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Reports


Inspection carried out on 30 January 2018

During a routine inspection

This comprehensive inspection took place on the 30 January 2018 and was announced.

Chameleon Care Dartford is a domiciliary care agency, providing personal care services to people living in their own homes. This included older and younger adults and people with complex health needs such as epilepsy, diabetes, dementia and physical disabilities.

Not everyone using the service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of the inspection, there were 37 people receiving the regulated activity of personal care from the service.

At our last inspection, the service was rated Good. At this inspection we found the service remained Good.

There continued to be 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. The registered manager was supported by a manager who was based at the location and was responsible for overseeing the day to day management of the service.

People were continued to be protected from abuse and neglect. There continued to be appropriate systems in place to safeguard people from the risk of preventable harm. Risks to people and staff were appropriately assessed, mitigated and recorded.

Staff understood their responsibilities around safeguarding people from abuse and protecting their rights.

There continued to be systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Robust recruitment processes continued to be followed and there were sufficient skilled and experienced staff to meet people's needs. We found appropriate numbers of staff were deployed to meet people's needs.

There continued to be safe systems in place for the management of medicines. Medicines were administered safely and administration records were kept up to date.

People received care from staff that had received training and support to carry out their roles.

Staff continued to have good levels of support and supervision to enable them to carry out their roles.

People's care preferences, likes and dislikes were continued to be assessed, recorded and respected, their care provided in line with up to date guidance and best practice. People’s cultural and religious needs were taken into consideration at the time of assessment and reviews.

We found that there was collaborative working with other community healthcare professionals to ensure that people received coordinated and person-centred care and support. People were supported to maintain a healthy lifestyle.

Staff told us that they seek guidance from healthcare professionals as required. They told us they would speak with people’s families and inform the manager if they had any concerns about people’s health.

People continued to receive care from staff that were caring, kind and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained when care was provided to them.

People were encouraged to make decisions about how their care was provided and staff demonstrated a good understanding of people's needs and preferences.

Staff understood the Mental Capacity Act 2005 and how to support people's best interest if they lacked capacity. People continued to be 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.

There continued to be policies in place. People were listened to and treated fairly if

Inspection carried out on 14 January 2016

During a routine inspection

This inspection took place on 14 and 19 January 2016 and was announced.

At our previous inspection on 10 and 11 December 2014, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to consent, good governance and person centred care. We found the provider had made improvements at this inspection.

Chameleon Care Dartford provides care services to people in their own homes mainly in Kent. The care they provided was tailored to people’s needs so that people could maintain or regain their independence. This included older people, younger adults and people with complex health needs such as epilepsy, diabetes and physical disabilities. There were 74 people using the service at the time of our inspection.

There was a registered manager employed at the service. 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 registered manager was not available during the inspection.

Staff were trusted and well thought of by the people they cared for. People spoke about the staff in a positive light regarding their feelings of being safe and well cared for. They thought that staff were caring and compassionate.

The registered manager assessed people’s needs and planned people’s care to maintain their safety, health and wellbeing. Risks were assessed by staff to protect people. There were systems in place to monitor incidents and accidents.

Staff had received training about protecting people from abuse and showed a good understanding of what their responsibilities were in preventing abuse. Procedures for reporting any concerns were in place. The registered manager knew how and when they should escalate concerns to the local authorities and understood the safeguarding protocols.

The registered manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interest if they lacked capacity to make certain decisions about their care.

Working in community settings staff often had to work on their own, but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people. The service could continue to run in the event of emergencies arising so that people’s care would continue. For example, when there was heavy snow or if there was a power failure at the main office.

Staff were recruited safely and had been through a selection process that ensured they were fit to work with people who needed safeguarding. Recruitment policies were in place that had been followed. Safe recruitment practices included background and criminal records checks prior to staff starting work.

Some people needed more than one member of staff to provide support to them. The registered manager ensured that they could provide a workforce who could adapt and be flexible to meet people’s needs and when more staff were needed to deliver care they were provided.

People felt that staff were well trained and understood their needs. They told us that staff looked at their care plans and followed the care as required. People told us that staff discussed their care with them so that they could decide how it would be delivered.

Staff had been trained to administer medicines safely and staff spoke confidently about their skills and abilities to do this well. If staff needed to use equipment in people’s homes, they were trained how to use it and checked it was safe.

The registered manager gave staff guidance about supporting people to eat and drink enough. People were pleased that staff encouraged them to keep healthy through eating a balanced diet and drinki

Inspection carried out on 10th and 11th December 2014

During a routine inspection

We undertook an announced inspection of Chameleon Care (Dartford) on the 10 and 11 December 2014. The registered manager was given 48 hours’ notice of the inspection. Chameleon Care (Dartford) provides care to people in their own homes. At the time of our inspection approximately 74 people were receiving care in their homes from the service.

The service provides personal care to people who are living with dementia, people who have a learning disability, people who were being supported to regain their independent living skills and people who require end of life care.

There is 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. There is also a manager who was in day to day charge of the service.

At our last inspection on the 2 June 2014 we identified breaches of the legal requirements in relation to care and welfare, recruitment, monitoring the quality of the service and records. The provider wrote to us on the 30 July 2014 and told us they were compliant. At this inspection we found that changes had been made to meet most but not all of the relevant requirements identified at the last inspection. People received their medicines as they needed, safe recruitment practices were now in place and systems to monitor the quality of the service were in use.

However, we also identified ongoing concerns around maintaining accurate records that required further improvement. Daily notes did not always show whether people had received the care they needed or had declined the care being offered to them. Regular audits of records related to medicines had identified areas requiring improvement in relation to staff completing medicine charts.

The management of the service did not always take appropriate steps to manage staff failing to notify the relevant staff member of their absence through sickness. The action they told staff they would take was not in line with the provider’s policy on staff sickness and absence.

Care planning was not always completed when supporting new people at short notice. This matter was addressed when it was brought to the manager’s attention. Risk assessments were not always updated to show that any potential risks had been considered when people’s needs had changed. Suitable arrangements were not always in place in relation to consent.

We saw examples where people had signed their care plans to confirm their consent to their care and support. No one was subject to an order of the Court of Protection and people had the capacity to make their own decisions although sometimes people chose to be supported by family members. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.

People told us their consent was gained by staff at each visit. However, we found that on two recent occasions staff did not follow the MCA in relation to one person’s request for them not to seek medical support in response to this person’s urgent health concern. Under the MCA people are not to be treated as unable to make a decision merely because they make an unwise decision. This meant that suitable arrangements were not always in place to obtain people’s consent for staff not to seek medical assistance if people did not wish staff to do so and follow this instruction in line with the MCA.

People felt safe whilst staff were in their homes and whilst using the service. Staff we spoke with knew what action to take in response to safeguarding concerns. Staff had received training in safeguarding adults. Staff demonstrated a good understanding of what constituted abuse and how to report any concerns.

People were protected by robust recruitment procedures. Staff files contained the required information to show they were suitable to provide care to people who used the service. Staff received training appropriate to their role and were supported in relation to their responsibilities to be able to deliver care and treatment to people safely and to an appropriate standard.

People had their needs met by sufficient numbers of staff. People received a service from staff skilled in meeting their specific needs and staffing numbers were kept under review.

People were happy with the service they received. They felt staff had the right skills and experience to meet their needs. Staff practice was monitored during unannounced checks to review their practice. Staff met with their managers to discuss their work and also attended group meetings with their managers and colleagues to share information. A record was kept documenting these meetings.

People were supported to maintain good health. The service made appropriate referrals, informed relatives and worked with health care professionals, such as community nurses. There were arrangements in place to ensure people received their medicines safely and when they needed them.

People felt staff treated them with “Dignity and are very caring”. People were treated with dignity and respect and their privacy was respected. People told us that staff were caring in their approach. Staff completed the tasks people expected them to undertake during their visits.

People’s independence was promoted because their care plans showed what tasks people could undertake for themselves. People were given written information about what they can expect from the service. Records were stored securely and therefore people’s confidentiality was upheld.

People felt confident in complaining and some complaints had been made and addressed. People had opportunities to provide feedback about the service. A recent survey had been completed and the results were to be reviewed with a view to improving the service where needed.

The provider had a vision for the service that included promoting people’s dignity, independence and happiness. Staff knew the vision of the service and felt supported overall.

The electronic system for monitoring staff visits to people was being piloted in one area and was under review with a view to it being used for all visits across all areas. There had been no late calls.

There were arrangements in place to monitor the quality of the service. These included monitoring staffing levels, accidents and incidents, complaints, staff visits to people and reviewing people’s care.

Staff had access to policies and procedures via the office where this written guidance was accessible.

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

Inspection carried out on 2 June 2014

During a routine inspection

Our inspection was conducted by one inspector. We spoke with four members of staff, looked at four people’s care records and spoke with fifteen people who used the service or their relatives. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found

Is the service caring?

Feedback from people who used the service and their relatives showed that the staff were caring towards them. Comments included I am “Very happy”, “They have been very good”, “They are all nice girls who are willing”, the staff were “Friendly”, “They know their job”. One person’s records showed that they had been cold and the staff member visiting them had “put a warm dressing gown on” them.

Is the service responsive?

We saw that people’s needs were assessed before they received support from the service. We saw that staff recognised and responded to people’s needs. For example, during the inspection a staff member telephoned the office to report that a person they were visiting appeared unwell. The coordinator knew the person had an ongoing health condition and instructed the staff member to call for medical assistance and stay with the person until this support arrived.

There was a process in place for the service to follow when responding to complaints. However, no records were kept to show when a complainant had been informed of the outcome of the investigations into their complaint in line with the service’s own policy. The service had identified through complaints and internal monitoring that the system in place to monitor when staff did not attend visits, or were late to visits was not effective. Therefore a new system was being brought in to accurately monitor service delivery.

There was evidence that learning from accidents and incidents took place.

Is the service safe?

Staff had received training in adult protection and knew how to recognise the signs of potential abuse and the action to take in response to this. There was an adult protection policy in place for staff to be able to reference that was accessible to them. People we spoke with and their relatives told us that they felt safe around the staff when they visited them in their homes.

The service had recruitment procedures in place, however these were not always followed. Appropriate checks had not always been completed before staff began working for the service. There were no records to show how the risks associated with these incomplete checks were being managed to ensure the safety and welfare of people who used the service.

Is the service effective?

People’s independence was promoted and staff maintained their privacy and dignity. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. For example, records showed that one person needed the support of two members of staff and records completed by staff on a daily basis showed that two members of staff had provided support to this person to ensure their needs were met safely.

However, people told us that staff did not always arrive at their homes on time and this meant that they did not always receive the care they needed on time.

Is the service well led?

Systems were not always in place to be able to monitor the quality of service delivery effectively. There was no effective system to monitor whether staff were completing records accurately when supporting people with their medication. Accurate records were not always kept in respect of each person’s care and the management of the service.

The service had identified that the system in place to monitor whether staff had visited people as planned was ineffective. This meant that there was no effective system in place to monitor this aspect of care.

Staff told us they felt supported in their role. However, there was no record kept of supervision with staff which was not in line with the service’s own policy. There was no record of discussions with staff about staffing levels to show that the impact on them and how they were meeting people’s needs was being monitored effectively.

Inspection carried out on 23 December 2013

During a routine inspection

People who used the service could be confident that their consent would be sort before any care or treatment was given. We found that before people received any care they were asked for their consent and that the provider had procedures in place that would ensure they acted in accordance with legal requirements.

We looked at care plans and found that these contained information staff would need to know to be able to support a person’s needs.

We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People told us “They are very helpful to me, I have got to know some of them as friends which was beyond their normal work role, I appreciate this very much.” Others said “I have had consistent care from Chameleon carers for a number of years, I am extremely grateful for this, it enables me to live at home with my husband.” and “All the carers are very pleasant.”

We sent out more than sixty questionnaires, generally people were positive about the care and support they received, all of the people who responded to our questionnaires told us that they had never experienced any form of discrimination by staff delivering care and support.

We saw that care plans were person centred and detailed support needs. We spoke to members of staff who confirmed that there was a care plan for each person they visited. These staff also confirmed that a brief overview of the support required was given on each person’s rota.

We found that there were effective recruitment and selection processes in place. The provider kept satisfactory documentation for all staff to evidence relevant qualifications and a full employment history with satisfactory written explanation of any gaps in employment.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.

Inspection carried out on 20 December 2012

During a routine inspection

We observed staff talking to people who use the service on the telephone, which was answered promptly and politely.

We reviewed seven care plans and risk assessments which demonstrated peoples needs were identified, they decribed how these needs were met were met by staff, and that these were regularly reviewed. People who use the service or their representatives told us that they are involved in the development and review of their care plans and risk assessments.

We saw that staff had received appropriate training which was was regularly updated. The staff had received safeguarding training and people we spoke with were able to explain what constitutes abuse and what action they would take. There were policies and procedures in place to support staff.

We found that the provider failed to provide regular supervision to staff. This may put both them and the people that use the service at risk.

We saw letters and thank you cards from relatives of people who have used the service in the past, thanking them for the care, respect and dignity that was provided during the period they provided end of life care. One relative said " The staff were excellent it made difference to the relatives by giving them the opportunity to have time sharing memories with the relative in their own home surroundings."

We found that the provider did not an effective system to regularly assess and monitor the quality of service that people receive.