Archived: Connie's Care Services Ltd

Connie’s Care Services Ltd is a home care service providing personal care to two people in their own homes at the time of the inspection. Both people received the regulated activity of 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 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.

Improvements had been made to assessment of risks to people although further work was needed to ensure moving and handling plans contained enough detail. The registered manager was not up to date with best practice guidance for the safe handling of people in social care.There were enough staff, who were safely recruited, they knew how to keep people safe from avoidable harm. People felt safe with the staff supporting them. Staff understood how to reduce risks to people.

Improvements needed to be made to the responding to and raising of potential safeguarding concerns to ensure that these were raised without delay.The registered manager was implementing changes to ensure this took place. Staff understood how to raise concerns and had undertaken training in safeguarding vulnerable adults.

People had access to health professionals when needed. Support was planned to meet people’s assessed nutritional and health needs. Staff received regular training, supervision and support. Staff ensured that they sought peoples consent before providing them with care and support.

Staff were kind, caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensured they did this. People were observed to have good relationships with the staff team.

Appropriate and responsive care was provided to people by staff who understood person-centred care. Staff knew the content of people's care plans before supporting them, helping them to understand their care requirements and preferences. People's care plans were reviewed and updated following changes in their needs, however current best practice guidance was not always reflected. Improvements to the recording of complaints and their outcomes was to be implemented.

The registered manager had implemented improvements following recent lessons learnt, although further improvements are required. The registered manager did not have up to date knowledge around best practice guidance and did not access any forum to enable them to do so.

We have made a recommendation in relation to this.

People, relatives and staff told us they had an open relationship with the registered manager and found them approachable. Some professionals we spoke with raised concerns the registered manager was not always approachable when concerns were raised to them.

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 Inadequate (Published 15 July 2019) and there were three breaches of regulations. 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.

This service has been in Special Measures since 15 July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Connie’s Care Services Ltd on our website at www.cqc.org.uk.

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.

Connie’s Care Services Ltd is a home care service that was providing personal care to four people in their own homes at the time of the inspection. All four people received the regulated activity of personal care.

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

The registered provider had not adhered to conditions imposed by the Care Quality Commission (CQC) to keep people safe from the risk of abuse. The necessary checks had not been made to ensure that staff working at the service were of good character. Improvements had been made to staffing levels which has resulted in more people receiving their care visits in line with their preferences. Staff understood good practice in relation to infection prevention and control. Risks to people when receiving care and support had been assessed and care records detailed any mitigating actions staff should follow. Staff did not have a good understanding of the external bodies that they could raise safeguarding concerns to.

Staff had received training and supervision to aid them in their duties however, spot checks of staff’s competence and skills was informal and not recorded. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Staff had completed training in the Mental Capacity Act 2015 but were unable to demonstrate they understood the principles of this key legislation. Staff were clear that they always gained people’s verbal consent before providing support. Staff had a good understanding of how to support people with their nutrition and hydration needs, including where people had a health condition that made this a risk to their wellbeing.

People told us the staff were kind and caring and promoted their independence. They also said they were treated with dignity and respect, and able to contribute their views and wishes. However, Care records did not identify that people had the opportunity to express a preference of gender of staff that supported them. People were involved in the planning and delivery of their care. People were aware of the complaint’s procedure in place and felt confident any concerns would be dealt with. Where appropriate, the provider had worked with people to discuss their preferences for end of life care.

The quality assurance systems were inadequate as they had not identified the shortfalls we found during our inspection and did not ensure people were always kept safe. The provider did not understand their statutory obligations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to providing access to registered locations for CQC inspectors when required, and ensuring imposed conditions were adhered to. We found that the provider failed to deliver a care service that was safe, effective or well led. This put people at continued risk of harm.

Rating at last inspection and update

The last rating for this service was Requires Improvement (5 June 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had been made in relation to a breach of Regulation 18 (Staffing). However, we identified further shortfalls and the provider was still in breach of Regulation 17 (Good governance). We also identified a breach of Regulation 13 (Safeguarding service users from abuse and improper treatment) and Regulation 19 (Fit and proper persons employed).

We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well led sections of this full report. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Connie’s Care Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to staff recruitment, safeguarding people from the risk of abuse and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Connie’s Care Services Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection 13 people were using the service which provides care to people in both Norfolk and Cambridgeshire.

The service had a registered manager in post. They were also the owner of the business. 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 were recruited safely but staffing levels meant that some people had missed calls and scheduling of calls sometimes meant that people could not receive all their agreed care hours. A small staff team of allocated carers provided consistent care to people and feedback on individual carers was positive.

There were systems in place designed to help protect people from abuse. Staff understood their responsibilities to report concerns if they suspected someone was being abused. The registered manager had not notified CQC of a significant safeguarding matter.

Risks to people’s health and safety were assessed and managed well in most cases. Staff required better understanding of the risks associated with pressure care. Staff understood their role in reducing the risk of infection and worked in accordance with best practice.

The provider carried out a detailed assessment of people’s needs and enabled them to be involved in decisions about their care and support.

Staff received the training and the formal and informal support they needed to carry out their roles. The provider needed better procedures for sharing important information about people’s needs between staff. We understand that new systems have been put in place since our inspection visit.

Staff worked in accordance with the Mental Capacity Act 2005 (MCA). The MCA ensures that people’s capacity to consent to their care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. People consented to their care, although some records needed review or clarification. Some staff did not have a record of further training in MCA and had only covered this in their induction.

Staff supported people to manage their eating and drinking and other healthcare needs and worked in partnership with other healthcare professionals. However, staff were not working in line with one person’s care plan which had been put in place by a healthcare professional.

Staff treated people with patience, warmth and kindness and relationships were good. Staff respected people’s privacy and maintained their dignity. People were encouraged to be as independent as possible and staff saw this as a priority.

People received person centred care which met their individual needs and preferences. Staff treated people as individuals and were committed to ensuring that people received their care in the way they chose.

A complaints procedure was in place but no formal complaints had been logged. There was not always robust recording to show what action had been taken in response to informal complaints.

There was no structured system of audits in place, although the registered manager regularly spoke with people directly about their care when carrying out spot checks of staff.

The provider demonstrated that they needed a clearer understanding of some aspects of the role of regulation. They also needed to consider the culture of the service as we received some mixed feedback about their management style, with some people finding it confrontational. The registered manager did not always robustly address staff poor performance in a way that drove improvement.

During this inspection we identified two breaches of regulation in relation to staffing and to the leadership and governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

The service was registered to provide personal care to people living in their own homes and there were 17 people accessing the service which meant a delivery at that time of 268 hours per week.

There was a registered manager for this service, who was available every day. 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.’

People felt safe using the service. Staff were trained in adult safeguarding procedures and could identify what to do if they considered someone was at risk of harm, or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and carried out by staff that were competent to do so. Risk assessments recorded what action staff should take if someone was at risk and referrals were made to appropriate health care professionals to minimise risk going forward.

There were sufficient staff to keep people safe and meet people’s needs, the registered manager had followed safe recruitment procedures. Staff were competent with medicines management and could explain the processes that were followed.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005. The registered manager understood that there should be processes in place for ensuring decisions were made in people’s best interests. However the registered manager did acknowledge that they required further training in this area and would be undertaking it soon.

Staff were caring, knew people well, and supported people in a dignified and respectful way. Staff acknowledged people’s privacy. People felt that staff were understanding of their needs and had positive working relationships with people.

Care provided was individualised according to each person’s needs and preferences. People and their relatives were involved in assessment and reviews of their needs. Staff had knowledge of changing needs and supported people to make positive changes to their care plans.

People and staff knew how to raise concerns and these were dealt with appropriately. The views of people, relatives, health and social care professionals were sought as part of the quality assurance process. Quality assurance systems were in place to regularly review the quality of the service that was provided.

All of the people who we spoke with were satisfied with the standard and quality of the support and care provided. Comments included, 'They are here for mum and are a great support for me'. We found that people's support and care met people's needs, including their main carer's needs, and respected their dignity.

Systems were in place to ensure that people were protected from the use of unsafe equipment. This included relevant training of staff. There was enough equipment available to promote people's health, safety and comfort needs.

All of the people that we spoke with had positive comments to say about the team of staff. People told us that members of staff were kind, attentive and trained and competent to safely do their job.

There were quality assurance systems in place that asked people, including members of staff, for their views and comments about the service. Other systems were in place monitor the standard of service provision, including monitoring of members of staffs' work performance. Our findings noted that people were satisfied with the standard and quality of the service provided. One person said that, in their view, the standard and the quality of the service provided was, 'Perfect'.

Improved standards of records indicated that a person's choice in how they wished to be dressed was respected. Their dignity and privacy was maintained to the standard that met the person's choice and expectations.

People received safer support and care due to the improveds standard of the environment and health risk assessments. Improvements were also made regarding the assessment, monitoring and reviewing of people's skin conditions.

There were improvements made to ensure that prospective staff underwent appropriate recruitment checks before they were allowed to work with vulnerable people who used the service.

Quality assurance systems had improved. Opportunities were provided for people to tell the provider about how they viewed the quality and standard of their support and care. Recording of concerns/complaints had also improved. People were now better supported due to an improved standard of care records.

People had no reservations in making a concern or complaint known when the standard and quality of care fell below their expectations. They had access to information about what to expect from the service and how to make a formal complaint if they chose to do so.

We also spoke with two external agencies, including the district nursing service. Neither of these agencies had major concerns about how the agency provided people with their support and care.

Although we had noted what people told us, we found evidence that people's health and safety were placed at risk. This was due to ineffective systems in place to assess, plan and review people's care. People were sometimes, but not always, supported in accessing the district nursing service.

Systems were in place to safeguard vulnerable people who used the service from abuse.

Staff were provided with training opportunities to ensure that people received safe and appropriate care. However, people were placed at risk from unsuitable staff due to inadequate recruitment and selection procedures.

There were ineffective quality assurance systems in place to ensure that people received safe and appropriate care and that their views were actively taken into account.