Archived: New Care (Exeter)

The inspection took place over three days and involved spending time at the service's Exeter office looking at records held on the agency's computer data base. We visited seven people and their relatives in their own home and looked at their care records and contacted 17 people by telephone to ask them about their experiences. We also spoke with thirteen staff who worked for the service which included care workers and office based staff.

We also spoke with the registered manager, and the recently appointed deputy manager. The deputy manager told us they would be taking over the day to day managing the service once they had completed their induction. This was because the registered manager was moving to another role within the service.

Owing to the concerns raised, this inspection was to check whether the service had enough staff to meet people's care and welfare needs safely.

The questions we asked on this visit were:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

This is a summary of what we found.

During the inspection the registered manager submitted an action plan to the Care Quality Commission (CQC) which told us what actions they were taking to rectify the staffing concerns. These included changes to the rota to ensure care workers were given a more consistent visit plan with allocated time for travelling. People would then receive more continuity of care by seeing the same care workers more regularly. The deputy manager told us the provider had sent three additional office staff from one of their other offices to assist to improve the office based systems at the Exeter office.

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

Is the service safe?

We found the service was not safe. People were not adequately supported because the service did not have sufficient staff employed to provide support for the contracted people they had agreed to provide support for. This meant people were having late and cancelled visits and were being visited by lots of different care workers, some of who didn't know about their needs.

Is the service caring?

People told us the service was caring. All of the people we spoke with were positive about the majority of care workers and felt they were working under difficult conditions. Comments included, 'They are lovely girls, I feel so sorry for them' and 'It is a shame, they do their best, they only have a short visit and spend some time finding out what I need' and 'Staff are very good, I can't fault them, we moan at them but it's not their fault'. However people were not happy with the support they received from the service's Exeter office. They told us, 'I have no problem with the staff, it is the people in the office who need to organise things better'.

We observed two people in their own home being supported by care workers, and saw the care workers were friendly, kind and respectful. For example, we saw one care worker arranging to get a sandwich for the person in their own time.

Is the service effective?

We found the service was not effective because care workers were being allocated visits which were several miles apart and were not given travelling time between visits. This meant there was not an effective system to stop people having late visits.

We found care records were up to date about people's risks and care needs, with one exception.

Is the service responsive?

The service was not responsive because we found care workers were allocated people they had not supported before. Staff were not always given information before their visit about how to enter people's homes. Two people told us they found it difficult to answer their front doors due to their mobility, but needed to because the care worker did not know how to get in.

On the first day of this inspection we visited the agency office and spoke with the manager and office staff. We looked at the care records for 14 people who used the service. We also looked at a sample of computer records to find out how they planned the care workers' rotas and visits to people who used the service. We also looked at the records of medicines administered by care workers.

We visited five people who used the service and spoke with sixteen people and/or their relatives on the telephone. We saw progress had been made to improve the service and to achieve compliance. For example, one relative told us the service had improved 'tenfold' since they first received care and another person told us that timekeeping had 'tightened up recently.' On 7 March 2014 we visited the agency office to give feedback to the registered manager.

Following the inspection the providers sent us further evidence of actions and improvements they had taken to meet compliance. The evidence included improvements to the consistency and reliability of care workers in recent months. They had improved their methods of informing people about the visits planned for the following week, including the names of care workers and expected times of their visits. They had systems in place to reduce or eliminate the risk of care workers failing to carry out a planned visit.

Each person had a care plan in their home providing care workers with detailed information about their care needs. The plans had been reviewed in recent weeks.

The agency had improved the safety of medicine administration, for example by providing more training and new policies and procedures. They had a range of quality monitoring procedures in place and we saw evidence to show they had already picked up and were addressing some areas of non-compliance, for example where they had found gaps in poor recording of medicines administered.

This visit was to follow up the warning notices we issued after our inspection on 4 March 2013 relating to outcome 4 - care and welfare of people who use services. During that inspection we also issued four further compliance actions.

We visited four people who received a service. We visited the agency office, reviewed records of care provision, and spoke with the registered manager, three senior managers and one care worker. We also spoke with six people and their relatives and nine staff on the telephone.

We found that actions carried out by the agency had resulted in improvements in the services people received. Most people received a timetable every week to let them know who would be visiting, and the times of the visits. People told us most visits were close to the expected time of arrival. The incidence of missed or late visits had reduced. People were more likely to receive a consistent service from a small number of care workers who visited them regularly.

Most care plans had been reviewed, updated and improved since our last inspection. Most risks had been assessed and there were instructions for care workers how to minimise those risks. People told us care workers carried out all of the tasks required. Most people told us they were happy with the service. We will carry out another inspection later in the year to ensure that compliance has been sustained.

We reviewed the compliance actions issued following our last inspection. We had received complaints and concerns that indicated people may be continuing to receive care that did not always meet their needs.

This inspection took place over three days. We met with the registered manager, three senior managers of Newcare (Devon) Ltd and two administrative staff. We looked at records held in the agency office including care plans and computer records. We visited six people who received a service, and we spoke with 27 people and/or their relatives on the telephone. We spoke with four care workers.

People did not always receive a safe service that met their needs. People did not know the times care workers would be visiting, or their names. Some people experienced late or missed visits. Care was not always provided by a consistent team of care workers.

Care plans were not always up to date. Risks to people's health had not been adequately assessed, and care plans did not provide sufficient information about how the risks should be minimised. Some people said care workers did not always read or understand their care plans.

The providers had already identified these problems and had drawn up action plans to address them. They had begun to carry out measures to improve the service. However, people continue to be at risk of receiving a poor service until all actions have been completed.