Walnut Care at Home

Walnut Care at Home is a domiciliary care service providing personal care to people living in their own homes. At the time of inspection there were 445 people using the service. 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 and what we found

Staff were provided with information about how to reduce risks associated with people's care. The providers own risk assessments were often generic and could have included more person-centred information. We discussed this with the provider who was aware of this and had plans to develop this in the future. Staff were aware of the risks associated with people's care.

People told us there were enough staff to meet their needs. Some people told us staff absence could result in last minute changes and late calls. Some people told us that sometimes staff rushed to deliver their care. We considered the impact the COVID-19 pandemic had on staffing. Staff were recruited safely and in line with requirements.

People were administered medicines by staff who were trained and competent. Records of medicines administration were checked by the provider and errors were addressed.

People confirmed staff wore the correct PPE when providing care to them in their own homes. Records showed staff were provided with infection control training. The provider had reacted and responded to the COVID -19 pandemic in a proactive and dynamic way. Staff were provided with the PPE they needed.

Since the last inspection the provider has developed improved systems to monitor and review care to ensure incidents are escalated and responded to. Staff told us they reported concerns to a senior member of staff during daily handover.

Staff received training to ensure they could recognise and report abuse. Staff described how they would report their concerns to someone more senior.

People's needs were assessed when they commenced using the service. A system was in place to check the information in local authority needs assessments prior to agreeing to provide care. People had care plans which reflected their basic needs.

Systems to support staff learning and development had improved since our last inspection. Training records showed staff received the training they required to carry out their roles.

Records showed staff escalated concerns about people's health and wellbeing. Systems had been improved since the last inspection to ensure information about people was more accessible and could be shared with health and social care partner agencies.

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.

People told us staff treated them with courtesy and respect and were kind to them. People told us they felt involved and consulted about their care. People told us staff respected their privacy and dignity.

The quality of information in care plans and person-centred care guides varied. Some contained a detailed description of people's preferences and wishes, and others were less person centred and required further development.

Records showed peoples care was reviewed and people were consulted about their care and encouraged to contribute ideas and views.

A complaints procedure was in place and records showed complaints were investigated and responded to.

Staff were provided with training and support to recognise frailty and support people who were at the end of their life. The provider had a system to ensure people who were at the end of their life had a palliative care plan in place.

Since our last inspection the provider had developed a clear governance process and had improved systems to ensure they had clearer oversight of the service and risk.

The provider had developed an improvement plan which incorporated actions from service checks, feedback from service users and complaints. The provider and senior management team had worked hard to drive improvements during the COVID-19 pandemic.

Some people told us they found it difficult to contact the office on occasion, others confirmed service checks were carried out and they were asked for feedback about their care.

Staff consistently told us they felt supported in their roles and they felt confident to raise concerns.

The provider has worked extensively with partner agencies and local groups throughout the pandemic and have shared information to support the local care network in the area.

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 requires improvement (Published 24 November 2020) and there were multiple breaches of regulation. A Warning Notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 was issued. Due to the COVID-19 pandemic we were unable to return within the specified timescale to check the Warning Notice had been met, therefore this was checked at this inspection. 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Walnut Care is a domiciliary care service providing personal care to people living in their own homes. At the time of inspection there were 494 people using the service. 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 and what we found

The provider had a governance policy which had not been reviewed for several years. The system used to check regulatory compliance was not effective for such a large service spread over a large geographical area. The provider did not have sufficient oversight, nor did they apply sufficient scrutiny of care delivery.

The provider did not monitor assessments, care planning and risk management. The review of daily contact sheets was not effective. Daily contact sheets were not always reviewed. The process of retrospective review of care meant that safety and compliance issues were not identified and therefore people experienced and were at risk of avoidable harm.

The provider had begun to develop new systems for recruitment and learning and development but had yet to make improvements to the way they managed compliance.

Known risks to people were not managed effectively. Risk assessments were not in line with current health and safety guidance. Known risks associated with choking, falls and infection were either not carried out or did not contain sufficient information and guidance to enable staff to provide safe care and support. Safe working practices for people at risk of health conditions such as diabetes had not been developed for staff to follow.

Systems for reporting accidents and incidents and medicines errors were not being followed. There were several occasions where incidents involving medicines and falls/admissions to hospital had not been reported to managers. Systems to analyse trends and patterns were ineffective because the provider did not know when incidents had taken place. Failure to identify incidents had resulted in people experiencing an avoidable decline in health and delays to receiving care and treatment.

Systems for managing the administration of medicines were affected by the failure of care and office staff to report medicines errors and concerns. Several incidents where medicines errors had occurred were not identified and recorded on the incident logs. Action taken following medicines errors was insufficient to reduce the risk of recurrence.

Sufficient numbers of staff were employed to meet people's needs. Staff were recruited safely and in line with regulations. Staff were trained to ensure they recognised abuse and knew how to report concerns. The provider had a policy in place and staff were provided with training. Staff were provided with equipment to reduce the spread of infection and received infection control training.

The provider did not routinely carry out needs assessments for people using the service. The provider had a system for checking the validity of local authority assessments but did not then carry out a formal assessment of people's needs subsequent to this.

The process for producing care plans and reviewing them was not clear. One person did not have a care plan in place and several people’s care plans were incomplete and did not reflect if they had been involved in developing their own plans. There was no formal evidence care plans were reviewed regularly and when people's needs changed such as being admitted to hospital. There was no formal evidence people had consented to their care as described in their care plan. People consistently told us they were not involved in developing their care plans.

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, however the policies and systems in the service did not support this practice.

Staff received induction training and were supported to obtain their care certificate. A large section of the staff team required refresher training and/or competency assessments for medicines which had not been carried out. Training to meet people's specific health needs had not been provided to staff, such as diabetes and end of life training.

Several people and their relatives told us they had not been asked about their views of the service. The provider had a system for surveying people and relatives and had begun the process for 2019/20. The provider did not have an improvement plan for the service.

Care records were not clear about people accessing healthcare services. We identified several occasions where delays occurred to people receiving prompt healthcare.

People and relatives told us they were happy with the support they received from staff to enable them to eat and drink.

People and relatives consistently told us that staff were kind and considerate. Several staff were highly commended for their attitude and approach. Staff knew people well and were able to describe people's needs. People and relatives told us staff respected their privacy and dignity and did their best to help them be independent.

The provider had a complaints policy and kept records of complaints. Records showed that complaints were responded to in line with the provider’s own policy.

Care plans did not include information about advance wishes. Staff had not received training in end of life care. The area manager gave us several examples of end of life care which was in line with what people wanted and was planned well.

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 01 August 2017)

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, caring, 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.

Enforcement

We have identified breaches in relation to Regulation 17 Good Governance, Regulation 12 Safe Care and Treatment, Regulation 9 Person Centred Care and Regulation 18 Staffing 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 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.

Walnut Care at Home is registered to provide care for people in their own homes. The service can provide care for older people and/or people who live with dementia. It can also provide assistance for people who have a physical disability and/or who have a learning disability and/or who have a sensory disability. At the time of our inspection the service was providing care for 600 people. Of this total, 37 people lived in a 'housing with extra care' scheme in Skegness.

The service had its office in Langrick and covered north and south Kesteven, east Lindsey, Boston, Skegness and Lincoln. The service employed 130 care staff who were organised into local teams each of which was headed by a team leader. The teams were organised into two groups each of which was overseen by an area manager.

The service was operated by a company for which there were two directors. One of the directors was the chief executive officer. The other director was the 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 7 May 2015 the service was rated Good.

At this inspection we found the service remained Good.

The registered manager and care staff knew how to keep people safe from situations in which they might experience abuse and people had been supported to avoid preventable accidents. Medicines were managed safely and people had been helped to obtain all of the healthcare they needed. There were enough care staff to complete planned visits in the right way. Although background checks for new care staff had not always been completed in the right way, the registered persons immediately made the necessary improvements to address this shortfall.

Care staff had received training and guidance and they knew how to care for people in the right way. This included supporting people to eat and drink enough.

CQC is required by law to monitor how registered persons apply the Mental Capacity Act 2005 (MCA) and to report on what we find. The registered persons and care staff had received training in this subject and they helped people to make decisions for themselves. When people lacked the capacity to make their own decisions the principles of the Mental Capacity Act 2005 and codes of practice were followed. This helped to protect people’s rights by ensuring decisions were made that were in their best interests.

People were treated with kindness and compassion. Care staff recognised people’s right to privacy and promoted their dignity. There were arrangements in place to assist people to access independent lay advocates and confidential information was kept private.

People had been consulted about the care they wanted and they had been given all of the assistance they needed. Care staff recognised the importance of promoting equality and diversity by supporting people to make choices about their lives. This included choosing which interests they wished to pursue and how they wished to meet their spiritual needs. There were arrangements to quickly and fairly resolve complaints.

People had been consulted about the development of the service and quality checks had been completed. Good team working was promoted and care staff were supported to speak out if they had any concerns about poor practice.

People told us their care was personalised to their needs. They said they were happy the staff adapted well when care changes were made. They confirmed staff kept notes on them and they were involved in the planning of their care. One person said,"Staff help me a lot, in a calm and caring way."

We did not ask people who used the service about staff recruitment but they told us they were confident staff could look after them. Staff records confirmed suitable safety checks had been made prior to each staff member commencing employment.

People told us staff knew a lot about how to look after them. They told us staff knew a lot about different conditions and illnesses. One person told us, "When staff don't know about a particular problem, they find out and it is sorted very quickly." The training records held on staff showed the provider had been proactive in ensuring staff had suitable training to enable them to meet the needs of the people they looked after.

People who used the service told us they had been informed how to make a complaint. One person said, "Any issue I have raised has been dealt with quickly." Staff knew how to record concerns raised by people who used the service and records confirmed how issues had been resolved.