Independent Care and Support Limited

Independent Care and Support is a domiciliary care agency providing personal care and support to people in their own homes. The service is registered to provide care for older people, people with dementia, a physical disability and younger adults. At the time of the inspection the service was providing personal care to 76 adults.

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

Quality assurance and monitoring systems were not always effective in identifying shortfalls and improving the service for the people who used it. When complaints had been raised it could not be ensured the provider had taken sufficient action to minimise the chance of the same thing from happening again. The recruitment of staff had not included establishing satisfactory character references before staff worked without supervision. This included obtaining checks from staff who had previously worked in the social care.

Feedback from people was not effectively reviewed and used to make improvements to the service. Quality checks on staff were limited and did not include direct observation of staff administering medicines so their competency could be continuously assessed. The provider had obtained a number of tools to aid their quality assurance systems and planned to put them into practice.

There was inconsistency in the detail of staff guidance to support people with their care. There was not sufficient information about the signs and symptoms of infection for people who used a catheter. For people who were anxious, staff were advised to talk to them but there was no indication of what topics people liked to talk about.

Staff undertook regular training in essential areas but it did not include regular practical competency based moving and handling or medicines training. We have made a recommendation about moving and handling, medicines and catheter care training.

Staff supported people to access health care services in a timely manner. There were mixed views about how effective staff were in encouraging people to eat.

The majority of people and relatives said they would recommend the service to others. There were mixed views about the quality of communication with the management team.

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 they received kind and caring support from staff. A person told us, “Staff are very friendly and caring. We have conversations and we talk all the time. I get on very well with them.” A relative said, “I’ve actually been there when staff have been there and seen the way they act and speak to my mum; they are very kind and caring in that respect. My mum is very relaxed around them.”

There were enough staff to meet people’s needs and keep them safe. Staff understood how to protect people from poor care and abuse.

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 23 January 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This included concerns about the overall management of the service. A decision was made for us to inspect and examine those risks.

Enforcement and Recommendations

We have identified breaches in relation to the recruitment of staff, management of complaints and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspection.

This service is a domiciliary care agency based at an office in Strood. It provides personal care to people living in their own homes. This included older people, younger adults and people with complex health needs such as epilepsy, diabetes and physical disabilities. There were 84 people using the service at the time of our inspection.

The registered manager was employed at the service. 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 the last Care Quality Commission (CQC) inspection on 21 October 2015, the service was rated as Good in all of the domains and had an overall Good rating.

At this inspection we found the registered manager and provider had consistently monitored the quality of their service to maintain a rating of Good.

Independent Care and Support offered an inclusive service. The staff followed policies about Equality, Diversity and Human Rights.

The registered manager was consistent in measuring the quality of people’s experiences and continued to work at putting people at the heart of the service.

The quality outcomes promoted in the providers policies and procedures were monitored by the registered manager. There continued to be multiple audits undertaken based on cause and effect learning analysis, to improve quality. Staff understood their roles in meeting the expected quality levels and staff were empowered to challenge poor practice.

The registered manager consistently understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA).

People, their relatives and health care professionals had the opportunity to share their views about the service either face-to-face or by telephone.

There continued to be enough staff deployed to meet people’s physical and social needs. Emergency backup systems continued to be operated to allow care to continue at all times.

The registered manager checked staff’s suitability to deliver personal care during the recruitment process. People’s medicines were managed and administered safely.

The registered manager continued to train staff so that they understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise any concerns. Staff understood the risks to people’s individual health and wellbeing and risks were clearly recorded in their care plans.

People were consistently supported to eat and drink according to their assessed needs. Staff supported people to maintain a balanced diet and monitor their nutritional health.

Staff continually received training that matched people’s needs effectively and staff were supported with supervision and with maintaining their skills.

Management systems were in use to minimise the risks from the spread of infection, staff received training about controlling infection and carried personal protective equipment like disposable gloves and apron’s.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. During our inspection people who used the service told us that staff delivered the care recorded in their care plans.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. Staff had access to support and advice at all times from a manager.

The manager ensured that staff underwent checks before starting work at the service. For example they checked a person's character by carrying out Disclosure and Barring Service checks (DBS). This was formally known as a Criminal Records check. The manager operated robust recruitment process.

Staff had been trained in safeguarding people from abuse and staff understood their responsibilities to protect vulnerable people.

The manager had systems in place to check if staff were delivering care safely. .People who used the service told us staff were competent in their roles and that they were supported safely.

Is the service effective?

People had an individual care plan which set out their care needs. We saw that people had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. People who used the service told us that staff were reliable and that they were happy with the service they received.

The manager of the service carried out checks on staff whilst they were delivering care and support. People who used the service had been asked their views about the standard of service they had received.

Is the service caring?

We found that people were treated with respect and their dignity was maintained. People we talked with told us that they were relaxed and comfortable with the staff that supported them. People told us that they had positive relationships with staff, both those that delivered care and support and those in the office. People who used the service told us that staff were friendly and caring. People said 'Before the staff leave they always make sure I have snacks and drinks within my reach'. Another person said, 'Staff always make sure I have my community emergency alarm with me before they leave.' Other people told us that staff were 'Always cheerful' and that 'Staff spent time chatting to me which is good'. One person told us how staff made sure that they were comfortable and safe after they had hoisted them into bed and before staff left the call. For example, staff ensured that the person had the television remote, the bed control and their home telephone to hand.

Is the service responsive?

The service reviewed people's care plans to ensure they were up to date. The manager of the service was available for people to contact. People who used the service told us that they did not have any concerns, but that they knew how to raise complaints.

There were policies and systems in place which ensured that the provider could learn from incidents that occurred to prevent them from occurring again.

Is the service well-led?

The provider continually monitored areas of risk at the service and made checks on quality. This included visiting people who used the service to ask what their views were of the service provided.

The manager ensured that people's care was planned. Staff understood people's needs because they followed people's assessments and care plans. Systems were in place to monitor quality and safety. The manager ensured that staff were recruited with the right skills and experience for the service users they cared for. Staff received an induction when they started with the organisation. Staff received on 'going training and were supervised by the manager. The manager gave staff the opportunity to develop their skills and knowledge in line with their job description and responsibilities.