Compassion Home Care Limited

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

We found that the provider failed to carry out comprehensive pre-assessments before people joined the service. Appropriate risk assessments were either not in place or not adequate. Risk management plans were not always in place to manage these risks, which included falls, mobility, mobility equipment, multiple sclerosis, dementia, epilepsy, asthma, diabetes, and skin integrity. Medicines were not always safely managed.

There was a system in place to log and investigate accidents and incidents, however, these were not analysed and learning from this was not disseminated to staff.

People’s independence was not always promoted, and people’s privacy and dignity was not always respected. Staff did not receive training in areas such as epilepsy and catheter bag care. People’s communication needs were not always clearly documented.

Staff did not have a good understanding of the Mental Capacity Act (MCA). Staff were not supported with regular 1:1 supervision meetings and staff meetings. Complaints were not always managed effectively.

Governance systems were not always effective at identifying and reducing risks to people's safety.

People or their relatives told us that they were involved in planning their care, although this was not always documented. People told us that they felt safe. People were protected from the risk of infection. Appropriate recruitment checks were carried out before staff joined the service. The service worked in partnership with key organisations and health and social care professionals when required.

Rating:

The last rating for this service was Good (published 17 November 2017). The service has deteriorated to inadequate.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations:

We have identified breaches in relation to safe care and treatment, staffing, person-centred care, dignity, MCA and good governance at this inspection. Please see the action we have told the provider to take at the end of this report. 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 therefore 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.

Compassion Home Care Limited is a domiciliary care service that provides care to people in their own home. At the time of the inspection the service was providing personal care to 45 people in their homes. People receiving care included older people.

The service had a registered manager at the time of the inspection. 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.

Staff were trained to keep people safe and report any concern of abuse. The likelihood of people experiencing avoidable harm was reduced because the registered manager assessed people’s risks and developed plans to alleviate them.

Staff reported incidents and accidents. The registered manager reviewed them and took actions to address them and reduce reoccurrence.

There were sufficient numbers of experienced staff to support people. Staff recruited were vetted to ensure they were suitable to deliver care and support to people. Staff provided people with the support they required to take their medicines safely.

People received care and support from trained, skilled and knowledgeable staff. People received the support they required to eat and drink. Staff supported people to maintain their health and access healthcare professionals as their needs required. People and their relatives were involved in making decisions about their care. Staff and the registered manager understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005.

People received care from staff who were compassionate and caring. Staff supported people to make day to day decisions about their care. People were involved in planning and delivering their care. People were encouraged to maintain their independence. People’s privacy was respected and their dignity was promoted. Staff knew people well and had developed positive relationship with them. The service delivered end of life care to meet people’s wishes.

People had their needs assessed and reassessments were also carried out when people’s needs changed and care plans were updated to reflect people’s current needs. People’s care was delivered in a flexible manner in line with their preferences and requirements. People knew how to complain if the wished. The service sought the views of people about the care they received and acted on them.

The service had a registered manager who is a qualified nurse. People, relatives and staff told us the organisation was well managed. There was an open management style at the service. The provider undertook checks and audits to monitor service delivery and drive up improvements.

Compassion Home Care Limited provides personal care and support for 44 people in their own homes in the London Borough of Bromley. On the day of our inspection there were 44 people using the service.

Compassion Home Care had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Risk assessments and care plans were not always updated when there had been a change in the person’s needs to ensure that staff had the appropriate guidance when offering the person support.

Staff new to the service, were inducted into the service appropriately. Staff had undertaken mandatory training, however we found safeguarding refresher training was not up to date. Staff received supervision, appraisals and training appropriate to meet people’s needs and enable them to carry out their roles effectively.

Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. The service had systems in place to manage accidents and incidents whilst trying to reduce reoccurrence.

Medicine records showed that people were receiving their medicines as prescribed by health care professionals.

There were enough staff on duty to meet people's needs and there was an out of hours on call system. The provider conducted appropriate recruitment checks before staff started work to ensure staff were suitable and fit to support people using the service.

The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and acted according to this legislation.

People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with kindness and people's privacy and dignity was respected. People were provided with information about the service when they joined in the form of a 'service user guide' which included the service's complaints policy.

People were involved in their care planning and the care and support they received was personalised and staff respected their wishes and met their needs. Care plans were reflective of people's individual needs and preferences and were reviewed on a regular basis. Peoples' care files were kept both in people's home and in the office. People were supported to be independent where possible such as going out to do their shopping.

People and their relatives knew about the service’s complaints procedure and said they believed their complaints would be investigated and action taken if necessary. People and their relatives were provided with opportunities to provide feedback about the service.

The service did have some effective processes in place to monitor the quality of the service; however improvement was needed in that formal internal audits were not carried out to identify any shortfalls. There were systems in place to carry out staff spot checks to ensure consistency and quality was maintained whilst supporting people in the community.

The registered manager was aware of their responsibilities as a registered manager in relation to notifying CQC about reportable incidents.

People told us they thought the service was generally well run and that the registered manager was supportive. People and their relatives were provided with opportunities to provide feedback about the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Staff were aware of the importance of consent and people were asked for their consent before care was provided. People's needs were assessed and risk assessments were carried out before care was provided. These were regularly reviewed so that staff were aware of the best way to provide support.

The manager and other supervisors were available on a daily basis and out of office hours to oversee the staff, and monitor that people were being safely supported, for example in helping people to be safe during personal care. Health care professionals and social services were involved in people's care planning and in responding to people's concerns when needed. The staffing levels were agreed and we were told by staff and people who used the service that the agreed numbers of staff were available when providing support.

There were arrangements in place to deal with emergencies and to make sure people were safe. People's health needs, such as epilepsy were included in their care planning to ensure that important health needs were met. The staff and manager were trained in protecting people from neglect or abuse and people told us they felt safe in their home.

Staff wore uniforms and carried photographic identification issued by the agency, to ensure that people who used the service were able to identify them and feel safe. All of the people we spoke with said that the staff always used these items and many said it helped them to be confident about who arrived at their door.

One person whose relative used the service said: 'I am extremely protective of my Nan and I am very confident in leaving her in the staff's hands, they are well trained and know what they are doing.' This was reflective of the views expressed by all of the people we spoke with and their families.

Is the service caring?

We spoke with eight people who used the service or their families and people told us that the staff and manager were very caring and supportive. Many said staff always took the time to speak with them and spoke with them in a manner they understood. One person said: 'the staff are always helpful and respectful and they make my life easy for me." Another person said 'they are brilliant at helping me and encourage me to do things for myself where I can.'

Is the service effective?

We saw from eight people's records we looked at that people's needs were assessed and a plan drawn up to meet those needs. People we spoke with told us they were happy with the plan provided. Regular reviews were made of the plan provided and people or their families told us they were involved in the reviews.

There were suitable policies in place for consent to care, assessing and planning care, safeguarding people, recruitment and quality assurance. All of the people we spoke with told us the staff knew how to support them well. People who used the service were consulted for their views on the service they received a regular basis, which involved the person, their family or advocate and social services. We saw that any changes they requested were included in a revised care plan.

Staff were provided with adequate support, guidance and training to do their job. They were experienced in supporting people with care needs such as dementia and hearing loss and they told us that the training they received equipped them to support people with confidence.

Is the service responsive?

People we spoke with who used the service told us that the staff and manager always listen to their concerns and do something to help sort out any problems they are experiencing. People were asked for their views about their service and action was taken to address any problems, for example comments received about staff being sometimes late had been discussed with individual staff where necessary and at team meetings.

People's support plans were reviewed and changed when necessary in response to changing needs, for example in negotiating higher levels of support when necessary. Three people told us that staff responded to requests for additional help such as making phone calls to family of GPs if needed, which they said was very helpful.

People who used the service comments included: 'the manager sent someone around quickly when I had an emergency recently, they arrived within 10 minutes and the manager called to make sure everything was ok,' and 'the staff are wonderful and provide the best care, they always ask if there is anything else I need doing before they leave and always stay to do it if it's important to me.' These comments were reflective of the views of all of the people we spoke with.

Is the service well led?

The registered manager was qualified and experienced and was involved in the day to day management of the service. The manager felt this meant they could identify any issues quickly and address them when they arose. There was an out of office hours on call system in operation to ensure that management support and advice was always available. There was a system for doing spot checks on staff working with people to monitor the quality and safety of care provided. Comments received from people who used the service and families included: 'the manager is wonderful and regularly calls to see how the staff are doing, I once had a problem with one staff and it was dealt with immediately,' and 'the manager is first class and is always on top of things.'

Staff we spoke with told us that they felt the agency was very well managed and they received direction and training to help them to support people. One member of staff said they had a special interest in caring for people with dementia and had a 'friends of people with dementia' training course agreed with the provider in response to their request. Regular staff meetings and supervision sessions were held and staff said they felt able to raise any issues with the management openly and honestly, and felt the manager followed up on any issues quickly.

People who used the service told us that they felt the agency was well managed and that they had regular contact from the office to check that their support was happening as planned.

There were a range of systems in place to monitor the quality of people's care, and to make sure any concerns about staff, management or the way in which care was delivered were addressed.