Archived: Concept Home Care

During the inspection we visited four of the people who used the service in their own homes and we contacted a further four people by telephone. We spoke with them and or their family members about the quality of care and services provided. We spoke with the manager and administrative assistant and inspected records regarding the management of the service and the care of people who used the service. We also spoke with two care staff in person and a further three care staff on the telephone.

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 safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

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

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the people who used the service were at risk of receiving unsafe and inappropriate care and support. The people who used the service spoke highly of the manager, staff and the standard of care provided but there was insufficient assessment, risk assessment and care planning documentation to ensure personal care was delivered safely and in accordance with each person's individual needs and personal preferences. From looking at records and talking to the people who used the service, their family members and staff we found that care had been provided for three of the people who used the service before their individual needs had been recorded or confirmed in an agreed plan of care. This showed us that people were not protected against the risks of unsafe or inappropriate care and treatment due to the lack of accurate records and appropriate information in relation to the care and treatment provided. A compliance action has been set and the provider must tell us how they plan to improve.

People were safeguarded from the risk of abuse because the provider had taken steps to ensure that staff had the skills to recognise and respond promptly and effectively to any evidence or suspicion of abuse. The people who used the service told us that they felt safe and well cared for and their relatives told us that they had confidence in the manager and staff.

The Mental Capacity Act (MCA) sets down legal requirements that need to be followed to ensure decisions made about people who do not have capacity are made in their best interests. They are designed to ensure that people who are unable to give consent for certain aspects of their care and welfare receive the right type of support to make a decision in their best interest.

We looked at the care records for four of the 11 people who used the service. We found that the manager and staff routinely involved people in decision making but had not followed correct procedures when there were doubts that the person had capacity to give informed consent. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service effective?

All the people we spoke with spoke highly of the manager and staff complementing them on the standard of care provided. They all told us that they benefited from continuity of care, usually having the same care worker or small group of care workers day in day out and they valued this highly. Some of the relatives spoken with told us that they were aware of the lack of assessment and care planning documentation and were concerned about the possible impact this could have on continuity of care and the safe and effective delivery of the service. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and knew them well. However, the lack of detailed assessments, care plans and risk assessment meant people were at risk of their needs not being met if circumstances changed and their usual care workers became unavailable suddenly.

Is the service caring?

We found that the manager and staff provided sensitive and compassionate care, with kindness, dignity and respect. All the people we spoke with made positive comments about the staff and the care provided. People were relaxed and at ease, in the presence of staff and we could see that both parties enjoyed good relationships which were based on a foundation of mutual respect.

Some of the people spoken told us that the manager was particularly good at matching care workers with the right skills and attributes to the meet their needs and personal preferences. One person said 'I hold my care worker in such high regard for the way they provide kind and considerate care that I can only say they are excellent and I would not want them to change anything they do. They always treat me with respect and they know the way I want things done'. Another person said: 'the care is very good, my carer is kind, considerate and anticipates and meets my needs'. This person's family member said: 'we could not wish for a better care worker the way she treats and supports Dad is wonderful'.

Is the service responsive?

Some of the people who used the service and some of their family members told us that they had been impressed at the speed in which packages of care had been put together and delivered, sometimes only taking a matter of days from the point of initial contact. Whilst this level of responsiveness was welcomed by the people who used the service and their families we could see that the manager had not always followed proper processes to ensure people were safeguarded from receiving unsafe and or ineffective care and support. The manager told us that he had made the mistake of responding to the request for care and support from a number of people at a time when he did not have resources to do so. This had resulted in him putting aside some vital management duties, including documenting assessments, risk assessment and care plans, because he had to act as a care worker and provide personal care himself. This is contrary to the requirement of the regulations and puts vulnerable people at unnecessary risk. A compliance action has been set and the provider must tell us how they plan to improve, as mentioned above.

Is the service well led?

We found that Concept Care was not well led. Since our last inspection the provider had responded to concerns we raised and told us that he had taken action to improve the standard of care provided but we found that all of the required improvements had not been sustained. We found that the manager had not kept his training and development up to date. He had not completed training on the MCA or risk assessment and this inspection identified gaps in his knowledge in both of these areas.

We found that the service's quality assurance system which had been in place at our last inspection had not been sustained. Whilst people told us that the manager sought their views on the quality of care provided from time to time the manager had not maintained records to confirm this. Care assessments, risk assessments and care plans were not audited and there was no evidence of any other audit being completed. A compliance action has been set and the provider must tell us how they plan to improve.

People who used the service and their relatives were unanimous in their praise for the staff and the standard of care provided by Concept Home Care Ltd.

People told us that they were treated with respect and were always involved in making decisions about their care and support. One person said 'These people have really made an enormous difference to the quality of my life. They take account of my preferences and choices and they listen to me and act on what I say'.

One relative said: 'I am absolutely delighted with the service, they are flexible and responsive, they know and understand my Mum's needs and the staff are well trained, caring and willing to learn about her special requirements. I have every confidence in them'. Another person's relatives said: 'They are excellent, we consider ourselves fortunate to have them'.

We saw that the agency forwarded quality assurance survey questionnaires to the people who used the service and saw the comments people made were very positive.

We looked at the care records for a number of the people who used the service and could see that arrangements made for their care and support were centred on their individual needs.

We found that there were areas where improvements were needed to ensure peoples' safety including risk assessment and staff recruitment.