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Inspection carried out on 14 August 2017

During a routine inspection

The inspection took place on 14 August 2017 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us. Pechiv Care Services provides support to people in their own homes within the Oxfordshire area. On the day of the inspection, five people were using the service.

The service was last inspected on 2 January 2017. During that inspection we found the provider did not have systems in place to assess the quality of the service provided. We also found not all risk assessments contained detailed guidance for staff on how to manage risks. We identified one breach of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. We imposed a condition on the provider’s registration to submit monthly audits to the CQC to ensure the quality of the service was being monitored.

At this inspection we found improvements had been made. Systems were in place to monitor and analyse the quality of the service. Guidance around risks had been improved.

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.

People received their medicines as prescribed. Staff had training and were checked to ensure they continued to be competent when administering medicines.

People who used the service felt safe and relatives had confidence in the ability of staff to keep people safe. Staff had received training on safeguarding adults and understood their responsibilities. Risks were assessed by the provider when someone first started using the service, and reviewed thereafter.

Recruitment processes were designed to ensure only suitable staff were selected to work with people. There were sufficient numbers of staff to meet the needs of people who currently used the service.

New staff received a five-day induction, as well as shadowing opportunities. During this time staff had mandatory training such as moving and handling techniques, food hygiene, and topics such as: handling medication and first aid.

Staff were supported through annual appraisals and a number of supervisions throughout the year. Staff told us that they felt supported by the registered manager and that communication was effective.

Staff were aware of their duties under the Mental Capacity Act 2005. They obtained people's consent before carrying out care tasks and followed legal requirements where people did not have the capacity to consent.

People who used the service and relatives consistently told us staff were caring, patient and upheld people’s dignity. People confirmed staff encouraged them to retain their independence on a day-to-day basis.

People felt consulted and listened to about how their care would be delivered. Care plans were personalised and centred on people's preferences, views and experiences as well as their care and support needs.

People who used the service knew how to complain, and who to. Complaints were investigated and responses given.

The registered manager was described in positive terms by people who used the service and relatives.

Auditing and quality assurance systems took place to monitor the quality of the service so that action could be taken where identified.

Inspection carried out on 5 January 2017

During a routine inspection

We undertook an announced inspection of Pechiv Care Services on 5 January 2017.

Pechiv Care services provide a personal care service to people in their own homes within the Oxfordshire area. On the day of our inspection 6 people were using the service.

We had previously carried out an announced comprehensive inspection of this service on 5 February 2015. At the last inspection we found staff supervisions were not always complete or in place and some staff training was not always completed. These issues were a breach of Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2014. We also identified concerns systems used to monitor the quality of the service were not in place. These concerns were breaches of Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2014.

After the comprehensive inspection in February 2015, the provider wrote to us to say what they would do to meet legal requirements in relation staff supervision and address our concerns relating to monitoring systems. The provider sent us an action plan in May 2015 stating the action they would take to improve the service to the required standard.

At this inspection we found actions had been completed and some improvements made. However, at this inspection we still found concerns relating to quality monitoring systems. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pechiv Care services on our website at www.cqc.org.uk.

The service was operating from a location that was not part of the conditions of their registration. This address was 5 East St. Helen Street, Abingdon, Oxfordshire, OX14 5EG.

There was not 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. At the time of this inspection the nominated individual was applying to CQC to register as registered manager.

The service did not have systems to assess the quality of the service provided. Audits were not conducted and processes not monitored which meant the manager did not have an accurate oversight of the service. It also meant information about people’s care could not be used effectively to improve the service.

Where risks to people had been identified risk assessments were in place and action had been taken to manage these risks. However, not all risk assessments contained detailed guidance for staff on how to manage the risk. Staff were aware of people’s needs and followed guidance to keep them safe. People received their medicine as prescribed.

The service was not displaying the ratings from the February 2015 inspection on its website. However, the provider took immediate action and displayed the ratings.

People told us they were safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

People were supported by staff who were knowledgeable about people’s needs and provided support with compassion and kindness. People received high quality care that was personalised and met their needs.

There were sufficient staff to meet people’s needs. Staffing levels and visit schedules were consistently maintained. People told us staff were rarely late and they had not experienced any missed visits. The provider followed safe recruitment procedures and conducted background checks to ensure staff were suitable for their role.

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Inspection carried out on 5 February 2015

During a routine inspection

This inspection took place on 5 February 2015. The inspection was announced. This was to ensure the registered manager was available to facilitate the inspection. The previous inspection of this service was carried out on 28 February 2014. The service was found to be meeting all of the standards inspected at that time.

This location is registered to provide personal care to people in their own homes. At the time of our inspection four people were receiving support from this service.

The service had a registered manager. 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 provider had ensured that people were safe. People told us they felt safe with the staff who provided them with care and support.

People were satisfied that staff had the right competency to meet their needs. Staff received on-going training to meet the needs of people they supported. Not all staff we spoke with had received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This legislation sets out how to proceed when people do not have capacity and what guidelines must be followed to ensure people’s freedoms are not restricted.

Not all staff received formal supervision and staff did not have appraisals to monitor their performance and development needs. Staff told us they could request supervision when they needed it.

People told us staff were kind, caring and respectful to them when providing support and in their daily interactions with them. Staff promoted people's independence and people and their relatives told us that staff knew them well.

People received care that was responsive to their changing health needs. Staff responded quickly and professionally and ensured that people’s changing health needs were met.

People were encouraged to comment on the service provided. However the provider could not demonstrate how feedback received influenced how the service was developed and improved.

Formal quality assurance systems were not in place to drive service improvements. It was not clear how the provider audited and checked records to ensure that staff followed people’s care plan needs. The registered manager could not provide evidence that audits were completed to monitor and continuously improve service delivery.

Records showed that we, the Care Quality Commission (CQC), had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 28 February 2014

During a routine inspection

On the day of our inspection, Pechiv Care Services were only caring for one person. This person was receiving a respite service. The live-in carer required regular time off. Pechiv Care Services supplied a care worker two days per week.

The initial assessment involved the person and their relatives. The care plan was person centred; it was clear and avoided unnecessary jargon. This meant the care worker was able to understand the needs of the individual.

The relative we spoke with told us, “I am very happy with Pechiv care they are reliable and have a good standard of carers; my relative currently has a care worker who has a teaching background. We feel they are well cared for and safe when family members are not there. We are very happy”.

Risk assessments were in place for all aspects of the service delivery. For example, one person required a second care worker when using a hoist to transfer them. We saw that the Pechiv care services had cooperated with the live in care workers agency and family to ensure the person was supported and remained safe.

We looked at the care workers file and saw the agency had a robust recruitment system in place. All appropriate pre-employment checks were on file. Checks’ had been completed satisfactorily prior to care workers starting work.

The agency had a quality assurance system. We looked at the previous quality assurance report and saw they had acted upon its findings. For example, two people had complained that no one told them if care workers were going to be late. The agency spoke to all care workers at that time and implemented a policy requiring care workers to call the office if delayed for more than ten minutes.

Inspection carried out on 11 March 2013

During a routine inspection

The agency was new and only providing care for two people at the time of our inspection. We spoke with the relatives of both people being cared for, the manager and two members of staff.

People’s privacy, dignity and independence were respected. People reported that the care and support given was good but no risk assessments had been written. People were protected from infection because the staff followed good practices.

We found that improvements in recruitment procedures were needed to make sure that the staff employed were of good character. Record keeping was of a good standard.

People's relatives told us what they thought about the staff. One said, "I think they do a wonderful job. They are nice people and genuine..." Another commented, "I'm very pleased, the staff are very pleasant and seem well qualified.."