Archived: Guinness Care Castleham Lodge

Guinness Care at Home (Devon) is registered with the Care Quality Commission (CQC) to provide personal care to people within their own homes. At the time of our inspection, the service was providing personal care and support to 184 people. When we visited there was a registered manager in post. 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.

People’s experience of using this service:

The feedback from people who used the services was consistently positive about their experiences. People and their relatives were equally positive about the approach of the care workers. For example, they said care workers, “…treat you with respect, they don’t talk down to you. They don’t say ‘we have to do this’ they ask you what you need.”

People said they felt safe because the staff group were caring and reliable. People continued to be supported by staff who respected their privacy and dignity. Staff relationships with the people they supported continued to be caring and supportive. There was a stable staff group which helped ensure a consistent approach. Staffing arrangements were flexible to meet people’s individual needs and to respond to changes. People's nutritional needs were met; staff supported some people with meal preparation. Care plans for each person held information about their dietary needs.

Risk assessments identified when people could be at risk and covered people's physical and mental health needs and the environment they lived in. Feedback from people and staff confirmed the provider recruited staff who suited the caring values of the service and recognised the importance of team work to provide consistent and safe care. People were protected from abuse because staff understood their safeguarding responsibilities.

People were supported by staff who were skilled and understood their needs. Since the last inspection, recruitment practice had improved. Staff spoke confidently about the care they delivered and understood how they contributed to people’s health and wellbeing.

Referrals were appropriately made to health care services when people’s needs changed. People were supported to maintain good health and had access to appropriate services, which ensured they received on-going healthcare support. Medicine administration, recording and auditing was safe.

There was a consistent approach to gain people's consent to care and treatment in line with requirements of the legislation and guidance. Information was in place to ensure people’s legal rights were protected.

There were systems in place to gain people's views and to address concerns and complaints. The service was well run by the registered manager and the provider. Senior staff assisted the management team with reviews and spot checks to ensure people received a good quality service. Feedback from people using the service and quality assurance records showed this had been achieved.

Rating at last inspection: This service was last inspected in 2018, when it was rated as requires improvement in two areas with requires improvement as an overall rating. The provider completed an action plan, which we reviewed, and used as part of the inspection planning.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Guinness Care at Home (Devon) provides personal care and support to people living in their own homes. The area the service covers includes Exeter, Mid Devon, South Devon and North Devon. At the time of our inspection there were 147 people receiving a personal care service and 89 staff worked at the service.

When we visited there was not a registered manager in post. 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. The service has been without a registered manager since May 2017.

At the last inspection in 2016, the service was rated as ‘Requires Improvement’ in questions relating to safe, effective, responsive and well led. There were two breaches of regulation linked to assessing and managing risk to people’s health and safety and consent. Improvement has been made and these regulations have been met. However, on this inspection there was a new breach linked to recruitment. The service has been rated requires improvement on two consecutive inspections and CQC will arrange to meet with the provider to discuss further improvements.

At the time of the inspection, the agency employed a manager, care co-ordinators, seniors, care staff and an administrator. The regional manager was based at the agency’s office. Agency staff were also supported by training, human resources, quality assurance and policy staff based at the head office.

People received care and support from care staff they felt safe with. Health and social care professionals were contacted to help support people in their own homes. There were enough skilled and experienced care staff to meet people’s needs. There was a positive culture to learning from complaints. People were supported with their medicines and action was taken when an error had been made.

However, improvements were still needed regarding the management of risk for several people. One staff file did not reflect the usual standard of recruitment checks and action had not been taken to manage an identified risk during the recruitment process. People received a reliable service but were unhappy when changes of staff or visit times were poorly communicated by the agency. Care staff said some visits were incorrectly scheduled in some areas, which impacted on their workload and resulted in them being late.

Staff had been trained to meet people’s needs with a comprehensive induction. Staff protected people’s confidentiality and need for privacy. Staff relationships with people were caring and supportive. Staff were committed to offering care that was kind and compassionate. People were involved in planning the care and support they received.

The regional manager demonstrated a strong commitment to providing a good service and was committed to improvements. However, the service had undergone a number of changes within some staff roles which meant a new way of working need to be embedded further. Different methods were used to gain feedback from people to improve the service.

We found one breach of the Health and Social Care Act (2008) Regulations 2014. You can see what action we told the provider to take at the back of the report.

Guinness Care at Home (Devon) provides personal care and support to people living in their own homes. The areas the service covers includes Exeter, Mid Devon, South Devon and North Devon. At the time of our inspection there were 132 people receiving a personal care service.

When we visited there was a registered manager in post. 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 time of the inspection the agency employed a registered manager, team leaders, seniors, care staff and an administrator. The agency staff were supported by quality assurance and policy staff based at the head office.

People received care and support from care staff they felt safe with. Their comments included: “I do feel safe they are lovely” and “They are very good I trust them.” Health and social care professionals were contacted to help support people in their own homes. People were safe because there was an effective recruitment system and employment checks were carried out on care staff before they worked with people to assess their suitability. There were enough skilled and experienced care staff to meet people’s needs. The service was reliable, people said “I get a rota and they stay the full time,” and “They are reliable always turn up and are very helpful and they have to put up with some awful hours.” There was a positive culture to learning from complaints.

However, improvements were needed regarding the management of risk for some people and how these were reviewed to ensure these risks or changes were recognised and managed appropriately. People were supported with their medicines but staff had not alerted management to gaps in records. Staff had not recorded steps to safeguard a person’s best interests. Improvement was needed to ensure there was a consistent approach to detail, reviewing and auditing of care records.

Staff had been trained to meet people’s needs, although there were some areas that had been identified for further development to ensure staff understood their responsibilities. For example, understanding the Mental Capacity Act (2008). Staff received supervision to develop their skills and support them in their role.

People were supported to maintain their independence and staff protected people’s confidentiality and need for privacy. Staff relationships with people were caring and supportive. For example, people told us “They are delightful with me; we have a nice relationship, they are very kind and courteous” and “They are very discreet.” Staff were committed to offering care that was kind and compassionate. People were involved in planning the care and support they received but there was not a consistent approach to reviewing and evaluating the standard of care.

There was a clear organisational structure, where staff knew their roles and responsibilities. The registered manager demonstrated a strong commitment to providing a good service and had begun to put plans in place to address areas for improvement but the development plan had not identified all of the areas highlighted during this inspection. However, steps were taken to address this following our feedback.

Different methods were used to gain feedback from people to improve the service. The organisation was reviewing their methods to assess the quality and safety of the service people received.

We found breaches of the Health and Social Care Act (2008) Regulations 2014. You can see what action we told the provider to take at the back of the report.

This inspection was carried out to check on the actions taken by the agency to address the problems we found at our last inspection on 23 and 24 July 2013. At this time we found people's care and welfare needs had not been fully met. During this inspection we found the agency had taken a range of actions to address the issues we found, and people's care was carefully assessed, planned and fully met.

We visited the agency office and looked at six care plan files and also checked the methods used to make sure care was delivered effectively. The registered manager was unavailable on the day of our visit, and instead we spoke to a senior manager who represented the provider. We also spoke with a team leader and a care worker who were visiting the agency office that day. After our visit we spoke with seven people who used the service on the telephone.

The questions we asked on this visit were:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

Is the service safe?

The service was safe because up to date information about all aspects of each person's health and care needs were available to care workers. Risks to people's health and welfare had been assessed and the records explained to staff how people wanted to be supported to minimise the risks.

People told us the care workers were competent and well trained. Comments included: 'The carers are well trained' and 'They are A1.'

Is the service caring?

People told us the care workers were always caring. Comments included 'They are always caring'; 'All my carers are lovely' and 'We have a lot of laughs!'

Care workers were given information and instruction about each person's preferences. This meant care workers understood each person's individual needs and understood the importance of listening to people and providing a caring service tailored to each person's wishes.

Is the service effective?

Each person's needs had been assessed at the start of using the service. A plan had been drawn up and agreed with them which outlined their requirements. Care workers were given sufficient information about how each person wanted to be assisted.

Daily reports completed by care workers showed that required tasks had been completed and needs had been met.

Is the service responsive?

People's care needs were reviewed at least every six months and care plans updated where necessary. Care workers were notified promptly by telephone, text messages, and by updated care plans of any changes to people's care needs. This ensured that care workers were given sufficient information about any changes to the care each person required.

Is the service well-led?

There were effective systems in place to plan, monitor and deliver care to people each week. There were good systems of communication and care workers told us they received the support they needed and could contact a manager at any time. People told us the service was 'Always reliable' and 'The care service is excellent.'