Care 77 Limited

Care 77 Limited is a domiciliary care agency which provides personal care to people in their own homes. At the time of the inspection 58 people were receiving a personal care service. People had a variety of health needs and some people had physical disabilities. 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

Some improvements were needed to the care plans and risk assessments for complex needs such as diabetes and catheter care, to ensure appropriate guidance was available. We found no evidence that people were harmed, and staff were able to tell us how to care for people with these needs.

Improvements had been made to recruitment processes. Staff had received all relevant checks before starting at the service and a new audit system helped the management team to monitor this. People and their relatives felt there were enough staff and were on time for care calls, anytime a call was late, they were kept informed. People told us they felt safe with the care they receive and knew who to go to if they had any concerns. Staff were able to identify potential signs of abuse and how to report any concerns.

Shortfalls were found at our last inspection in relation to checks and audits. We found similar concerns on this inspection, where audits completed did not identify issues related to diabetes and catheter care.

Staff were positive about the management team and felt supported in their roles. People and their relatives felt the service was managed well and knew how to contact the manager if they needed too. The registered manager worked with others to provide joined up care for people. New quality assurance systems have just been introduced to help the management team have better oversight of the care provided. The registered manager had plans to improve the service and worked on a service improvement plan.

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 26 February 2020. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an announced comprehensive inspection of this service on 17 December 2019. 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 Regulation 19 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

We have found evidence that the provider needs to make improvement. Please see the Safe 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. 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 Care 77 on our website at www.cqc.org.uk.

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.

Care 77 Limited is a domiciliary care agency which provides personal care to people in their own homes. At the time of the inspection 47 people were receiving a personal care service. People had a variety of health needs and some people had physical disabilities.

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

The registered manager was unable to demonstrate all of the required checks had been made before new staff had commenced work which could pose a risk to people receiving support. Quality systems did not ensure robust monitoring of the service. It had not been identified that recruitment checks had not been completed appropriately for all staff that were supporting people. Although the registered manager made some checks on parts of the service, there was no formal auditing system to identify areas which could improve. We received a mixed response from people regarding the calls they received. Although nobody said calls were missed some people felt they were not always well informed if staff were running late or if the staff booked to provide calls had changed. Checks around this was not robust although the registered manager was trying to improve this and a new computer system was being trialled. Risks were assessed, and measures implemented to reduce the risk of harm to people and staff. Staff understood their responsibilities to keep people safe and had received safeguarding training to recognise the potential signs of abuse.

We noted that information around two people’s health needs needed more detail, so staff could provide effective support. The registered manager took action during the inspection to improve this. Staff received enough training and support to complete their roles and care for people well. 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 their dignity and independence were respected by staff. Staff understood the needs of people and spoke about them in a caring and respectful way. Nobody raised concerns about the way they were treated by staff.

People had care plans to inform staff of how care and support should be delivered in line with their needs. A complaints policy and procedure were available for people, staff and other individuals should they wish to make a complaint. Lessons were learnt when concerns were raised.

The views of people, staff and other individuals was sought so action could be taken to improve the service. Staff were clear about their roles and responsibilities. Staff told us they felt well supported and able to go to the registered manager at any time.

Rating at last inspection

The last rating inspection for this service was good.

Why we inspected

This was a planned scheduled inspection.

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.

Care 77 Ltd is a domiciliary care agency which provides personal care to people in their own homes.

They operate in and around Paddock Wood and surrounding areas.

At the time of the inspection the service was supporting 37 people and there were 16 staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

The service enabled people to receive care in their own homes. One person told us, “I like being in my own home. The carers are great. Help me greatly and I feel safe."

People had good relationships with staff, who were knowledgeable of their physical and emotional needs, as well as likes, dislikes and interests. #

Staff were responsive to changes in people's health needs. If needed, they sought advice from relevant professionals.

People were supported with their medicines and medicines were managed safely

People had risk assessments in place to help them keep safe.

People were encouraged to be as independent as possible.

People’s needs were assessed, care plans were reviewed regularly.

People were treated with kindness. People’s privacy and dignity was respected.

People felt comfortable raising any complaints with staff and the registered manager.

People were fully involved in their care planning and received information in a way that they understood.

When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act were followed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice .

The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS) and had applied for authorisations when there was a risk that people may be deprived of their liberty to keep them safe.

People were protected from the spread of infection.

People were asked feedback about the service they received.

People found the registered manager approachable and supportive.

Rating at last inspection: This service was rated, “Good” at the last inspection. (4 November 2016)

Why we inspected:

This was a planned comprehensive inspection to check the service remained Good.

Follow up: We will continue to monitor the service through the information we receive. We will carry out another scheduled inspection to make sure the service continues to maintain a Good rating.

Care 77 is a care agency providing personal care and support to adults living in Paddock Wood, Sevenoaks and the surrounding villages. The service currently provides support to older people, people living with dementia and people with physical disabilities. The service provides calls at a minimum of 30 minutes for personal care, but can offer a ‘pop in’ service of 15 minutes to those who require a task such as administering eye drops.

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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns. People told us that they felt safe using the service. We have made a recommendation to add an expiry date to staff ID badges so that people could be assured of their validity. Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of recurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs. The registered manager followed safe recruitment practices. Staff had completed the training they needed to care for people in a safe way. They had the opportunity to receive further training and qualifications specific to the needs of the people they supported. All members of staff received regular one to one supervision sessions and were scheduled for an annual appraisal to ensure they were supporting people based on their needs.

People told us that staff communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. People were satisfied with how their care was delivered. The registered manager held person centred values that formed the basis of the service and these were followed by staff in practice. People’s privacy was respected and people were supported in a way that respected their dignity and independence. The staff promoted people’s independence and encouraged them to do as much as possible for themselves.

Staff knew each person well and understood how to meet their needs. People’s care plans could be further improved by including more specific and personalised information to help staff deliver their care. This would ensure staff were consistent in their approach and that care was provided in line with people’s preferences. We have made a recommendation about this.

People’s individual assessments and care plans were reviewed regularly with their involvement. People’s support plans were updated when their needs changed to make sure they received the support they needed. People were supported to manage their medicines in a safe way. Staff responded quickly to changes in people’s health and worked with healthcare professionals to meet their needs.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and the requirements of the legislation. Staff sought and obtained people’s consent before they provided support. When people declined, their wishes were respected and staff reported this to the registered manager so that people’s refusals were recorded and monitored.

Clear information about the service, the management, the facilities, and how to complain was provided to people. People’s views were sought and acted upon and the registered manager took account of people’s comments and suggestions.

Staff told us they felt supported by the registered manager. The registered manager notified the Care Quality Commission of any significant events that affected people or the service. Quality assurance audits were carried out to identify how the service could improve and the registered manager had an ongoing and effective improvement plan for the service.

We asked the provider for an action plan which we received on 28 April 2014. This outlined how improvements would be made within a set time frame.

During this follow-up inspection, we found that action had been taken and the provider had achieved compliance with Regulation 23 of the Health and Social Care Act 2008.

We looked at people's records, staff files and training schedules. We spoke with three relatives of people who used the service, five members of staff and the registered manager.

During this inspection, the inspector focused on answering our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were trained in how to reduce the risk to people from the spread of infection. Staff knew how to assist people with restricted mobility safely. Training was provided for staff about how to safeguard people from abuse. Some staff had completed these courses and others were due to do so by 15 February 2015.

Is the service effective?

Staff were clear about their responsibilities and had appropriate knowledge and understanding of how to meet people's needs. Staff were trained and knew how to carry out their roles competently and meet people's needs. 'Spot checks' were undertaken on staff, whilst they were assisting people in the community. Annual appraisals of staff took place. This made sure that staff were meeting people's needs appropriately.

Is the service caring?

People told us that staff were caring and promoted people's privacy and dignity. All staff were due to complete training in how to value people's equality and diversity by 15 February 2015. Training was planned for how to care for people who were nearing the end of their life.

Is the service responsive?

Individual staff met with the manager or senior staff once a week and had the opportunity to discuss any concerns about the care that they provided. People's care needs were reviewed regularly to check whether there were any changes. Changes of people's needs and guidance for staff were appropriately recorded in their care plans. Staff delivered care and treatment according to people's care plans.

Is the service well-led?

The registered manager had put systems in place to make sure that staff were trained and supported to deliver care safely and to an appropriate standard. There was an on-going programme of staff training, with completion dates throughout the year. The registered manager checked on staff, when they were providing care in people's homes. This took place every six months, to make sure that good standards were maintained. The registered manager was in the process of undertaking staff annual appraisals, which would be completed by 6 February 2015.

Most people that we spoke with were complimentary about the way the support and care was organised, and told us that staff were reliable and always arrived on time and stayed for the length of time arranged.

People were protected from the risk of abuse. One person told us 'I feel very safe with the staff who help me'. We found that staff reported their concerns to the manager, who was knowledgeable about how to refer to and work with the appropriate authorities.

Most people that we spoke with told us that they thought staff had the right skills to meet their needs. However, we found that people were cared for by staff who were not all sufficiently supported or trained to deliver care safely and to an appropriate standard.

There was a system in place to assess and monitor the quality of service that people received. People were asked for their views about the service provided, which were acted upon. People told us that they were generally happy with the service provided.