Care Assurred Limited

Care Assurred Limited is a domiciliary care service that provides support and personal care to older people in their own homes. 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. At the time of our inspection 55 people were receiving support with personal care.

People’s experience of using this service and what we found

People told us they felt they received care from staff that made them feel safe and were confident they were well looked after. Staff showed a good understanding of their roles and responsibilities of keeping people safe from harm. Risks to people had been assessed and those identified were managed safely by competent staff. Where people required support with medication this was managed safely; people and family members confirmed that medication was received at the right times. Where required, people had access to appropriate equipment and were supported to ensure their homes remained safe.

Sufficient numbers of suitably qualified and skilled staff were deployed to meet people’s individual needs. Staff had received a range of training appropriate and support to enable them to carry out their role safely and effectively. People told us they received the right care and support from consistent staff who were well trained and knew them well. People also told us staff never missed a call and always arrived on time.

People’s needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People received support to maintain good food and drink intake and their healthcare needs were understood and met. Care was delivered in a personalised way and in line with information recorded in people’s care plans.

Staff were motivated to deliver care in a person-centred way based on people’s preferences and likes. People and family members told us staff were kind and caring and always treated then with respect. People felt listened to and told us staff always had time to sit and chat with them. Family members told us staff were keen to offer them additional support where needed. People were supported to maintain relationships with family members and to access community activities to reduce social isolation.

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

People and family members spoke positively about the management of the service and felt well supported. They knew how to make a complaint and felt confident any would be dealt with appropriately. Staff felt supported in their role and keen to implement the person-centred culture and approach encouraged by the registered manager and provider. Effective quality assurance systems were in place to monitor key aspects of 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 and update: The last rating for this service was requires improvement (published 30 July 2018) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The service is registered to provide personal care to people in their own homes and operates around the St Helens and Newton-le-Willows area. At the time of our inspection there were 160 people receiving support.

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.

When we conducted a previous inspection on September 2016 we rated the service requires improvement and found the registered provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because quality monitoring systems were not robust and policies and procedures did not contain enough detail. We asked the provider to complete an action plan telling us how they would address the issues. We found that whilst some improvements had been made, there were still issues in relation to quality monitoring and documentation.

There were individual risk assessments in areas such as manual handling and environmental risks. Risks such as nutrition, pressure sores and falls had not been separately documented however where risks in these areas had been identified they were recorded within the manual handling risk assessments or within care plans. The registered manager took action to address this to ensure that individual risks were assessed and recorded appropriately.

There were sufficient numbers of staff in place to meet people’s needs, however visits were not always at the allocated times; this was seen within people’s care plans and daily logs.

Quality assurance audits were in place to monitor the quality and safety of the service however not all audits were effective in identifying issues/errors.

Care records contained information regarding people’s individual care and support needs; each file provided a detailed time table which documented the support required. However, care records were not person centred and lacked information to assist staff to know the person they were supporting.

Care records detailed where a person required support with medication and staff had received training in the safe administration of medication. However medicine administration records were not always completed correctly.

We have made a recommendation about the management of medicines.

People were supported with their nutritional needs and had access to other health and social care professionals to help maintain their health and well-being.

Consent for care was being obtained in line with the principals of the Mental Capacity Act 2005 (MCA); the registered manager showed a good understanding of their roles and responsibilities regarding the MCA legislation.

People and their relatives spoke positively about the care and support being provided by Care Assurred; people told us staff were kind, caring, and respectful of people’s dignity.

Staff had completed training in relation to safeguarding and provided a good understanding of how to identify and report safeguarding concerns. The registered manager kept a record of any safeguarding concerns reported.

The service had a robust recruitment process in place to ensure newly recruited staff were suitable to work with vulnerable people.

Staff had received training in areas such as manual handling, first aid, MCA and infection control. Staff were supported in their role through supervision and appraisals.

Care and support plans were based on individual needs and had been reviewed regularly. However, care plans lacked detailed information for staff to get to know the people they were supporting and reviews lacked information regarding any identified changes in needs.

We have made a recommendation about the recording of information within care plans.

People and their relatives spoke positively about the registered manager; they were described as approachable and always willing to listen and help.

People and their relatives were provided with details on how to make a complaint and how it would be dealt with. There were no complaints recorded for the last 12 months.

There were systems in place to gather feedback from people and their relatives; feedback from the most recent surveys was positive.

This is the second consecutive time the service has been rated Requires Improvement.

The service is registered to provide personal care to people in their own homes and operates around the St Helens area. At the time of the inspection the service was supporting 223 people.

There was a manager in post who had been registered with the CQC since October 2010. 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.

There were limited quality monitoring systems in place to monitor the service and identify where improvements may need to be made. For example an audit of accidents and incidents was not completed, a medication audit was not in place and an audit of care records had not been carried out. It is important that quality monitoring systems are in place so that trends and patterns can be identified, which can help with preventing issues from reoccurring in the future. You can see what action we told the provider to take at the back of the full version of the report.

There were policies and procedures in place; however these did not always go into sufficient detail. For example a Mental Capacity Act 2005 (MCA) policy was in place; however this did not contain information around the roles and responsibilities of the registered provider or staff in relation to the MCA, or the processes that should be followed in order to maintain people’s rights and liberties. You can see what action we told the provider to take at the back of the full version of the report.

Risk assessments were not always in place to ensure that people were protected from harm. For example pressure area risk assessments were not always in place for those people at risk of developing pressure sores. In another example there was no risk assessment in place for managing the medication needs of one person who was alcohol dependent. There was also no risk assessment around protecting staff, despite an episode of aggression from this person towards staff. We have made a recommendation regarding the completion of risk assessments in relation to people’s needs.

Staff training records showed that staff had received training in the safe administration of medicines. However staff did not always sign medication administration records (MARs) when medication had been given. We raised this with the registered manager who stated they would ensure staff filled these out in the future. We have reported further on this under the well led domain. We asked people whether staff gave them their medicines as prescribed and they told us that they did.

The registered provider and the registered manager were not aware of their roles and responsibilities in relation to the MCA. Staff had not received training in this and did not have a good understanding of their roles and responsibilities in relation to the Act. The registered manager had made enquiries regarding training for staff around this. It is important that the registered provider, the registered manager and staff have an understanding of the MCA to ensure that they act within the law, and work to uphold people’s rights and liberties. We have made a recommendation around implementing the requirements of the MCA.

Staff had completed safeguarding training and were aware of the signs and indicators that may indicate abuse is taking place. Records indicated that concerns were being raised by the registered manager with the local authority as required.

There were sufficient numbers of staff in place to meet people’s needs. People confirmed that staff arrived on time, and that they stayed the correct length of time. The registered provider had a system in place to monitor when staff arrived at people’s homes, and to ensure that they stayed the right amount of time.

People told us that staff were kind and caring in their approach. We observed examples where staff spoke respectfully to people and their relatives, and it was apparent that good relationships had developed.

People told us that the care provided was sufficient to meet their needs. Care records contained details about people’s likes, dislikes and also provided a time table for staff around what tasks they needed to complete. Where staff had concerns about people’s needs they reported these to the registered manager, for example where they felt that one person was socially isolated they had followed this up to ensure that additional support could be put in place by the person’s social worker.

There was a complaints process in place, and people confirmed that they would feel confident in making a complaint. People felt that the registered manager would work to resolve their concerns.

There were processes in place for gathering feedback. The results of these showed that people felt the service they were being provided with was good overall.

' 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.

Care Assured is a Domiciliary Care Agency (DCA). The agency was providing support and care to people living in their own homes. At the time of the inspection Care Assured were providing a service to 223 services users in Haydock, Parr and Newton-Le -Willows.

Is the service safe?

We saw that people had been cared for in their own homes and the service had checked if this was safe, clean and hygienic. Equipment in people's homes to assist staff was assessed by the service as suitable to meet people's needs. We were told by people who used the service that the staff arrived on time, except in an emergency and stayed for the correct amount of time. People told us, 'I always get treated with respect' and 'I am happy with the carers and always feel safe'.

We also saw records which demonstrated that there were sufficient numbers of staff available to meet people's needs.

Is the service effective?

We visited three people in their own homes who told us they were happy with the care that had been provided. Some of the comments were, 'Generally on time, sometimes I get more time than I should', 'Never had to complain, but I would know what to do, if I needed to complain' and 'I keep the number of Care Assured in my purse, just in case I need to contact them'. We spoke with four members of staff and they were able to demonstrate a clear understanding of people's needs and how to meet them.

We found that Staff training was consistent, with appropriate and relevant training being provided. We saw that supervision of staff was regularly provided. This meant the provider could demonstrate that the staff employed to work for the service had the training and support to meet people's needs

Is the service caring?

The staff we spoke with during our inspection gave good examples of how they supported people in a caring and sensitive manner. Staff expressed how they felt enthusiastic about caring for people. One of the comments was, 'I really enjoy the work, I love caring for people'.

People we visited told us, 'When my carer went on holiday, I really missed her', 'The carers are like daughters to me', 'I'm happy with the carers and I enjoy having chats with them' and 'They (staff) are great, we always have a laugh'.

Is the service responsive?

The agency assessed people's needs before they were offered a service; this was to make sure they could meet people's needs. Peoples care plans did not contain any background or social history for people using the service. The manager confirmed that they have developed new care plans, which included a social / background history. We were shown a copy of the new care plan document, which was observed to be more person centred and individualised.

One person we visited said, 'I would like to get out more in my wheelchair'. The manager said they would pursue this with Social Services and ask for a review of the person's needs.

Is the service well-led?

The agency had developed a new quality monitoring booklet, which was in the process of being implemented. We observed the targets set by the local authority for electronic monitoring of visits. We saw that from March 2013 to January 2014 98% of care calls had been achieved. We also saw evidence of carers logging in via electronic monitoring, when they arrived and left a person's home. The percentage for this was 93%. The local authority's expectation was 80%.

We observed a new survey questionnaire format, which had recently been developed. The manager informed us that the surveys will be more person centred, for example, will ask people if they feel safe and well cared for and supported. The previous surveys just asked for 'yes' or 'no' answers. This new survey questionnaire will ask for specific comments. This meant that the provider would be able to ascertain people's opinions and views, which could positively change the service delivery.

Some of the comments from people using the service were, 'Never had to complain, I would if I needed too' and 'I have known them all (manager and staff) a long time, always been supportive'. We found the management were fully aware of people's health and social life.

We looked in detail at 21recruitment and personnel records and found that staff had been recruited appropriately; including checks to ensure new staff were suitable to work with vulnerable adults.

A comprehensive four-week induction programme was in place. This involved weekly sessions with the training coordinator, competency assessments, electronic training and shadowing a more experienced member of staff for a minimum of three days.

The organisation was in the process of working through a rolling programme for staff supervision and appraisal. Staff meetings were held twice a year and these were well attended by support staff.

We did not seek the views of people who use the service as part of this inspection.

We looked at various documentation including, the care records of four people using the service. We spoke with three of the staff and their feedback about the organisation was positive.

We saw the training records and supervision records for members of staff.

We found all of the documentation in the office was up to date and well organised.

We visited the homes of three people who were receiving a service to gain their views about the quality of the service that had been provided. Each person had a care file in their home and we found the files to be up to date, containing the same information that we had observed in the care files in the office. Some of the comments from people receiving a service were, 'They (staff) are very good, they help me get up of a morning', 'I don't know what I would do without them (staff)' and 'I have no complaints, I am satisfied with the care I get'.

We spoke with five of the carers employed by the care agency.

We made home visits to three people who used the service to gain their views about the quality of the service provided. We looked at care files in people's homes.

The people we spoke with said support workers had always treated them with dignity and respect.

Some comments from service users were, 'The girls are really good with me,' 'They (carers) are fine, champion. I have never been treated better in my life,' 'I'm not kidding, I get treated with respect,' 'They are very good, couldn't ask for better carers' and 'I am quite satisfied with everything'.