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Inspection carried out on 30 March 2017

During a routine inspection

Empathy Nursing and Social Care provides personal care and treatment for adults and children living in their own homes. On the day of the inspection the registered manager informed us that there were a total of 18 people receiving care from the service.

A registered manager was 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 and associated Regulations about how the service is run. The previous inspection was carried out in March 2016 to follow up Warning Notices issued at the comprehensive inspection of November 2015 with regard to providing safe care and ensuring a quality service. We found the warning notices had been complied with. At the last comprehensive inspection of November 2015, we asked the provider to take action to make improvements to people’s personal care, and this action has largely been completed.

People and relatives we spoke with told us they thought the service ensured that people received safe personal care. Staff had been trained in safeguarding (protecting people from abuse) and staff understood their responsibilities in this area.

We saw that medicines were, in the main, supplied safely and on time, to protect people’s health needs though improvements to records were needed.

Risk assessments were not always comprehensively in place to protect people from risks to their health and welfare. Staff recruitment checks were in place to protect people from receiving personal care from unsuitable staff.

Staff had received training to ensure they had skills and knowledge to meet people's needs, though this had not always covered some relevant issues.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives, though assessments of people's capacity had not been in place to ensure people's ability to make decisions was comprehensively protected.

People and relatives we spoke with all told us that staff were friendly, kind, positive and caring. They told us they had been involved in making decisions about how and what personal care was needed to meet care needs.

Care plans were individual to the people using the service to ensure that their needs were met, though they did not include all relevant information such as people's past histories.

People and relatives told us they would tell staff or management if they had any concerns, they were confident these would be properly followed up. Evidence of complaints made had not always showed they had been properly investigated.

People and their relatives were satisfied with how the service was run. Staff felt they were supported in their work by the senior management of the service.

Management carried out audits in order to check that the service was meeting people's needs and to ensure people were provided with a quality service, though action was not always shown to be taken for some issues.

Inspection carried out on 24 March 2016

During an inspection to make sure that the improvements required had been made

This inspection took place on 24 March 2016 and was unannounced.

We previously carried out an unannounced inspection of this service on 23 November 2015. Three breaches of regulations were found, two of which led to warning notices being issued, and the service was judged to be ‘Requires Improvement’ overall.

The warning notices were issued because the registered person did not have effective systems and processes in place to ensure people using the service were provided with safe care. They also did not have appropriate systems in place to enable them to assess, monitor and improve the quality of the service provided in the carrying out of the regulated activity.

After this inspection we asked the provider to produce an action plan stating what they would do to meet legal requirements in relation to the breaches. The provider sent this to us. This outlined action that would be put in place to ensure that these breaches in regulations were rectified.

We undertook this focused inspection on 24 March 2016 to check that the provider had now met legal requirements with regard to the warning notices. This report only covers our findings in relation to the warning notices. We will check the other issues at a future inspection.

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

Focused inspections evaluate the quality and safety of particular aspects of care. They take place when we are following up after a comprehensive inspection, or when we have received concerns and have decided to look into them without doing a comprehensive inspection of all aspects of the service. They only ask the relevant key questions, rather than all of them.

The provider informed us on the day of the inspection that Empathy Nursing and Social Care provided personal care for 40 people living in their own homes. The agency is situated in a city centre location in Leicester City.

A registered manager was 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 and associated Regulations about how the service is run.

On this inspection we found the provider had taken action to meet these breaches of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 with regard to having systems in place to provide safe care, and there was a quality assurance system in place to check that personal care had been properly supplied to people using the service.

People using the service and the relatives we spoke with said they thought the agency ensured that people received safe personal care.

Risk assessments for people were in place to help ensure staff understood how to support people safely.

Staff had been safety recruited to help ensure they were appropriate to work with the people who used the service.

People and relatives we spoke with told us they liked the staff and got on well with them, and we were told of examples of staff working with people in a friendly and caring way.

Management carried out audits and checks to ensure the agency was running properly.

Inspection carried out on 23 November 2015

During a routine inspection

This inspection took place on the 23 and 26 November 2015 and was unannounced.

We carried out an unannounced inspection of this service on 16 February 2015. Three breaches of legal requirements were found. The registered manager had not ensured that people were protected against the risks of unsafe care being provided by unsuitable staff, had not supported staff with adequate training to meet people's needs and had not provided proper care and welfare to people using the service.

After this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this unannounced inspection on 23 and 26 November 2015 to check that the provider had followed their plan, and to confirm whether they had now met legal requirements. We found improvements in some aspects but not all issues had been properly followed up.

Empathy Nursing and Social Care provides personal care for people living in their own homes. On the day the inspection the registered manager informed us that there were 42 people receiving a service from the agency.

A registered manager was 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 and associated Regulations about how the service is run.

Since the last inspection we had received information from whistleblowers which had stated that medication was not properly dealt with and that people receiving the service were always dealt with in a polite manner. We followed up these issues at this inspection. We found that people were respectfully dealt with and evidence that people had usually received their medication properly, though improvements were needed to ensure there is always evidence that this has happened.

On this inspection we found breaches of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 with regarding to providing safe care. You can see what action we have told the provided to take on the back of the full version of this report.

People using the service and the relatives we spoke with said they thought the agency ensured that people received safe personal care. Staff were trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

Some risk assessments were in need of improvement to help ensure staff understood how to support people safely.

People using the service and relatives we spoke with told us they thought medicines were given safely and on time. Some improvements were needed to evidence that medicines were properly supplied to people.

Some staff had not been safety recruited to ensure they were appropriate to work with the people who used the service.

The registered manager had provided staff with more training to ensure they had the skills and knowledge to be able to meet people's needs though this needed to be expanded to ensure staff had the skills to meet all people's needs.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives.

People had plenty to eat and drink and everyone told us they thought the food prepared by staff was satisfactory.

People's health care needs had been protected by timely referral to health care professionals when necessary.

People and relatives we spoke with told us they liked the staff and got on well with them, and we were told of examples of staff working with people in a friendly and caring way.

People, or their relatives, were involved in making decisions about their care and support.

Care plans were not fully individual to the people using the service and did not fully cover their health and social care needs.

People and relatives told us they would tell staff or management if they had any concerns and were confident they would be followed up. However, we found evidence that issues had not all been followed up from expressions of concerns made by people and their relatives.

Staff were generally satisfied with how the agency was run by the registered manager.

Management carried out audits and checks to ensure the agency was running properly. However, audits did not include all issues needed to provide a quality service.

Inspection carried out on 16 February 2015

During a routine inspection

This inspection took place on 16 and 17 February 2015 and was unannounced.

Empathy Nursing and Social Care provides personal care services to people in their own homes across Leicestershire. At the time of our inspection the service was supporting 32 older people some of whom were living with dementia.

The service has 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, and associated Regulations, about how the service is run.

At our last inspection on 24 April 2014 we identified some concerns with the care provided to people who used the service. People were not fully protected from unsafe care and support because risk assessments had not been undertaken for some people who had health conditions. Improvements were needed in relation to how the provider monitored the quality of the service and the training and support provided to staff. We asked the provider to send us an action plan outlining how they would make improvements.

At this inspection we found improvements had been made in relation to how the quality of the service was monitored, however further improvements were needed to ensure that people received safe care and that staff received the training and support they needed to undertake their job roles.

People were not fully protected from unsafe care and support because risk assessments had not always been undertaken for people who had health conditions and care plans did not always provide staff with the information they needed in order to deliver people’s care safely.

The provider supported staff by an induction and some on-going training. However, training was not comprehensive to enable staff to be fully equipped to deal with all the needs that people had. Staff told us that whilst they felt supported by the management team, opportunities for one to one discussions with their line managers and opportunities to share their views about the service were limited.

Recruitment checks had not always been carried safely to reduce the risk of unsuitable staff from being employed at the service.

Arrangements were in place so that there were enough staff available to support people at the agreed times in order to meet their care and support needs. However, some people told us that their care calls were late and some staff members told us that they had to work long hours to cover these calls.

People told us that staff supported them to take their medicines as needed. However, medication records did not always show that people had received their medicines.

People told us that they felt safe with the staff who supported them. Staff had received training on how to protect people who used the service from abuse or harm. They demonstrated they were aware of their role and responsibilities in keeping people as safe as possible. However we found that there was one incident of a safeguarding nature that had not been reported to the relevant authorities for investigation. The provider had not notified us of this incident.

People who used the service and relatives told us they found staff to be caring, compassionate and respectful. They thought their rights to dignity, choice and independence were protected by staff. People told us that they were involved in decisions about their care. People told us that their consent was sought before care was provided to them. However, people’s capacity to make their own decisions was not always fully assessed because staff had limited knowledge in this area.

Staff told us that, overall, the management team were supportive and approachable should they have any concerns they wished to raise. The management team had identified that further improvements in relation to the monitoring of the service provided were needed and actions were in place to address most of these issues. Arrangements were in place to provide people with opportunities to put forward their suggestions about the service they received however these required further development.

People told us that they knew how to make a complaint, however they had not been provided with a copy of the complaints procedure. People told us that they were not always advised of the outcome of concerns raised and that this meant that they did not always know if actions were being taken to address issues raised. People also told us that on occasions, communications with the provider’s office staff was poor.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 . 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 24 April 2014

During a routine inspection

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

The detailed evidence supporting our summary please can be read in our full report.

Is the service safe?

People told us they felt safe. One relative told us his mother had not felt safe because of the actions of a staff member. The manager told us that the safeguarding authority were investigating these concerns and the staff member had been suspended from duty pending this investigation.

People told us that they felt their rights and dignity were respected.

Staff were aware about care plans and risk management plans that had been written for some people with particular needs. This provided protection to people from unnecessary risk of harm.

Recruitment practice was generally safe.

Is the service effective?

People’s health and care needs had been assessed and care plans were found to be in place. There was evidence of people being involved in assessments of their needs and planning their care. People told us that staff had spoken with them about their care needs. Dietary needs were assessed and included in care plans, though more detail was needed in some plans to ensure people received the right care. Detailed individual information about a person with dementia had not been included in the care plan. This would have assisted staff to have effectively communicated with the person and provide more opportunities for stimulation. It was therefore not possible to confirm that all people’s needs were being met.

Is the service caring?

Four people told us about the staff supporting them. They told us that: “staff are good. They try their best and are friendly” and “staff help me. I have no problem with them.”

Not all people using the service, or their relatives, had completed an annual satisfaction survey. No action plan had been produced for the small number of questionnaires that we saw, so there was a risk that not all issues had been dealt with. The registered manager told us he would be developing an action plan in future to ensure people received good quality care.

Is the service responsive?

People said that they could make a compliant if they wanted to, but no one we spoke with had needed to. People told us when they told management about anything that had concerned them, it had been quickly put right. They were satisfied with the outcome of their concerns.

Is the service well-led?

Staff told us that if they witnessed or heard of poor practice they would report their concerns to their management.

The service had a quality assurance system. However, the system did not cover all essential processes with regard to the running of the agency, so there was a risk that people may not had received high quality services at all times.

There were suggestions made by relatives we spoke with; that communication from head office needed to be improved so that people know if staff were running late, and that staff needed to be careful when using a wheelchair so they did not damage paintwork to doorways.

Inspection carried out on 29 November 2013

During a routine inspection

We met two people who used the service and spoke with another by telephone. We also spoke with two care staff and with the care coordinator and office administrator. The registered manager was unavailable at the time of the inspection visit.

People who used the service, or their representative, had signed a formal contract to confirm they agreed with the arrangements that were in place for the provision of their care and support.

Care plan documents had been updated at regular intervals and reflected peoples’ current circumstances. People who used the service, and relatives of these people, told us that they received the support they needed and staff followed the routines that were outlined in the care plans.

There was no clear written information for staff to explain the types of abuse that a vulnerable person who used the service may be at risk of. Neither was there any written information to explain what action they should take if they had concerns about the welfare or safety of a person they supported.

The provider had not always completed sufficient checks to ensure that prospective employees were suitable for the role. The provider had also not checked that staff had relevant and up to date training, skills and knowledge.

Regular checks were carried out to help ensure that the service was delivered reliably and that staff were performing their duties well.

Inspection carried out on 21 November 2012

During a routine inspection

This is a new agency and when we visited it employed one staff member to provide care for one person who used the service. We did not have the opportunity to speak with the person who used the service, however we did talk to the agency’s manager and the staff member who provides care.

The member of staff told us people were encouraged to make choices about all aspects of their care and support. They said, “The person I work with knows what they want and is very particular about their care. They make choices about what to eat, what to wear, and what type of care they need. I always respect their choices and understand it’s up to them how their care is provided.”

We visited the agency’s offices to look at records and talk to the manager about how staff provided safe and appropriate care to people. The manager told us care plans were produced in consultation with the person using the service and included information about their care needs, wishes, preferences, and personal goals.

The member of staff told us they felt well supported by the agency. They said, “I meet with the manager once a week to discuss my work and he is always available by phone if I need him.” The manager told us he had already visited the person who used the service to check they were satisfied with their care.

The agency’s offices have parking directly outside the building, level access, and a lift. This means that people with limited mobility who want to visit the offices are able to do so.