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Care at Home Services (South East) Ltd - Canterbury, Herne Bay & Whitstable Good

This service was previously registered at a different address - see old profile

Reports


Inspection carried out on 30 October 2017

During a routine inspection

The inspection was carried out on 30 October 2017, and was an announced inspection.

Care at Home Services provides care and support to a wide range of people including, older people, people living with dementia, and people with physical disabilities. The support hours varied from 24 hours a day, to a half hour call and from one to four calls a day. Some people required two members of staff at each call. At the time of the inspection 167 people were receiving care and support from the agency.

There was a registered manager employed at the agency. 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 previous inspection on 24 and 25 October 2016, we found continued breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action and issued out two warning notices. Care and treatment was not provided in a safe way for people because the provider did not have sufficient guidance for staff to follow to show how risks to people were mitigated. There was a risk of people not receiving their medicines as prescribed. The provider had failed to ensure that people were receiving their medicines safely. The provider had failed to ensure that suitable systems and procedures were in place in order to assess, monitor and drive improvement in the quality and safety of people. The provider had failed to mitigate risks relating to health, safety and welfare of service users. The provider had failed to ensure that people were protected against the risks of unsafe or inappropriate care arising from a lack of proper accurate records.

We also found breaches of Regulation 9 and Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to make sure that people received person centred care and treatment that was appropriate, meet their needs and reflected their personal preferences. The provider had failed to ensure that people's capacity was assessed in line with the Mental Capacity Act 2005.

The provider sent us an action plan on 09 January 2017, which showed they planned to make the changes and meet regulations by May 2017.

At this inspection the provider had made improvements and they had met the warning notices.

The provider carried out risk assessments when they visited people for the first time. Other assessments identified people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed. Care was planned and agreed between the agency and the individual person concerned. Some people were supported by their family members to discuss their care needs, if this was their choice to do so.

Effective systems were in place to assess and monitor the quality of the service. There were formal checks in place to ensure that all records were up to date. Care plans and assessments had been consistently reviewed.

Staff treated everyone with respect. They involved people in discussion about what they wanted to do and gave people time to think and made decisions. People told us that staff were caring.

The agency provided sufficient numbers of staff to meet people’s needs.

The agency continued to have suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

The agency continue to have robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular inter

Inspection carried out on 24 October 2016

During a routine inspection

The inspection took place on 23 and 24 October 2016 and was announced.

Care at Home Services provides care and support to a wide range of people including, older people, people living with dementia, and people with physical disabilities. The support hours varied from 24 hours a day, to a half hour call and from one to four calls a day, with some people requiring two members of staff at each call. At the time of the inspection over 200 people were receiving care and support from the service.

The service is run by a registered manager, who was present on the day of the inspection visit, together with the training and development manager. The operations director was also present on the second day of 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 and associated Regulations about how the service is run.

At the previous announced inspection of this service on 28 and 29 September 2015, three requirement notices was served due to breaches of regulations. The provider did not have sufficient guidance for staff to follow to show how risks to people were mitigated. Medicines were not being administered safely and people were not receiving personalised care. In addition, the systems in place to monitor the quality of the service were not effective. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. The provider sent us an action plan. We undertook this inspection to check that they had followed their plan and to confirm they now met legal requirements. At the time of this inspection some improvements had been made, however, the provider had not taken appropriate action with regard to these issues and the breaches of regulations continued.

There was still insufficient guidance for staff to follow to show how some risks were mitigated especially when moving people. Some people needed support to wash and bath. Risks to them and staff had not been assessed. Measures were not always in place to mitigate risks when supporting people with their epilepsy and diabetes. This had been identified in the previous inspection in September 2015 and remained an ongoing shortfall.

The systems to ensure people received their medicines safely had been reviewed; however, there were still shortfalls in medicines administration and recording. People were not always receiving medicines at the appropriate time as instructed by health care professionals. This had been identified in the previous inspection in September 2015 and remained an ongoing shortfall.

People and relatives told us they were involved in the assessment and planning of their care and support. However, in some care plans there was a lack of information about people’s skills in relation to different tasks and what help they required from staff, to ensure their independence was maintained. Although some improvements had been made to address these shortfalls some care plans did not include this information.

Although generic information had been added to care plans with regard to people’s medical conditions, the plans were not individual to people’s specific needs relating to their epilepsy and diabetes. People’s care plans did not always contain the guidance that staff needed to ensure that people were receiving the care they needed. Health care professionals, like community nurses and doctors, were contacted if there were any health concerns.

People were supported by staff to make their own decisions and mental capacity assessment forms were in place. However, the information in the assessments was not consistent and at times were contradictory saying that people had capacity when they actually needed support to make decisions.

Audits were carried out to moni

Inspection carried out on 28 and 29 September 2015

During a routine inspection

The inspection took place on 28 and 29 September 2015 and was announced. Forty eight hours’ notice of the inspection was given, as this is our methodology for inspecting domiciliary care services. The previous inspection on 23 April 2014 found no breaches in the legal requirements.

Care at Home Services provides care and support to a wide range of people including, older people, people living with dementia, and people with physical disabilities. The support hours varied from 24 hours a day, to an hour to one to four calls a day, with some people requiring two members of staff at each call. At the time of the inspection105 people were receiving care and support from the service.

The service is run by a registered manager, who was present on the day of the inspection visit, together with the regional manager and operations director. 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 and associated Regulations about how the service is run.

Risks associated with people’s care and support had been initially assessed but the assessments did not have guidelines for staff to follow to ensure that risks were being managed and people were being moved safely.

Medicines were not always listed or recorded safely so it was not always clear what medicines people were taking. Staff had not always signed the medicine records to confirm people had received their prescribed medicines. Staff were applying creams to people’s skin as part of personal care routines, but in some cases there were no proper records maintained to say what and when creams should be applied.

Some people told us they were involved in the assessment and planning of their care and support, however, this detailed information was not included in the care plans to reflect the care being provided. There was a lack of information about people’s skills in relation to tasks and what help they may require from staff, in order that their independence was maintained. Some plans had been reviewed but any changes were only recorded on a review form and this information was not transferred to the content in the care plan to make it clear to staff what changes had been made.

People’s care plans did not always contain the guidance that staff needed to support them with their specific health care needs, such as diabetes and catheter care. Health care professionals, like district nurses and doctors, were contacted if there were any health concerns.

People were supported by staff to make their own decisions and mental capacity assessment forms were in place. Not all staff had received training on the Mental Capacity Act 2005. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions. Training to address this shortfall had been booked to ensure all staff received this training. Staff were aware that meetings would be held involving relatives and other health care professionals to make decisions in people’s best interests.

Records were stored safely but were not always updated and completed accurately. Some medicine records were hand written and not checked to make sure the correct medicines had been recorded.

Staff had received training in how to keep people safe and demonstrated a good understanding of what constituted abuse and how to report any concerns. Accidents and incidents were reported, investigated and necessary action taken to reduce the risk of further occurrences.

Staff had schedules to plan the delivery of care so that people received care from regular staff. People’s calls were allocated permanently to staff rotas and these were only changed when staff were sick or on leave There was enough staff employed to give people the care and support that they needed and an ongoing recruitment drive ensured that staffing levels were maintained. There was an on-call system covered by the registered manager and senior staff, which people could access if they needed to.

New staff were recruited safely. They received induction training, which included shadowing experienced staff and there was an ongoing training programme in place. Staff had a range of training specific to their role, but there was a lack of specialised training being provided, such as end of life and diabetes training. Staff practice was monitored during unannounced checks to ensure they had the skills and competencies to perform their role. Staff told us they felt supported and attended one to one meetings with their manager to discuss their practice.

People told us how staff supported them to remain as healthy as possible and took prompt action if they noticed any concerns with their health. Within the domiciliary care service most people required minimal support with their meals and drinks. People told us that staff always offered them a choice of what food and drink they wanted. Staff ensured drinks were left out for people to access before they finished their calls.

People were treated with respect and their privacy and dignity was maintained. People we visited told us the staff were polite, caring and kind. They told us that staff listened to what they wanted and always asked if there was anything else they needed before they left.

People had information about how to complain within the folder kept in their home, so that they were aware how to complain. People we visited were confident they would complain if necessary but did not have any concerns. There were systems in place to monitor and follow through minor concerns as well as complaints.

The service had systems in place to audit and monitor the quality of service but there was a lack of evidence to show how and when the results of these checks had been reviewed and actioned to continuously improve the service.

People had opportunities to provide feedback about the service provided. Quality assurance questionnaires were sent out annually but the results had not been summarised and there was no evidence to show what action had been taken to address any comments made and measures implemented to improve the service. Feedback had not been sought from a wide range of stakeholders such as staff, visiting professionals and professional bodies, to ensure continuous improvement of the service was based on everyone’s views.

People told us that communication with the office was good. Staff said that the service was well led and they were supported well by the management team. They were clear about their roles and responsibilities and felt confident to approach senior staff if they needed advice or guidance.

We found three breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 23 April 2014

During an inspection to make sure that the improvements required had been made

We carried out a planned inspection of the service on the 31 October 2013 and 5 November 2013. We judged the service non-compliant with Regulation 9, Care and Welfare of people who used services; Regulation 10, Assessing and monitoring the quality of service provision; Regulation 11, Safeguarding people who used services from abuse; Regulation 13, Management of medicines; Regulation 18, Notification of other incidents; Regulation 20, Records and Regulation 23, Supporting Workers. Seven compliance actions were made at that time. We asked the provider to send us an action plan, which would give us the details of what action was being taken to address these areas of non-compliance. We received an action plan that detailed the action being taken to address the areas of non-compliance.

We carried out a responsive follow up inspection visit to the agency office on the 23 April 2014 and 24 April 2014. We spoke with staff and looked at records. We telephoned people that used the service and telephoned members of staff working in the community on the 25 April 2014. We collated all of the information in order to see what improvements had been made and to judge whether the service was compliant with Regulations 9,10,11,13,18,20 and 23. We found that improvements had been made.

We found at this visit that a new manager had been appointed. The service obtained suitably detailed information about people's needs to enable staff to provide effective care. Assessments and reviews of care plans had been undertaken. New staff had been recruited in order to meet the needs of the people that used the service. Staff training had been updated, and supervision and appraisals were ongoing. Effective quality assurance procedures ensured that people were provided with a good service. The keeping of records required by regulation had improved.

There were positive comments made in a survey carried out by an external consultant. These comments included: “All staff are lovely and competent”; “They are a pleasure to have in my home”; “When X has regular carers and they are on time, all is great”; “Some individual staff are fantastic”; “Care at Home do well to maintain a team of carers who will come in the late evening time” and “I could not manage without their visits to help me”.

Inspection carried out on 31 October and 5 November 2013

During a routine inspection

We found that a number of concerns had been raised stating that the service had failed to support people with the care they needed. Health and social care professionals held meetings with the service to discuss how improvements could be made. As a result the Operations Director and Regional Manager of the company were overseeing the service to monitor and improve the quality of care being provided.

We spoke with 12 people using the service and six relatives, the Operations Director, Regional Manager and six staff.

The staff we spoke with had knowledge and understanding of people's needs and knew how they liked their care to be provided however we found that although people's needs were assessed, we cannot be assured that care and treatment was planned and delivered in line with their individual care plan. There was no detailed guidance in the care plans for staff to follow about how to support people's needs and reduce potential risks.

We saw evidence that the majority of staff had completed safeguarding training. However, the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening to protect people from the risks of abuse.

The systems to make sure medicines were administered safely required improvement.

We found that staff had not completed the required training and had not been appraised to identify and develop skills to ensure that they could meet people’s individual needs safely and appropriately.

The systems to manage the service were not effective and the day to day running of the service was being overseen by the Regional Manager.

Systems to make sure records were fit for purpose and accurate were not adequate