Care Outlook (Crawley)

Care Outlook (Brighton and Hove) is a domiciliary care agency. It provides personal care to approximately 141 people living in their own homes in the community. Care Outlook (Brighton and Hove) supports people with a range of health and social care needs, such as people with a physical disability, sensory impairment or people living with dementia. Support was tailored according to people’s assessed needs within the context of people’s individual preferences and lifestyles to help people to live and maintain independent lives and remain in their homes. 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:

Care Outlook (Brighton and Hove) provides a service to people living in the areas of Brighton and Hove and other parts of Sussex. On the whole, people receiving care in Brighton and Hove were happy with their care. However, people we spoke with living in the mid-Sussex areas were not happy with the care they received. They felt they were treated with kindness by their care workers and they felt safe, however, they did not feel the care received met their needs and preferences. People’s care visits were often late or early and on occasion cut short. Systems for scheduling care visits did not reflect people’s assessed needs or preferences and did not provide continuity of care.

Systems were in place for the recording of incidents and accidents. However, we could not see evidence that incidents and accidents were followed up, monitored and analysed over time to recognise any emerging trends and themes, or to identify how improvements to the service could be made.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. However, these systems had not ensured the areas of improvement identified at this inspection had been acted upon and prevented.

People’s feedback was mixed in respect to feeling the service was well managed. They did not feel routinely involved in their care, or feel their concerns and issues were acted upon.

The provider was aware of the issues we identified at this inspection and had started to implement improvements.

People’s medicines were managed appropriately and staff followed infection prevention and control (IPC) procedures to keep people safe. Staff told us they felt supported in their roles and said they liked working at 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

The last rating for this service was Good (published 18 October 2017).

Why we inspected

We received concerns in relation to the service providing regular care calls that met people’s needs and preferences. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well-led sections of this full report.

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.

At the last inspection on 27 July 2015, the service was rated overall Good. At this inspection we found the service remained overall Good.

At the last inspection we found there was no record that people’s work history had been discussed to ensure there was evidence of a full work history with a written explanation as to any gaps when people were not working. At this inspection we found systems had been put in place to address this. However, we found policies and procedures had not always been followed in relation to written references being sought. This is an area in need of improvement. At the last inspection there were policies and procedures in place for staff to reference. They told us they had been taken through key policies and procedures as part of their induction, and knew where these were available to read should they need to. These had been updated to ensure current guidance had been considered. However, we found that staff had not been following the most up-to-date policy and procedures. We found at this inspection this had been addressed.

Systems had been maintained to keep people safe. People and their relatives told us they felt safe with the care provided. They knew who they could talk with if they had any worries. They felt they could raise concerns and they would be listened to. Assessments of risks to people had been developed. Staff told us they had continued to receive supervision, and be supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. People told us care staff had the knowledge and skills to provide their care and support.

People's individual care and support needs continued to be identified before they received a service. Care and support provided was personalised and based on the identified needs of each person. People told us they felt listened to, supported to be independent and they were involved in decisions about their care. One member of staff told us,” I always encourage independence even if they can only wash their hands and face.” Where people were unable to make decisions for themselves this had been considered under the Mental Capacity Act 2005, and appropriate actions continued to be followed to arrange meetings to make a decision within their best interests. Staff had a good understanding of consent.

People were happy with the care provided. People continued to be supported by kind and caring staff who treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. People’s comments included, “The staff know what they are doing, very happy,” “Fabulous carers,” “Wonderful care staff,” and “They really do care.” If needed, people were supported with their food and drink and this was monitored regularly. People continued to be supported to maintain good health.

People, their relatives and staff told us the service was well led. One person told us the service was, “One of the best agencies.” Another person told us, “If I call the office I find the staff very helpful.” A member of staff told us, “It’s good, it’s busy. I like working here, it’s a family run business. The values are better. I like working with people who care. They will go out and do the job. Nobody says it’s not their job.” When asked what the service did well one member of staff told us, “We listen to what people want. We are flexible with carers with their hours. We work together as a team. There are some really good carers out there who give 101%.”

Staff told us the registered manager was always approachable and had an open door policy if they required some advice or needed to discuss something. Senior staff carried out a range of internal audits, and records confirmed this. People and their relatives were regularly consulted about the care provided through reviews and by using quality assurance questionnaires.

Further information is in the detailed findings below.

A person told us 'I feel fully involved in my care plan, I sign from time to time that I'm still agreeing to it.' Where people were unable to consent to care, family carers were included in their assessment. We saw support plans were reviewed regularly and signed by the person visited, or an advocate.

Care workers said support plans gave good guidance to the care people needed. A person told us 'they read the plan but they seem to have knowledge as well before they come.' People said they found the office approachable and amenable to requests for change. All the people we spoke with had met the service manager and felt confident complaints or suggestions would be listened to.

Three office staff monitored the quality of service provided. People were contacted within two weeks of their first visit and regularly thereafter. Staff were subject of unannounced spot checks and field observations of their performance.

People told us delayed visits were rare and the service informed them if a planned visit would be late.

Recruitment records showed new staff were recruited in a consistent way. They were unable to start work until checks on their suitability were complete. They received induction training and shadowed experienced staff before working alone.