Archived: Four Seasons Community Care

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

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 people's personal care needs in Torpoint, Millbrook, Downderry and Looe areas of Cornwall.

At the time of our inspection 72 people were receiving a personal care service. These services were funded either privately or through Cornwall Council or NHS funding.

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

Since the last inspection improvements had been made to the way the service was planned and delivered. This had resulted in people receiving the care and support they needed at mostly the times they had agreed. People told us the reliability of the service was much better, their times had been reviewed with them and most people had a team of regular staff. Records showed, and people confirmed, there had not been any missed visits since the beginning of December 2019.

Rotas were now being effectively managed. A new rota system had been introduced and this had taken time to set up and fully implement. This meant people had not all benefitted from the improvements to the reliability of the service until the beginning of January 2020.

Since the last inspection the service had started a programme to review and update each person’s care plan and input these onto an electronic system. The care plans for people with the highest needs had been prioritised and these had all been completed. A small number of other care plan reviews were still outstanding and there was a plan to complete these in a few weeks.

Systems to assess and monitor the service provision had been introduced since the last inspection. A registered manager, employed by Cornwall Council, had worked full-time in the service from October 2019 to January 2020 to support these improvements. This meant the risk of people receiving unsafe and ineffective care had reduced. Some of these systems were still being developed and had not been fully implemented.

Assessments to identify any risks to the person using the service and to the staff supporting them had not been completed for some people. Where risk assessments had been completed there was not a robust system to keep them under review.

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 were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Staff were recruited safely and received regular supervision and support from management. New staff completed an induction which involved training and a period of shadowing more experienced staff. Training was regularly updated so staff were aware of any changes in working practices.

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 Inadequate (published 28 September 2019) and there were three breaches of regulations. Following the inspection, the service was placed in ‘special measures’ and we took enforcement action.

At that inspection we imposed a condition of registration that required the provider to submit monthly action plans to show what they would do and by when to improve.

During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. The service has now improved to requires improvement. However, the provider was still in breach of regulations and the condition for them to submit monthly reports remains in place.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

At this inspection we have identified continued breaches in relation to care plans and the governance and oversight of the service.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 people's personal care needs in Torpoint, Saltash and Looe areas of Cornwall. This includes people with physical disabilities and dementia care needs. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals.

At the time of our inspection 137 people were receiving a personal care service. These services were funded either privately or through Cornwall Council or NHS funding.

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

People were at risk of harm because they did not always receive the care and support they needed at the agreed times. Most people did not know when staff would be coming and the times of their visits were inconsistent. Some people had experienced missed visits and others had one worker booked for visits assessed as needing two.

The provider had failed to effectively assess and monitor the quality and safety of the service provided to people. Rotas were not effectively managed. Systems to record people’s agreed times were not robust, which meant rotas were completed without the correct information about the times some people needed.

Systems were either not in place or robust enough to demonstrate the service was effectively managed and resulted in the risk that people could receive unsafe and ineffective care. However, the provider had recognised these failings and was working with Cornwall Council’s quality monitoring team to improve processes and systems.

Assessments to identify any risks to the person using the service and to the staff supporting them had not been completed for some people. Where risk assessments had been completed there was not a robust system to keep them under review.

Care plans were personalised to the individual and recorded details about each person’s specific needs and wishes. However, some people did not have a care plan in their home and where care plans were available not all had been updated to reflect people’s current needs. Staff told us they were informed of people’s needs from reading the daily notes in people’s homes and through messages sent to their phones from the office.

People told us they did not always have consistent staff. However, they were happy with all the staff who provided care for them. People said staff stayed for the full time of the visit and were competent in their roles.

Staff were recruited safely. Where staff vacancies had occurred, and had not been possible to fill, notice had been given on packages in the area those staff had worked. Until these packages finished management and other staff were covering visits. Staff received regular supervision, training and support from management. There were gaps in the delivery of some staff training. However, staff had been booked to complete training when required. Staff told us the registered manager/provider was approachable and they listened to them when they had any concerns or ideas.

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 were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

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 13 February 2019).

Why we inspected

The inspection was prompted due to concerns received about the service being unreliable, poorly managed rotas, staff not being appropriately trained (particularly in relation to pressure care and the use of equipment) and difficulty contacting the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive 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.

Enforcement

We have identified breaches in relation to inconsistent timing of visits, care plans and risk assessments not accurately reflect people’s needs and ineffective quality and monitoring processes at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 people's personal care needs in Torpoint, Saltash, Liskeard and Looe areas of Cornwall. This includes people with physical disabilities and dementia care needs. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals.

At the time of our inspection approximately 160 people were receiving a personal care service. These services were funded either privately or through Cornwall Council or NHS funding.

Everyone we spoke with told us they were happy with the quality of the care provided. They said they felt safe using the service and trusted the staff who supported them. Comments included, “I feel very safe, nothing is too much trouble”, “We are very happy with them” and “They keep my dignity and respect. I have no family, [worker’s name] is my family, and friend.”

People had a team of regular, reliable staff, they had agreed the times of their visits and were mostly kept informed of any changes. Staff told us their rotas allowed for realistic travel time, which meant they arrived at people’s homes as close to the agreed times as possible. Staffing levels were managed in a way to ensure staff were available to provide a consistent service to meet the needs of people who used the service. Rotas were well managed and the registered manager knew the location and times where new packages could be accepted.

Staff were knowledgeable about the people they cared for and responded appropriately as people's needs changed. Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and preferences.

Each person had a care plan, that had been developed with them, and was personalised to their needs and wishes. There was a system in place to review care plans every three months, or sooner if people’s need changed. The review of some care plans had fallen behind and we were assured that these care plans would soon be updated.

Risk assessments clearly identified any risks and gave staff guidance on how to minimise the risk. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person. They were designed to keep people and staff safe while allowing people to develop and maintain their independence. People who needed help taking their medicines were appropriately supported by staff.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. The service had robust recruitment practices, which meant staff were suitable to work with vulnerable people. Management provided staff with appropriate training and supervision. Staff told us they found the training to be beneficial to their role and said they were encouraged to attend training to develop their skills and career.

Management and staff acted within the legal framework of the Mental Capacity Act 2005(MCA). Management and staff understood how to ensure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

There was a positive culture within the staff team and staff spoke passionately about their work. Staff were complimentary about the management team and how they were supported to carry out their work. The management approach was open and inclusive.

There were effective quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. People were regularly asked for their views about the quality of the service they received. People had details of how to raise a complaint and told us they would be happy to make a complaint if they needed to.

Four Seasons Community Care provides domiciliary care services to adults within East Cornwall. On the day of the inspection Four Seasons Community Care was providing personal care support to 100 people including those with physical disabilities, sensory impairments, mental health needs and people living with dementia.

The service had a registered manager in post; the registered manager was also the registered provider. 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 last inspection on 12, 21, 22, & 26 May 2015 we asked the provider to make improvements to how people’s care was recorded, to ensure staffing met people’s needs and preferences, and to demonstrate how people consented to their care. Improvements were also required in respect of how risks associated with people’s care were managed, and how the provider monitored the ongoing quality of the service. During this inspection we looked to see if improvements had been made and we found that action had been taken.

People were critical of late or missed visits. People told us they had raised their concerns, but were frustrated because action had not always been taken to rectify the problem. Overall, staff told us they had enough traveling time between each person; however, some staff told us rotas were not always effectively designed. However, a new computer system was being put into place at the time of our inspection, which we were told by the registered manager, would help to improve this.

People told us they felt safe when staff entered their homes to provide care. People were protected from abuse, because staff knew what action to take if they suspected someone was being abused mistreated or neglected. People’s risks associated with their care were managed to help ensure they were kept safe. Risk assessments relating to health care needs, such as diabetes were not always in place, but the registered manager told us she would take immediate action to rectify this. People’s medicines were managed safely and staff received training.

People received care from staff who had undertaken training to meet their individual needs, and additional training was organised if staff felt they required further knowledge. People had consented to their care and had their human rights protected, because the registered manager and staff understood their responsibilities in respect of the Mental Capacity Act 2005 (MCA). People were encouraged to eat and drink, and were supported to access healthcare services to maintain their health and wellbeing.

People told us staff were kind and caring. Staff understood the importance of respecting and promoting people’s privacy and dignity. People received individualised care and had detailed care plans in place to enable staff to know how to support them. People were involved in decisions relating to their care, and were invited to take part in the review of their care plans, to ensure they were reflective of their wishes and preferences. People’s complaints were investigated and used to make improvements to the service.

People and staff had an increased confidence in the management and leadership of the service. Plans were in place to recruit a deputy manager, who would assist with the day to day running, management and quality monitoring of the service.

There was a culture of honesty and openness which reflected the requirements of the duty of candour. The registered manager was open and transparent when working with external professionals; they listened to advice and implemented changes as required. The registered manager valued feedback about their service to enable improvement and development.

The service was underpinned by a number of policies and procedures, made available to staff and these were reviewed in line with changing regulations. There was a whistleblowing policy in place which protected staff should they make a disclosure about poor practice. Staff told us they would not hesitate to raise concerns about staff conduct or practice.

There were processes in place to help monitor the quality of care people received and further systems were being developed. People and staff were asked for feedback about the service which was used to make improvements.