WrightChoiceCare

People’s experience of using this service: We received very positive views from people about the support provided to them. Without exception, people said they felt safe and staff were respectful.

People received their medicines safely and on time and their health was well managed. Staff had positive links with health care professionals which promoted people’s wellbeing.

People said they received care in a timely way from a regular team of care staff. They had good communication with the office and were given information about which care staff would be making their visits each week.

Staff had received appropriate induction, training and support to enable them to carry out their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The registered manager and senior team worked with the staff team and led by example to ensure people received a good service. People and staff told us the registered manager and senior team were approachable and listened to them when they had any concerns. All feedback was used to make continuous improvements to the service.

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

Rating at last inspection: Requires improvement (report was published 20 January 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service has improved to good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

At a comprehensive inspection in January 2016 the service was rated as ‘Inadequate’ because the provider was in breach of five regulations assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made requirements regarding non-adherence to the Mental Capacity Act and the ineffective recruitment systems. We issued the provider with warning notices regarding unsafe management of medicines, poor staff training and ineffective quality assurance systems.

At a second comprehensive inspection in June 2016 the provider was no longer in breach of any of the regulations, as they had improved in all of the areas. We could only change the rating to ‘Requires Improvement’ because we had not seen sufficient consistency in meeting the regulations for a sustained period of time.

At this inspection we found the overall rating for this service remained as 'Requires Improvement'. This was because although sufficient consistency had been achieved by the provider and was sustained over the last 16 months, there were still some areas in which improvements were needed. The rating is based on an aggregation of the ratings awarded for all 5 key questions.

This domiciliary care agency is based in Wistow, near Selby in North Yorkshire. They provide a service through bespoke care packages to children, young people and vulnerable adults, either living with their family, in care or independently. The service can provide companionship and assistance with household tasks, everyday activities, hobbies, outdoor pursuits and personal care. The service currently provides support to 27 people of different ages and with different needs.

The provider was not required to have a registered manager in post, as they were registered as an individual provider. On the day of the inspection the service was being managed by the provider.

People were not always supported by qualified and competent staff, as not all staff had received hoist training from a qualified trainer. We have made a recommendation about appropriate training for staff.

The provider had not always exercised good governance in striving for an improved service based on 'best practice' and up-to-date legal requirements. There was a system in place for checking the quality of the service using audits, satisfaction surveys and meetings, but the audits were not always effective and communication among the staff could have been better. We have made a recommendation about ‘best practice’ guidance.

Safeguarding systems protected people from the risk of harm because they detected and monitored potential or actual safeguarding concerns and ensured they were reported to the local authority safeguarding team. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities with regard to this. Risks were managed and reduced for each individual to avoid injury or harm. Staffing numbers were sufficient to meet people’s need. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to support vulnerable people. The management of medicines was safe and good infection control practices were followed.

Staff received supervision and an appraisal of their performance. Mental capacity act requirements were appropriately met and people’s rights were protected. Staff had knowledge of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005. They understood the importance of people being supported to make decisions for themselves. People were supported with nutrition and hydration. People’s homes were monitored regarding safe environments.

Staff were kind, caring and compassionate towards people. Staff and the provider understood about people’s preferences and wishes. People’s wellbeing, privacy, dignity and independence were respected. This ensured people felt satisfied and were enabled to take control of their lives.

People were supported according to their person-centred care packages, which reflected their needs well and were regularly reviewed. Staff encouraged people to be active and independent and to maintain good family connections and support networks. An effective complaint procedure was available and complaints were investigated without bias.

People had the benefit of a culture that was family orientated and a management style that was positive. People were assured that recording systems protected their privacy and confidentiality as records were well maintained and held securely.

This inspection took place on 3 June 2016 and was announced.

WrightChoiceCare provides care and support to people living in their own home. The registered provider supports people with a range and variety of complex needs. They provide support to children and younger people with physical disabilities and / or learning disabilities and autism. They also offer support to older people some of whom live with dementia. The service is a family run business; the registered provider manages the service. They employ an assessment officer and a staff coordinator who form part of the management team. The management team also deliver care and support. The service operates in Wistow and the surrounding villages.

During this inspection we found the provider was no longer in breach of the previously identified regulations and had made improvements to the service and the care people received.

The service does not have a registered manager. This is because the service is run by a sole provider who is in day to day control of the service and therefore, it is not a legal requirement to appoint a separate registered manager.

Risks to people were identified and risk management plans were put in place to mitigate the risks and reduce the risk of avoidable harm. People, relatives and relevant professionals were, where required, involved in the development of these.

Medicines were now safely managed, staff had received up to date medicines training and underwent various competency checks before they administered people’s medicines.

Recruitment processes were safe. Reference checks had been sought and provided for all members of staff.

Staff training had been provided and the registered provider had carried out competency checks to ensure staff had the skills and knowledge required to deliver safe and effective care.

The service was following the principles of the Mental Capacity Act (2005) and we were given examples of how staff sought consent on a routine basis. Training and support had been provided to staff. Staff now understood the legislation and how this applied to people who used the service.

Arrangements for quality assurance and leadership within the service had improved.

People told us the service was flexible and responsive. People told us the fact that it was a family run business made a difference to them and they felt valued by staff and the management of the service.

The service is located within a small community and we saw some individual touches such as visiting people in hospital, supporting people to interact with their local community and looking after people’s animals which are positive aspects of local care.

Care was provided by a consistent team of care staff who people knew and trusted. People received a copy of their staff rota and so knew who would be visiting them in advance.

People told us they were supported to enjoy nutritious meals. The service referred people to health care professionals as required and worked with them to ensure people’s needs were met.

Staff described a supportive culture and they said staff morale was good.

People and their relatives, where appropriate, were involved in the development and review of their care plan. People told us they could speak with the registered provider or member of staff if they wanted any aspect of their care to change and this was accommodated. People knew how to make a complaint; however, they told us they had not needed to.

The registered provider had ensured the management team had time away from delivering hands on care to ensure the service was well-led. They had developed quality assurance systems to audit the care provided to people. Record keeping was robust.

Whilst we have seen significant progress we need to see consistent good practice over time, therefore we will continue to monitor the service and return to monitor the improvement and review these areas again at the next inspection.

WrightChoiceCare provides care and support to people living in their own home. They provide support to children and young people with learning and physical disabilities and autism. They also offer support to older people some of whom live with dementia. The service is a family run business, the provider manages the service. They employ an assessment officer and a staff coordinator who form part of the management team. The management team also deliver care and support. The service operates in Wistow and the surrounding villages.

The service does not have a registered manager. This is because the service is run by a sole provider who is in day to day control of the service and therefore, it is not a legal requirement to appoint a separate registered manager.

At the time of our inspection the service supported 17 older people and six younger people. Care staff worked across the service user groups.

The overall rating for this provider is ‘Inadequate’. The means the service has been placed into ‘Special Measures.’ The purpose of special measures is to:

1. Ensure that providers found to be providing inadequate care significantly improve.

2. Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

3. Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

People’s medicines were not safely managed; we found medicine administration records contained errors. There were no audits of people’s medicines which meant there were no effective safeguards for identifying these errors. For people who required ‘as required’ medicines there were no protocols in place about when these should be administered. Risk assessments and risk management plans were basic. They did not provide staff with the guidance and direction they needed to keep people safe. Staff were provided with plastic gloves but did not have access to aprons, this meant there was a risk infections could be spread. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not have systems in place to ensure staff were safely recruited. Although they completed DBS checks there was no evidence the provider sought employer reference checks. (DBS checks assist employers in making safer recruitment decisions by checking prospective staff members are not barred from working with vulnerable people). This was a breach of Regulation 19 (2)(a)(3)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were significant gaps in the training records we reviewed and we could see that staff had not been given training about the Mental Capacity Act 2005 (MCA) or deprivation of liberty safeguards (DoLs). In addition staff were not provided with supervision. This meant they did not have the opportunity to discuss their development needs or any concerns they may have. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was not working in line with the principles of the Mental Capacity Act (2005).The provider identified people they said could not make an informed decision with regard to their care and treatment. We did not see mental capacity assessments or best interest decisions recorded in there care plans. Staff demonstrated a lack of understanding with regard to the providers responsibilities in relation to MCA 2005. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not have systems in place to audit the care people received. This meant that issues could not be identified in a timely manner and rectified. Record keeping was poor. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

The provider sought support from health care professionals in a timely manner. People told us they received care from staff who were kind and compassionate and their dignity was maintained.

People told us they were involved in the development of their care plan at the initial stage. However, there was a lack of person centred information in people’s care plans. We have made a recommendation about this.

People said although they did not have formal reviews they were kept informed of any changes.

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

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

Is the service safe?

People are treated with respect and dignity by the staff. A person we spoke with told us how they had felt valued and listened too by the manager of the service. Safeguarding procedures are in place and the manager knew how to report any issues raised to the Local Authorities Safeguarding team for their consideration.

The agency had policies and procedures in place in relation to the mental capacity Act and Deprivation of Liberty Safeguards (DOLS). There was no one currently using the service who had a DOLS in place. The manager and staff waiting to start work for the agency had undertaken safeguarding training in these areas. This helped to protect people.

The manager had systems in place to monitor the quality of service provided. These systems were just starting to be used because the agency had just recently taken on its first client. We will look at these systems in more detail on our next inspection of this service.

Is the service effective?

People using the service could gain access to an Advocacy service to access additional support.

People's health and care needs were assessed with them, and they were involved in stating what care and support they wished to receive. A person we spoke with said 'The agency was very accommodating of my needs.' The manager spent time with people who were able to ask questions before making a decision about if to use the agency. People told the agency when they wanted to receive their care and support and this was put in place for them. Systems were in place for the manager to monitor if the service being provided was effective to meet people's needs.

Is the service caring?

A person we spoke with spoke highly of the help and support they had received from the manager. They told us that the manager had arranged to visit them in their own home and had spent time with them to ensure their likes, dislikes and preferences were known and could be met.

We saw from the care records we inspected that people's preferences, interests, aspirations and diverse needs had been recorded and support was being provided in accordance with people's wishes.

Is the service responsive?

There was a complaints policy in place which people were made aware of. A person we spoke with said 'If I had any issues or concerns I would raise them straight away.' Systems were in place so that people could gain help and advice from the manager at any time.

The manager told us how people were treated as individuals and that the agency would provide help and support to the individual and their family, where necessary, to make sure people using their service were supported to live their life the way they wanted too. The manager confirmed staff would be as flexible as the person required, in order to achieve this.

Is the service well- led?

The manager had developed systems to monitor the quality of the service. These systems were being developed and will be looked at in more detail on out next inspection because the agency had just started to look after people even though they had been registered with us for some time.

The manager of the service had worked in the care industry before and appeared knowledgeable. They had passed their fit person's interview to become the registered manager of this service.

There was a clear message given to us about the ethos of this service. This was to provide bespoke packages of care to people that met all aspects of their needs.