Archived: Welcome Independent Living Limited

We considered all the evidence we had gathered under the outcomes we inspected.

We used this information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

The provider did not have effective recruitment procedures in place and therefore there was a risk that the agency would employ people who were not suitable to work in the care sector. We have told the provider they must take action to meet the requirements of the law in relation to the recruitment of staff.

We found improvements had been made in relation to the training provided to staff. All the staff we spoke with confirmed they had undertaken moving and handling training and this included practical training on the use of equipment, such as hoists. However, we found further improvements were needed to make sure training was maintained and staff were supported to develop their knowledge and skills. We have asked the provider to tell us what they are going to do to improve this aspect of the service.

The majority of people we spoke with were satisfied the staff were able to meet their needs. However, one person said they were concerned some of the staff were very young and did not have the right skills and/or experience to provide care and support to people living with dementia.

The manager told us they reviewed accidents and incidents to look for trends and patterns and identify areas for improvement. However, there was no written evidence to support this. We have asked the provider to tell us what they are going to do to improve this aspect of the service.

Is the service effective?

We looked at four people's care records. We saw people's needs were assessed and there were care plans in place to show how they would be supported to meet their needs. The care plans we looked at provided information about people's individual needs and preferences. There were risk assessments in place for such areas as the environment, moving and handling and health and safety.

The staff we spoke with confirmed people had care plans in their homes. They said this had not always been the case but had improved since the last inspection in April 2014.

Seven of the eight people we spoke with told us they were very happy with the services provided by the agency. One person said 'Without the care and support my relative receives from Welcome Independent Living they would have no alternative but to move into a residential home ' they have helped them live at home for longer than I ever thought possible.' Another person said 'The staff have helped me to retain my independence which has improved my quality of life and made me feel life is still worth living.'

Is the service caring?

The people we spoke with were very complimentary about the staff. One person said 'I would recommend the agency to anyone looking for good quality care, the management team and staff are first class and really care about the people they support." Another person said "All the staff are caring and always ask if I need anything doing before they leave. I would have no hesitation recommending this agency"

The care workers we spoke with told us they felt confident the service they provided to people was good and they had a good staff team.

At the last inspection we found the agency's office was located within a mobility aids shop and no provision had been made to protect people's privacy and ensure confidentiality. During this inspection we found the provider was making alterations to separate the office area from the shop. The provider also told us they rented a room in the Town Hall which provided a place to hold confidential meetings.

Is the service responsive?

We found people's needs had been assessed and this information had been used to develop individualised plans of care.

The manager told us they contacted people who used the service to obtain their views. However, this information was not always recorded and therefore the service was not able to demonstrate they were listening to and responding to feedback from people who used the service.

The relative of one person who used the service told us they were not satisfied with the way the agency had managed a recent incident. They told us they had not been contacted by the provider or manager following the incident. They said they had contacted the agency but had not been given any feedback on any action taken following the incident.

Is the service well-led?

The staff we spoke with told us they were supported by the management team. They said they were always available and acted on any concerns raised.

The Registered Manager told us they had no previous experience in management. They said they were undertaking a National Vocational Qualification in management (level 5) to develop their management skills. The provider told us they had appointed and administrator to support the management team with the day to day running of the service.

We found people were not protected from the risk of unsafe and/or inappropriate care. This was because the provider did not have effective systems in place to monitor and assess the quality of the service. In addition, the provider did not have suitable arrangements in place to make sure appropriate and accurate records were maintained. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of the service and maintaining appropriate and accurate records.

We considered all the evidence we had gathered under the outcomes we inspected.

We used this information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Before this visit we had received information about people's care and support not being properly planned, safeguarding procedures not being followed, staff not being properly trained and recruitment procedures not being appropriate. We looked at these issues during our visit and found evidence to support some of this information.

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

Is the service safe?

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Risk management for people using the service needed further development. For example there were no checks in place for the servicing of moving and handling equipment people were using.

There was no evidence that learning from incidents / investigations took place and appropriate changes were implemented. We have asked the provider to make improvements.

Appropriate checks were not undertaken before staff began work. Effective recruitment and selection processes were not in place. We have asked the provider to make improvements.

Staff did not receive appropriate training and professional development. We did not see any evidence to show staff had the appropriate skills, knowledge and competencies to meet people's needs. We have asked the provider to make improvements.

One person using the service told us, 'I have to be hoisted and I recently found out that none of the staff have been trained to use a hoist. That really concerns me.' They also told us, 'Between Christmas and New Year something went wrong with my hoist; it fell over and I ended up on the floor. My wife saw what happened. I am totally immobile.'

The same person told us, 'The staff are all lovely. The company expects long hours and they daren't say no for fear of their jobs. The company treats them very badly; it really upsets me.'

One care assistant told us, 'I have worked for other care agencies previously and this is the worst one ever. I don't know how they got their licence.'

Is the service effective?

We looked at six people's care records and saw their individual needs were not being adequately assessed. Care and support plans were not always being developed from the assessments of their needs. Care plans were brief and did not contain sufficient detail. The managers agreed there was some work to be done around care planning; there were no emergency plans or medication care plans in place.

Staff we spoke with told us they had not received appropriate training for their roles. This confirmed what we had found at the inspection visit; staff were not appropriately supported in their responsibilities. There was no evidence to show that induction, training, supervisions or appraisals were taking place. We have asked the provider to make improvements.

Is the service caring?

People and their relatives told us they were supported by kind and caring staff. Feedback forms from the service's annual satisfaction survey from February 2014 showed people were generally satisfied with the care provided.

The owner told us, 'We are victims of our own success.' This same comment was made by a visiting health professional we spoke with after the visit.

Three people using the service told us they were very happy with the care provided. The fourth person said, 'They lived up to expectations initially.'

The care workers we spoke with told us they felt confident the service they provided to people was good and they had a good staff team.

The agency's office was located within a mobility aids shop, owned by the same company, in Hebden Bridge. We saw and heard staff working in the shop dealing with shop customers at the same time as answering calls from people using the service. There was no privacy in the shop and no area to talk confidentially. This arrangement did not respect the privacy of people using the service and meant staff could not give them their full attention, either when they visited the shop / office or over the phone.

Is the service responsive?

Care records showed some people's needs had been assessed before they started using the service; however care assistants supporting other people were using brief task lists provided by outside agencies or previous care agencies to provide guidance for care workers. We noted these were not all up to date. People's preferences, interests and life histories had been not been recorded.

People using the service did not always experience care, treatment and support that met their needs and protected their rights.

The owner explained that the service had taken on extra care packages about a month ago from the local authority. This meant 100 hours of extra care were needed each week. The manager and owner admitted they were struggling to find the staff resources to meet the needs associated with this work. They told us they were planning a recruitment drive. The owner said, 'Recruiting people is a nightmare.'

The manager explained that some people did not have care plans in place because they had been too busy. They told us they currently had to go out to do care calls, and so did the senior carers working at the service.

Is the service well-led

The manager told us they had been in post since the service started in May 2013 and had recently become the registered manager at the service, following a successful interview with the Care Quality Commission.

When we asked staff whether they felt well-supported by the management team their responses were mixed. Some said they felt well-supported but others said they didn't. One said, 'The manager is out of their depth; they have no managerial skills.'

When we spoke with the manager they told us they had previously been a senior care assistant and had never been a manager before. They confirmed they had no previous experience of recruitment or quality assurance, and had received no training in these areas since joining the agency. They told us they were planning to undertake the Registered Manager Award, but had not had time enrol for the course yet.

Staff and people using the service told us they were concerned about the staff rotas. They said calls were often late or missed because of confusion about the rotas.

We found people were not protected against the risks of inappropriate or unsafe care because the provider did not have an effective system to assess and monitor the quality of service people received. We have asked the provider to make improvements.