Ryedale Homecare

Ryedale Homecare is a domiciliary care service providing personal care to young adults and older people who may be living with dementia, physical disabilities, a learning disability or autism spectrum disorder. At the time of our inspection there were 19 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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support:

People were not always supported in a way which promoted safety. Risk assessments were not in place to reflect people's current needs. We could not be assured these risks were known to staff and mitigations were in place to help minimise the risk of harm. People told us they received their medication when required, however, records did not reflect this. People were not always supported to have maximum choice and control of their lives and records did not reflect staff were working in their best interests; the policies and systems in the service were in line with best practice guidance but their practice did not support this. We have made a recommended for the service to review their understanding of the Mental Capacity Act 2005.

Safety and quality within the service had not always been assessed. Audits did not highlight the concerns raised at the inspection and there was no evidence that practice had been improved when something went wrong.

People told us they were well supported and praised the staff team. One person told us, “We’ve never been unhappy and there have been no concerns at all.” One relative, when discussing the support provided by the service, told us, “The staff have been tremendous".

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity and understood and responded to people's individual needs. However, more detail was needed in the care plans to ensure people’s needs and preferences were fully understood and recorded. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

We received positive feedback about the care provided. One person told us, “My overall impression is that they are very good and always treat me with the utmost respect. We’re all like friends now and its really lovely. The way that they care for me is just wonderful."

Right Culture:

The management team and staff promoted a caring culture, were providing person centred care was the focus of the service. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. People were asked to provide feedback on the care provided and they had confidence in the registered manager to deal with concerns appropriately. Staff felt supported in their roles and were provided with the opportunity to discuss any issues which they may have in an open and inclusive way.

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 4 February 2021) and there was a breach of regulation. At this inspection we found the provider remained in breach of regulations. This service has been rated as requires improvement for the past two inspections.

Why we inspected

We carried out an announced focused inspection of this service on 8 December 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains as requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ryedale Homecare on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safety and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Ryedale Homecare is a domiciliary care service providing personal care to younger adults and older people who may be living with a physical disability, dementia, a learning disability or autistic spectrum disorder. At the time of our inspection 28 people were using the service.

Not everyone who used the service received personal care. The Care Quality Commission (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

People praised the kind and caring support staff provided and how management were responsive and worked well with other professionals to help meet their needs. However, improvements were needed to make sure people’s medicine were managed and administered safely.

Clear and complete records were not always available to demonstrate the service was effectively managed. People’s care plans and risk assessments did not always contain enough person-centred information to support staff to provide safe care. Although no one had been harmed because of the concerns we identified, the provider did not have a robust system of audits and checks to monitor the quality and safety of the service. This put people at increased risk of harm.

The provider needed to update their policies and procedures to reflect current best practice guidance and develop a training plan to help monitor and make sure staff had the training required to safely meet people’s needs.

People praised staff’s reliability and punctuality. Staff wore appropriate Personal Protective Equipment (PPE) to keep them and other safe. People felt safe with the support staff provided and were confident management would respond to any issues or concerns they had.

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 11 November 2017).

Why we inspected

The service was involved in a planned pilot virtual inspection. The pilot looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the COVID-19 pandemic. During this pilot, we identified concerns about risk management, auditing and the governance of the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ryedale Homecare on our website at www.cqc.org.uk.

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.

Ryedale Homecare is based in Malton and provides personal care to people in their own homes within Malton and surrounding areas. The service was registered with CQC in October 2012.

At the time of inspection 56 older people used the service, some of whom were living with dementia. The director, who was the registered manager, was present throughout the inspection.

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 the last comprehensive inspection in September 2016, we identified breaches of regulations. The registered provider had failed to keep accurate records of medicines that were administered. They had not completed appropriate recruitment checks before new staff were employed at the service and had not ensured completed and accurate records were maintained. The service was rated at that time as requires improvement overall. The registered provider wrote to us telling us what action they would be taking in relation to the breaches of regulation.

At this inspection, we found the provider had implemented their action plan and met all requirements within the regulations.

Robust recruitment procedures were now in place. We found that appropriate checks had been completed before new staff commenced employment. Staff recruitment records contained full employment histories and gaps in employment had been explored. References had been obtained and there was clear recorded evidence of interviews taking place.

Clear procedures were now in place to guide staff on the safe administration of medicines and staff had received medicines training. Records showed that people had received their medicines as prescribed. Where gaps in records had been identified, appropriate action had been taken. The manager had worked hard to improve quality assurance processes that were in place and now carried out a number of quality assurance checks to monitor and improve the standards of the service. Action had been taken when concerns were found.

Records showed risks were well managed through individual risk assessments that identified potential issues and provided staff with information to help them mitigate risks, while supporting people to maintain their independence. These had been regularly updated to reflect current needs.

There were systems and processes in place to protect people from the risk of harm. Staff we spoke with were all aware of the different types of abuse, what would constitute poor practice and what actions needed to be taken to report any concerns.

New staff completed an induction before they began working in the community. There were systems now in place that ensured staff received the training and experience they required to carry out their roles. Staff performance was monitored and recorded through a regular system of supervision and competency assessment.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005. Staff were aware of the procedure to follow if they suspected a person lacked capacity to make decisions. Signed consent had been sought where possible.

Some people were supported by staff with meal preparation. Records and people confirmed that they were given choice and appropriate support was provided in this area.

Care records contained evidence of close working relationships with other professionals to maintain and promote people’s health. People were clear about how they could get access to their own GP and other professionals and staff at the service could arrange this for them. Care plans focused on each person as an individual and the support they required to maintain their independence. They identified people’s daily care needs and were person-centred.

People we spoke with told us they were well cared for and treated with dignity and respect by all the staff. There was a small, consistent staff team which enabled people to build relationships with the staff that supported them. Staff knew the people they cared for and understood their individual preferences.

People who used the service told us they could approach any of the staff with any concerns. The provider had a complaints procedure in place. The document included guidance on how to complain and what to expect as a result.

People who used the service and the staff were enabled to provide feedback. Questionnaires had been submitted to people on a regular basis to gain their views.

Regular staff meetings had not always taken place but plans were in place to improve this. Staff told us they were included in the service and felt supported by the management. They were confident they would deal with any issues raised.

Ryedale Homecare is a domiciliary care agency run by Ryedale Homecare Limited. It is registered to provide personal care to people living in their own homes. At the time of our inspection, the service was supporting 72 people who lived in and around Malton.

The service was last inspected in July 2014 when it was found to be compliant with the regulations in force at the time.

The registered provider is required to have a registered manager as a condition of their registration for this service. At the time of our inspection, there was a registered manager in post. They had been the service’s registered manager since October 2012. 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.

During the inspection, we identified that robust recruitment checks were not consistently completed before new staff started working. This meant people who used the service were exposed to increased risk of harm.

Medication Administration Records (MARs) were not completed appropriately. Poor recording on MARs increased the risk of medication errors occurring. Because of poor recording, we could not be certain that people who used the service were receiving their prescribed medicines. Robust checks were not completed of the support provided with medicines, meaning these issues had not been identified and addressed.

People who used the service, relatives and staff we spoke with were positive about the management of the service and felt it was well-led. However, the registered provider did not have robust systems in place to monitor the quality of the care and support provided. Concerns found during our inspection had not been identified and addressed by the registered provider.

The registered provider ensured new staff had an induction, had the opportunity to shadow more experienced members of staff and received on-going training and support. We identified that some staff training needed was not up-to-date. We have made a recommendation about this in our report.

People who used the service were supported to make decisions; however, staff did not document mental capacity assessments or best interest decisions regarding consent to care. We have made a recommendation about this in our report.

Staff we spoke with understood the types of abuse they might see and knew how to respond to safeguarding concerns to protect people from harm. People’s needs were assessed and risk assessments put in place. Risk assessments were reviewed and updated as people’s needs changed. There were sufficient staff employed to meet people’s needs safely and we received positive feedback about staff’s reliability and punctuality.

People who used the service were supported where necessary to ensure they ate and drank enough. Staff were attentive to people’s health needs and provided support to ensure people could access healthcare services where needed and in an emergency.

We received positive feedback about staff. People who used the service told us staff were kind, caring and provided support in a way that maintained their dignity.

People were supported by familiar staff who understood their needs. Person-centred care plans were put in place to guide staff on how best to meet people’s needs. People who used the service felt able to raise issues or concerns with the registered manager or staff in the office and were confident that their comments would be listened and responded to.

We found breaches of regulation in relation to recruitment checks, managing medicines and the governance of the service. You can see what action we told the registered provider to take at the back of the full version of this report.

As part of this inspection we looked at records for ten people who used the service. We spoke with the manager, four people who used the service and a relative of a person who used the service. We also spoke with two carers and a senior carer. We reviewed records relating to the management of the service.

Below is a summary of what we found. The summary describes what people who used the service and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were systems in place to monitor staffing levels and organise rotas for calls. This meant that carers usually ran to time with visits. Both people we spoke with who used the service and staff confirmed that arrangements for staffing were well organised. This ensured that people were safe because their calls were carried out in a timely manner.

We spoke with people who used the service and a relative about whether they felt safe when being supported by staff. One person told us 'The staff seem well trained so I always feel safe'. Another said 'I feel safe as I have consistent carers and I know them well'.

We saw evidence of people consenting to their care plans and people told us they had been involved in developing them. Staff had a good understanding of the importance of getting people's consent before carrying out care.

Is the service effective?

People had an individual care plan file which contained a care plan and any associated risk assessments that were required. We saw care plans contained information about people's needs. The care plans we looked at contained sufficient information and were relevant to the person's current needs. The risk assessments were sufficient to identify and minimise risks.

We spoke with people who used the service and they felt the support they received was meeting their needs well. Comments made to us included 'They are very supportive and helpful', 'They support my relatives needs very well' and 'They are a big help and I am very satisfied'. When we spoke with staff they felt they were able to provide fully effective care.

Is the service caring?

All the staff we spoke with were enthusiastic about providing caring and effective support. When we spoke with people who used the service they told us that staff were friendly and helpful. They also told us that staff were very good at respecting their privacy and dignity when providing support. Comments made to us included 'They are very supportive, friendly and respectful. They definitely maintain my dignity', 'They are very caring, gentle and mindful of my privacy' and 'The staff are very careful and I very much happy with the way they respect my dignity'.

Is the service responsive?

There were audit systems in place regarding health and safety, documentation and people's satisfaction with the service they received. This was designed to allow management to monitor the quality of service. There were also systems in place for highlighting issues and learning from accidents, incidents, surveys and resident meetings, staff feedback and complaints.

We spoke with people who used the service about the ways they fed back and how this information was used. Comments made to us included 'I would contact the office if I had any problems and they would listen and act', 'I know how to raise issues and I have previously given feedback which has been listened to effectively' and 'I tell them what I think and they take notice of what you say'. The provider also formally gathered feedback from people who used the service in order to ensure improvements were customer led through questionnaires. Staff contributed through staff meetings. Staff training was also closely monitored.

Is the service well-led?

There was an consistent permanent staff team and no vacancies at the time of our inspection. Many of the permanent staff that worked in the service had done so for some time and knew people well. There were low levels of sickness and absence. The staff we spoke with told us that the manager was approachable and pro-active.

People who used the service and their relatives told us they were very satisfied with the support they received and comments included 'They go above and beyond in supporting me', 'They really care about people' and 'I am very satisfied with them'.

We found that staff were up to date with safeguarding training and they showed good knowledge of spotting the signs of abuse and the action they should take. People who used the service reported that they always felt safe when being supported.

The provider had robust systems in place for carrying out recruitment checks and staff said they felt supported by management. Regular supervisions and training opportunities were given to staff. There were processes in place to monitor the quality of service provision and the agency gathered feedback from people and acted on it appropriately.