Archived: Four Seasons Community Care

Updated 13 November 2020

The inspection

This was a focused inspection to check on the action taken by the provider to meet the requirements of the regulations.

Inspection team

The inspection was carried out by a lead inspector and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. We announced the inspection several days in advance to ensure the registered manager would be available to participate in the inspection process, to make arrangements for information to be shared with the commission prior to the site visit. We invited all people who received support from Four Seasons, and staff, to have an opportunity to speak with us if they wished. Before we visited the services office, we discussed infection control processes for people, staff and inspectors with reference to Covid 19.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and the information we had requested when the inspection was announced.

We had not requested the provider send us a provider information return as this inspection was completed in response to information of concern that the commission had received. We used all this information to plan our inspection.

We spoke with 11 people who used the service, on the telephone, prior to the office visit. We also spoke with four relatives. The inspector spoke with 20 staff on the phone. We sought feedback from two health and social care professionals who had regularly worked with the service.

During the inspection

The lead inspector visited the locations office and met with the registered manager, and three of the management team who were responsible for specific areas of the running of the service. We looked at four care records in relation to people who were being supported with a regulated activity, risk assessments, quality assurance records and information related to the running of the service.

After the inspection visit

We continued to seek clarification from the provider to validate evidence found. We reviewed the additional documentation we had requested from the registered manager prior and during the site visit.

Updated 13 November 2020

About the service

Four Seasons Community Care is a domiciliary care agency that provides care and support to adults of all ages, in their own homes. The service provides help with personal care needs in Torpoint, Milbrook, Downderry and Looe areas of Cornwall. At the time of this inspection 64 people were receiving a service from Four Season. These services were funded either privately or through Cornwall Council or NHS funding.

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

At the last inspection we found care plans had not always been completed for everyone using the service. There was not a robust system in place to help ensure risk assessments were always reviewed in a timely manner. At this inspection everyone had a care plan and risk assessments were present in all care plans as required. Staff were provided with clear information regarding any risks to the person and to themselves. Risk assessments were updated appropriately.

At our last inspection we found management oversight of the service needed to be more robust. At this inspection the registered manager had delegated specific roles, such as rosters and recruitment to others, and the overall management of the service had improved. This was confirmed by everyone we spoke with. Quality assurance processes were in place to monitor the quality and safety of the service.

People told us they received their visits at the agreed times. No one reported having had a missed visit. People told us issues that had concerned them at the last inspection, such as late visits, had been resolved and the service had improved. People told us they were happy with the service they received. Comments included, “I can honestly say at the moment the service is excellent."

Rota management had improved since the last inspection, and staff told us they were able to travel from visit to visit within the time allocated. Staff appreciated receiving their rotas in advance.

Staff reported an improvement in the consistency of visits made by the same staff. Comments included, “Yes I have the same round, its good as you get to know people well and they like that” and “I have a good relationship with all my regulars.”

Staff were mostly positive about the improvements and how the service was run. Comments included, “It is definitely a lot better than last year. We were in a mess then. It is so much better now,” “Its brilliant now, things have really changed. The rotas are on time, we all know what we are doing in advance, people are happier” and “Compared to last year there have been massive changes for the better. To think I was going to leave last year, I am glad I didn’t.” A small number of staff were less positive. Comments included, “Some of us get spoken to badly and pressured to work and take on more and more” and “We ring in and say we are really tired and not well and they just tell us to keep going.” The management team assured us that staff were not made to work when unwell. The provider told us they had bought in changes to the way the service was run and acknowledged that some staff had found this challenging.

Staff were recruited safely. Additional staff had been taken on recently to help ease the pressure on existing staff who had worked additional hours throughout the Covid-19 pandemic lockdown period. Comments from people included, “They have a number of new carers who are excellent.”

Staff were clear of their roles and responsibilities in relation to safeguarding. Staff had received necessary training to carry out their role safely.

Every person receiving a service had a care plan. Most were held electronically, a few were still paper based. Care plans contained information to direct or guide staff on how to support people according to their preferences. Some care plans required additional detail to help ensure all staff were clear on how to provide safe and effective care and support. We have made a recommendation about this in the Safe section of the full report.

Care plans were reviewed appropriately. People were provided with paper copies which were held in their homes.

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.

Systems were in place to ensure the effective management of medicines. Staff who were administering medication had been trained and had their competencies checked to ensure correct procedures were followed. Medicine records were regularly audited.

Staff were aware of the Public Health England guidance on the use of personal protective equipment (PPE) such as masks, gloves and aprons. Comments included, “They (staff) regularly wash hands on entering and leaving and feel they are complying in every way possible”.

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 17 February 2020). There were two breaches of the regulations. The service had conditions imposed on their registration following the inspection 28 September 2019. The conditions remained in place and required the provider to submit monthly reports to the Care Quality Commission.

Why we inspected

The inspection was carried out to follow up on the action we told the provider to take at the last inspection. As a result, we carried out this focused inspection to review the key questions of Safe, Responsive 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. 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 changed from requires improvement to good. This is based on the findings at this inspection. The condition on the registration of this service will be removed.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Four Seasons 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