Archived: Somerset Care Community (Taunton Deane)

At the time of the inspection 369 people were receiving the regulated activity ‘personal care’.

This inspection was announced and took place on 26 and 27 September 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be at the office and able to assist us to arrange home visits.

There was 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 our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

People told us they felt safe with the care provided and staff who visited them. One person said, “I have never felt anything other than safe. They[staff] are excellent and I look forward to their visits.”

There were sufficient staff to meet people’s needs. People confirmed they had a small team of care workers whom they had got to know. People’s comments on the timing of visits varied. Some people were happy that staff arrived at the agreed time and stayed the agreed length of time. Many commented on staff who stayed longer and did more than they expected. However, some people said they experienced staff arriving either earlier or later than planned. One person said they went to bed at 9pm and got up at 7am which they thought was too long in bed. The registered manager explained they tried to accommodate all time requests but they were open and honest with people at the start of the care package about any timings they could not achieve.

People were protected from harm because the provider had a robust recruitment process and staff received training in how to recognise and report abuse.

People’s medicines were managed safely and people told us they received support to take their medicines correctly and at the right time.

People were supported by staff who knew their needs and understood the importance of delivering effective care and support. Records showed all staff completed the organisations mandatory training and training relevant to the needs of the people. Staff received regular supervision and support from the management team. This was carried out either in one to one or team meetings. People told us that senior staff carried out ‘spot checks.’ This meant the senior staff arrived unannounced to check on staff and ask people what they thought about the team supporting them.

All new staff received an induction and initial training. Before working alone, they were able to shadow more experienced staff and meet the people they would be supporting. Staff told us the training provided was good and that they could also access training specific to people’s needs.

People were supported to have a balanced and nutritious diet. Some people required meals cooked for them and support to eat. At other times, staff supported some people to prepare their own meal and maintain their independence.

People were supported to have maximum choice and control of their lives. Staff helped them in the least restrictive way possible. The policies and systems in the service also reinforced this practice.

People were supported by staff who were very kind and compassionate. People thought staff often went over and above their job roles to ensure their comfort and well-being. People told us how staff had worked in their own time to ensure they were safe. Staff had supported one person to move into a new home. Another person was assisted when they were in hospital and confused. During adverse weather conditions staff had gone above and beyond to ensure people continued to receive a visit.

People told us they could talk with staff if they wished to raise a concern. One person said, “I know who to talk to but I also know I can trust the carers to take anything I am concern about back to the office for the manager to deal with.”

People were supported at the end of their life to have a comfortable pain free death. Care plans showed people’s advance decisions were taken into consideration and acted upon. Staff worked with the community team and local hospice to ensure people could remain in their own home towards the end of their life if that was their wish.

People received care and support that was responsive to their changing needs. Staff had a clear understanding of people’s needs and how to meet them effectively. People were involved in discussing and setting up their care plans.

The service was well run by a registered manager who had the skills and experience needed to run a domiciliary care agency. This meant people received good person-centred care. The registered manager led a team of staff who shared their commitment to providing a good standard of care.

There were systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and complaints and learnt from the issues raised. The provider sought people's views and opinions through regular telephone monitoring and an annual survey.

Somerset Care Community (Taunton Deane) provides personal care for people living in their own homes in the Taunton, Bridgwater and Chard areas. At the time of this inspection they were providing personal care for 509 people. They also provided a domestic service to people in their own homes. This was the first inspection since the service was reorganised following the Chard and Taunton office merger.

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.

People who received personal care from Somerset Care Community (Taunton Deane) told us they were happy with the care and support provided. They said the management and staff were open and approachable and cared about their personal preferences and kept them involved in decision making around their care. One person said, “Since I changed to Somerset Care I have been very happy with the support I receive.” Another person said, “They [staff] are always very cheerful and nothing is too much for them.”

Some people who used the service and care workers said office staff did not allocate sufficient time for care workers to travel between visits. One person said, “The staff are very well organised, but the company is not organised, they don’t recognise the distance the staff travel.” Some staff spoken with also said planners did not recognise the time it took to travel between calls. These people felt this was the reason some calls were later than planned. The registered manager confirmed planners carried out care duties every six months and covered for staff sickness so they would have an idea of the time it took staff to travel. One staff member said, “Travel time can vary a lot in this area as traffic congestion can change in a second and then it puts everything out, so it is difficult to plan for that.”

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed staff took time to talk with people during our home visits. Most people said they had a consistent team of care workers who visited. They said they were usually on time and very few people said they had experienced missed calls. However some people said they were not informed when a care worker was changed or if they were going to be late. The registered manager confirmed they would only take new people on if they could meet their needs. If they were unable to meet their needs they would signpost them to another agency or health care professionals.

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Care workers had access to training specific to their roles and the needs of people. For example they could ask the training team to provide specific training in the person’s home if they had new equipment. They understood people’s needs and were able to explain to us how they would care for each person they visited.

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care or a relevant representative. All care plans included written consent to care. Care workers had comprehensive information and guidance in care plans to deliver consistent care the way people preferred. Daily progress reports showed care workers had followed the care plan. One person told us the care workers always read their care plan when they visited them.

There was a corporate philosophy of care for the agency which was to provide a service which was to, “promote dignity, privacy, respect for human rights, equal opportunities and the right to enjoy the highest possible quality of life. We support the personalisation agenda and believe people receiving services should be at the centre.” The registered manager said their philosophy was to ensure best possible care meeting people’s needs safely, recognising their preferences and choices. They also said they aimed to empower staff giving them extra responsibilities so they felt valued. Staff and people spoken with said they felt people were at the centre of the care provided. People commented on the involvement they had with their care plans and any changes. The registered manager had also introduced customer meetings when people could meet staff and discuss their views and experiences.

People were protected from abuse because the provider had systems in place to ensure checks of new staffs characters and suitability to work with vulnerable adults were carried out. Staff had also received training in protecting vulnerable people from abuse. People said they felt safe when being cared for; and we observed people were happy and relaxed with care workers during our home visits.

Most people were able to access health care professionals independently but assistance could be provided if requested. Staff monitored people’s health with their consent and could direct to healthcare professionals as appropriate.

The agency had a complaints policy and procedure that was included in people’s care plans. People said they were aware of the procedure and had numbers they could ring. People and staff spoken with said they felt confident they could raise concerns with the registered manager and senior staff. Records showed the agency responded to concerns and complaints and learnt from the issues raised.

There were systems in place to monitor the care provided and people’s views and opinions were sought regularly. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

We gathered the views of people who used the service by visiting them in their home and by telephoning them. We contacted 42 people and were able to speak with 27 people using the service and three relatives.

In addition to speaking with people who used the service and/or their representatives, we met or spoke with 34 members of staff, individually or in small groups. We also reviewed a range of relevant documentation.

Is the service safe?

People who used the service told us they felt safe with the staff that provided care and support for them. Comments included, 'Staff are very considerate. They recognise when I get breathless and never rush me'; 'I have confidence in the staff. They are never abusive. I trust them'; and 'I am treated very well by the staff'.

Care plans and risk assessments were available in eight of the nine people's homes we reviewed for staff to follow, so people received the care they needed. However we found people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

Equipment was available where necessary, for example hoists, to aid people's safe moving and handling.

We found systems and processes were in place to safeguard people from harm and abuse. This was because staff had received training to provide them with the knowledge to identify abuse and where to report abuse, so appropriate action could be taken. All staff spoken with were aware of the processes for raising safeguarding alerts.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was monitoring of events and incidents and measures were put in place to minimise a repeat of any issues. This included, changes to health care needs and some medication incidents.

Is the service effective?

People and their families described how they were involved in the assessment and care planning of their care needs, so they received care that met their needs and supported their rights. When staff had regular rotas it enabled continuity of care and ensured they knew people well.

The service worked with a local authority independent living team providing care, support and rehabilitation for up to six weeks. External professionals working with the service told us this service 'worked incredible well' and that they were happy with the joint working which delivered an effective and responsive service.

Staff had completed comprehensive training before they started work to ensure care and support was delivered safely and respectfully and in accordance with the registered provider's policies and procedures.

There were effective recruitment and selection processes in place.

Is the service caring?

People told us care staff respected their choices and maintained their dignity. Comments from people using the service included, 'The staff are very good indeed. Very friendly and polite, always respectful. That (respect) couldn't be better'; and 'The staff are lovely. They stick to my routine and give me choices. They are mindful of my privacy and dignity'. One person told us they felt more in control and able to stay living at home because of the agency support.

During our visits to people's homes we saw staff interacted positively and gave encouragement when supporting people. Staff were polite, friendly and knowledgeable.

Is the service responsive?

The service was not always responsive to people needs as preferences relating to the timing of visits and continuity of staff were not always met, which caused frustration and anxiety for some.

The service was generally responsive to people's complaints. The majority of complaints were responded to in a timely way and most were resolved satisfactorily.

Is the service well-led?

The service worked with other agencies and services to make sure people received their care in a joined up way.

The service had quality assurance processes in place to monitor the quality of the service provided. We saw steady improvements were being made, especially with missed visits. We also saw that unallocated visits were also being addressed and had fallen to 10% in June from 15% in April 2014, which meant better continuity for both people using the service and care staff.

People who used the service and their representatives and staff confirmed they had regular monitoring visits to check the quality of the service and that the care provided continued to meet their needs.

Staff we spoke with told us they felt supported by the management of the service. Staff were clear about their roles and responsibilities. Discussions at team meetings included issues of best practice, improved ways of working and knowledge sharing, which aimed to improve the service provided.

People praised their regular carers and said they were considerate and respectful. One person said; 'I think the carers are very good. They are considerate, they definitely show respect'. Another person said 'All the carers we have had are first class, they can't be more helpful. I would recommend the agency'. Another person said 'All in all, absolutely top notch'. People could easily change their carer if they were unhappy with how they provided their care.

The main concerns that people fed back to us were carers arriving after or before their scheduled time. Two people commented 'the timings could be better'. People felt that it was how care was planned that affected the timings of their care.

We found concerns with how the agency managed time critical medicines. People were receiving time critical medicines at the wrong intervals. This meant that the medicines taken could be ineffective and have an impact on their health. The provider did not have adequate systems in place to identify if people requiring time critical medicines received them at the correct intervals.

The provider had systems in place to ensure they had the correct level of staffing to meet people's needs.