity had not been assessed in line with current guidance.

People were supported to eat and drink to maintain a healthy diet.

The service worked with health care professionals to ensure people received the support they needed.

Caring

Good

Updated 10 November 2017

The service was caring.

People told us that staff were kind and caring. They said they were treated with dignity and their independence was promoted.

People told us that staff gave them choices and they were involved in the care they received.

People's records were securely stored.

Responsive

Requires improvement

Updated 10 November 2017

The service was not always responsive.

People's needs were assessed before they started to use the service. Care plans were not always personalised with details of people’s preferences. The plans had been reviewed regularly and updated with people’s current care needs.

People told us they knew how to complain and did not have any concerns.

Staff told us how they supported people to access the community, such as dropping them off at social activities of their choice.

Well-led

Requires improvement

Updated 10 November 2017

The service was not always well-led.

The registered managers had not identified the shortfalls found at this inspection. The audits in place had not ensured that the quality of service was checked to assess the care being provided.

Policies and procedures had not been updated in line with current practice and legislation.

Feedback was sought from people and staff to give them an opportunity to voice their opinions to improve the service, other stakeholders such as health care professionals had not been included.

People and staff told us the service was well organised and there was an open positive culture in the service.