Archived: Newcross Healthcare Solutions Ltd (Exeter)

Newcross Healthcare Solutions (Exeter) provides personal care and support to people living in their own homes in the Exeter and East Devon areas. The agency provided three main areas of care – complex care, enabling care, and a sitting service. At the time of this inspection they provided care and support to approximately 34 people.

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 told us they felt safe and said they had never experienced any issues or concerns about abuse or harm. Staff had received training and information on how to recognise and report any suspicions of abuse and they were confident any concerns would be acted on promptly. A relative said, “If there are any issues, Newcross are on it instantly and I’m informed even if they are not worried. They keep me in the loop”. The provider had a robust recruitment process which minimised the risks of abuse to people. Staff had received training and guidance to make sure they knew how to recognise and report any suspicions of abuse.

People received reliable and consistent support from staff who were well trained, with the knowledge and skills to meet each person's health and personal care needs safely and effectively.

Staff were well supported. Staff told us they received regular supervision and support, either in the agency office or by telephone. They also received regular monitoring checks by a senior member of staff while they were working directly with people. A member of staff said “They do come and sign you off for competency.”

Each person had their needs assessed by a team leader or a member of the management team before the service began. Care plans were detailed, well laid-out, and easy to read. The plans covered all aspects of the person’s needs, their support network, likes, dislikes, and usual routines. Staff told us the care plans provided them with all the information they needed about each person’s care needs. One person said, “They come and sit down with me and discuss my care. They come and see me to check I’m ok. They check on me. They’re very good like that. I have a copy of the care plan.”

People received their medicines safely from staff who were trained to carry out the task. Medication administration records (MAR) were drawn up by a qualified nurse. The records we looked at were completed accurately and there were no unexplained gaps. Staff monitored people’s health and liaised closely with relevant professionals to make sure people’s healthcare needs were met.

People who used the service, their relatives and people closely involved in their care were involved and consulted. People were always asked for their consent before staff assisted them with any tasks. Staff respected people’s privacy and people were treated with respect and dignity. The agency sought to match care staff to the people who used the service, for example by matching staff with similar interests to the person.

The service was well led. The provider had an effective quality monitoring system to ensure standards of service were maintained and improved. People were involved and consulted about all aspects of the service.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service well led?

This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

This inspection was undertaken to follow up that required improvements have been made in relation to people's care and welfare, safeguarding, medicines management, staffing and quality monitoring following our previous inspection in January 2014.

The agency was providing personal care to 34 people when we visited. We spoke with 16 people and relatives about the care they received and looked at eight people's care records. We spoke with eight staff and looked at six staff files. This including office staff, care workers and the regional manager.

Is the service safe?

We found the service was safe. The agency had enough staff with the right skills to support the care needs of people. We found medicine management systems had been improved and medicines were safely administered. The agency had introduced a telephone monitoring system so that any delays or missed visits were highlighted to them with 15 minutes. Risk assessments had been undertaken to identify extremely vulnerable people, who were totally reliant on the agency carers. Each person's records included details about relatives or other supporters who could be contacted in the event of an emergency. This meant the agency could prioritise those people and make alternative arrangements for their care in an emergency situation. This meant vulnerable people were protected because contingency plans were in place for their care.

Is the service effective?

We found the service was effective. People's health and care needs were assessed, and people and relatives were happy with the quality of their care provided. Care workers confirmed they requested reviews of people's care when their needs changed, for example due to deteriorating health or mobility. In the care records we looked at, we found that people's needs were regularly reviewed.

Is the service caring?

People were supported by caring staff. People and relatives we spoke with told us they were treated with dignity and respect at all times while care workers were in their home and when they provided personal care. Comments included, 'Lovely girls', and 'Very polite', and 'We are very happy with them and all staff'.

Is the service responsive?

The service was responsive because people and relatives we spoke with told us the service from the agency was very reliable. They received weekly rotas about their visits and staff arrived on time, most of the time, usually within 15 minutes of their planned visit time. If there were any problems, they told us the office would call them to let them know so they would not worry. Where two care workers were needed for the visit, people told us the agency always provided two staff. None of the people we spoke with had experienced any missed visits.

Is the service well led?

The service was well led. At the time of the inspection, the registered manager was on maternity leave and the provider notified us of the interim arrangements for managing the branch. The day to day running of home care service was managed by a team leader with support and advice available from the operations manager who visited the Exeter branch regularly. The agency also employed a clinical assessor who led on assessing people's needs, risks and developing individual care plans and reviewed people's care needs regularly.

Following the last inspection, the provider undertook a review of their quality monitoring arrangements within the company and strengthened their complaint and incident monitoring systems. This included introducing new policies and procedures for staff about how to report incidents and concerns and to make sure these were logged, investigated and reported to the provider. All complaints and incidents were monitored to ensure action was taken and improvements were made. We found wider learning from individual complaints and incidents was shared with staff via the secure intranet system. This showed the provider ensured lessons were learned within the branch and across other branches of the agency.

We spoke with seven people and relatives about the care they received and looked at eight people's care records. We spoke with twelve staff and looked at six staff files. This included office staff, care workers, the registered manager, an operations manager and the Head of Homecare for Newcross. We also spoke with two care managers at the local authority.

Most people we spoke with were happy with their care. One person said, 'I am happy with my care', another said, 'The carers are really kind and nice people but they are always in a desperate hurry'. A third person said, 'Up until now, they have been good but it's gone a bit haywire over Christmas'. We found people's care needs were assessed and we found good care plans in place about how to meet those needs. These included detailed information about any individual risk factors and how to reduce them. People said they thought the agency was reliable, they confirmed they received weekly rota information and said staff mostly arrived on time, and stayed for the agreed period.

However, we found the agency had missed seven home visits for four people over the past three months. We looked at each of these missed visits and six of the missed visits were related to communication difficulties between the office staff and care workers. We also found the agency was short staffed in both areas. Staff told us about the impact of those shortages in the office and in the homecare team. We saw examples of poor communication between the office and the care workers. Staff reported being unable to get through to the office and messages left not being passed on or acted on. One care worker said, 'we sometimes don't get information about new clients or about changes in existing clients, we have to chase for the information and things are always getting forgotten'. Staff also reported difficulties accessing support and advice in a timely way. Six of the eight care workers we spoke with told us they had not received any supervision or spot checks in the past three months.This meant that routine quality checks on staff practice were falling behind.

The registered manager told us several clients and staff had left the agency over the previous few months and confirmed the agency was short staffed. However, they explained how they were able to minimise the impact of the reduction in care workers on people's care. This was because the agency had care workers available who normally covered shifts in care homes and were helping by doing some of the home visits until more permanent staff were recruited. The manager also told us about plans underway to recruit more staff for the office.

We also found inadequate incident reporting and complaint investigation systems in place. This was because of inconsistencies in how complaints and incidents were reported and investigated. We found that common themes and trends were not identified, safeguarding concerns were not recognised and lessons were not being learnt. The provider told us about plans to undertake a thorough review of their systems and about their commitment to make the improvements required. The agency confirmed they would not take on any new clients until they were confident they could provide a safe and effective service.

We will undertake a follow up visit to check the required improvements have been made.