Archived: Carmel Domiciliary Care Limited

Carmel Domiciliary Care Ltd provides personal care to people with mental health needs who live in supported living accommodation. People generally share a home with up to five other people. The service supported six people with personal care at the time of this inspection. 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

People told us they felt safe amongst staff and praised the caring nature of the staff who supported them. Staff understood people’s physical and mental health needs and related risks well and supported people with dignity and respect. Staff encouraged people to maintain relationships with family members when safe to do so.

Care records reflected people’s care needs, and care was being delivered in line with current practices. People’s personal risks had been assessed and were being monitored to ensure they remained safe and free from harm or abuse. People received their medicines as prescribed and were supported to attend health care appointments. Staff liaised with health care professionals and services to help people maintain their physical and mental health and reduce any risks.

Staff provided personalised care which was responsive to people’s needs. People were supported to progress in their well-being and build up their confidence and levels of independence. They told us they enjoyed and had access to a range of activities of their choice. 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.

Any concerns, and complaints received by the registered manager and staff were investigated and acted on. Staff supported people to address any concerns about their accommodation to their landlords.

Sufficient numbers of suitably recruited staff were available to support people. Staff had been trained and supported to carry out their role. Effective systems were used to monitor the service and provision of personal care. Staff spoke positively about the support of the registered manager and felt the service was well led. A new provider supported the registered manager to run the service and meet their regulatory requirements. The registered manager and staff acted on concerns and learnt from and took actions in relation to accidents, incidents, complaints and feedback from people to improve people’s experiences of the service.

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 November 2016).

Why we inspected

This was a planned comprehensive inspection based on the previous rating. We undertook a focused inspection in March 2017 to follow on the breach of legal requirements found at our inspection in September 2016 and to check the provider had followed their action plan and met legal requirements. This inspection confirmed that the improvements found in March 2017 had been sustained.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carmel Domiciliary Care Limited 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.

A registered manager was in place as required by their conditions of registration. 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 our previous inspection, the systems to assess, monitor, action, evaluate and mitigate any risks relating to the welfare of people, staff development and the quality of the service were not effective. Since this inspection, a new provider had acquired the service.

At this inspection we met with the new provider and registered manager and found they were acting on our concerns and implementing systems to monitor the quality of the service and improve the records relating to people’s care.

A system was now in place to monitor staff recruitment, training and support. The new provider was planning to implement a new support plan format to capture people’s care and support needs. People’s risks and medicines were now recorded in detail to provide staff with guidance on how people should be supported. The new provider had established quality monitoring systems to monitor the service and identify any shortfalls. The registered manager also regularly worked alongside people and staff which gave them an insight into the running of the service and people’s needs.

We found that the service had met the legal requirements. However we could not improve the ratings for well-led from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

A registered manager was in place as required by their conditions of registration. 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. The registered manager was only available on the first day of our inspection; however a team leader assisted us on the second day of our inspection.

The registered manager regularly worked alongside people and staff which gave them an insight into the running of the service and people’s needs. However, the systems in place to assess, monitor, action, evaluate and mitigate any risks relating to the welfare of people, staff development and the quality of the service was not effective.

People were protected from harm and abuse. People were supported to take risks such as accessing the community alone but the management of their risks was not always recorded. People were protected from financial abuse as new systems were in place to store and record people’s income and expenses.

People received their medicines as prescribed. The service was working with a new pharmacist to ensure there were safe systems in place to manage their medicines. Protocols were needed for people who required medicines ‘as required’ such as if they became agitated.

There were adequate numbers of staff to meet people’s needs. The registered manager was reconsidering the management structure to ensure people and staff had clear direct line of support. A safe recruitment system was in place though any discrepancies in staff employment histories were not always recorded. Staff told us they felt trained and supported, although clear recorded systems were not in place for monitoring their training and development requirements.

There was caring and friendly interaction between staff and people. Relatives were positive about the care people received. They complimented the nature of staff. People had access to a range of activities of their choosing. Some people preferred their time at home while others enjoyed community based activities. People were encouraged to maintain a healthy and well balanced diet. Together they planned the weekly menus with staff to ensure their preferences were catered for.

People had been involved in the planning of their care. Staff always sought people’s permission before they supported them with care. Staff described people and the support they required positively. They showed a good understanding of the triggers for a person’s anxiety and how they supported them. Care plans were tailored to the person. Where a person’s mental or physical health presentation had changed it was evident staff worked with other professionals including the community mental health team. Staff had also supported people to attend routine health care appointments.

We found a breach of 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.

This service has been inspected under the location name of Shenley House, however the service is locally known as Carmel Domiciliary Care Limited. As part of this inspection we spoke with three people who used the service, the registered manager and four members of staff. We also spoke with two health and social care professionals and we visited people in their homes. We reviewed records relating to the management of the service which included five care plans and daily records. Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at.

Is the service safe?

This service was unsafe because new staff had not been fully vetted and trained before they started to work with vulnerable people. The processes and systems in place to protect people's finances were not effective. We saw that people's money was not being managed appropriately. People's risk assessments were not clear and had not always identified people's emotional and behavioural support needs. This left staff with little guidance on how to support people when they became upset or their mental health deteriorated. The records of reviewed care plans, analysis of incidents and investigation of complaints were not always clear.

People told us they felt safe using the service and their choices and wishes were respected and supported by the staff. Staff understood the service's policies and procedures to protect people who they cared for from abuse and harm. Staff were able to explain their role and responsibility to report any suspicions or allegations of harm or abuse. However staff were not aware of local organisations that were involved in protecting vulnerable people.

Is the service effective?

This service was effective as people's needs and choices had been identified and delivered in line with their care plan. People said 'I enjoy living here'. People were encouraged to live their lives in the way they chose and to be as independent as possible. People told us that their relationships with staff and other health and social care professionals were good. We observed that staff were kind and caring. We were told that staff had requested more support and training to improve their skills but this had not always been acted on.

Is the service caring?

The service was caring because people were cared for in an individual way and were encouraged to be independent. People were supported to be involved in the assessment of their needs. Their individual needs, choices and preferences were reflected in their care records. Information shared by other health care professionals was not always available although we were told by a health and social care professional that their recommendations of care were always implemented. We saw that relationships between staff and people who used the service were friendly and warm.

Is the service responsive?

The service was not always responsive as people's personal and emotional risks had not always been identified. We saw staff responding well to people's day to day requests such as activities and meals. There were no planned systems in place to capture the views and experiences of people who used the service. The registered manager supported people with external mental health review appointments and helped people to implement changes to their care and treatment. Complaints had been investigated but there was no evidence of recommendations to prevent the incident reoccurring.

Is the service well-led?

This service was not always well led as staff were not always suitably vetted or trained before they started to work with vulnerable people. This meant that the character and employment history of a new member of staff had not always been clarified. Established staff were not fully trained or supported however the management team provided informal support to staff and people who used the service. Staff told us they were clear about their role and responsibilities. The management did not understand the principles of good quality assurance. This meant that the service was not regularly monitored and assessed for areas of improvement.

The service had a registered manager in post who was a qualified registered mental health nurse. The registered manager was involved in the support and care of people and supported them with health related appointments. Complaints were not always dealt with in line with the provider's complaints policy.