Archived: Radis Community Care (Derby)

The inspection took place on 7 and 8 February 2018. The inspection was announced because we wanted to make sure that the registered manager was available to conduct the inspection.

At our last inspection we identified regulatory breaches related to safe care and treatment and good governance. The provider supplied an improvement action plan detailing improvements that were to be made to the service. At this inspection we found the registered provider had made sufficient improvements to meet previous breaches of regulations, though improvements were still needed in some areas.

A registered manager was in post. This is a condition of the registration of the service. 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 and associated Regulations about how the service is run.

People and their relatives told us they were safe receiving personal care from staff. They said staff provided care that they liked and they got on well with them.

People's risk assessments provided staff with information on how to support people safely, though some assessments were not fully in place. Calls to people had not always been timely.

People were protected from the risks of infection. Medicines were managed safely and people told us they had received their medicines.

Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities to act and report when needed.

Some people and their relatives told us they were satisfied with how the service was run by the registered manager. Staff were satisfied with the support they received from the management of the service. However, some people and their relatives said that the service needed to improve.

Management had carried out audits and checks to ensure the service was running properly to meet people's needs though some important issues had not been identified.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Radis – Derby provides personal care and treatment for adults living in their own homes. The registered manager informed us that there were a total of 67 people receiving care from the service.

A registered manager was in place. 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 and associated Regulations about how the service is run.

Risk assessments were not consistently in place to protect people from risks to their health and welfare. Robust staff recruitment checks were not fully in place to protect people from receiving personal care from unsuitable staff.

Calls to provide care to people were not always at the agreed and assessed times, which meant people’s safety had not been comprehensively promoted to ensure they received care at the times they needed.

Management had not audited the service comprehensively in order to check whether people's needs had been fully met and to take any identified action needed to ensure people were provided with a safe and quality service.

People and relatives told us they would tell staff or management if they had any concerns, but they were not all confident these issues had been all would be properly followed up. A number of people and relatives were not satisfied with how the service was run, with concerns about untimely calls and unresponsive senior management staff. Staff did not feel they were fully supported in their work by the senior management of the service.

People and relatives we spoke with told us they thought the service ensured that people received safe personal care from staff. Staff had been trained in safeguarding (protecting people from abuse) and staff understood their responsibilities in this area.

We saw that medicines had been, in the main, supplied safely and on time, to protect people’s health needs.

Staff had received training to ensure they had skills and knowledge to meet people's needs. Specialist training on people’s health conditions had been provided to allow staff to understand the challenges people had in their lives.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives. Assessments of people's capacity to make decisions were in place to determine whether they needed extra protections in place.

People and relatives we spoke with all told us that staff were friendly, kind, positive and caring. People told us, in the main, they had been involved in making decisions about how and what personal care they needed to meet their needs.

Care plans were individual to the people using the service to ensure that their needs were met, though this did not include all relevant information such as full details of people's preferences, likes and dislikes.

Notifications of concern had been reported to us, as legally required, to enable us to consider whether we needed to carry out an early inspection of the service.

A registered manager was in place. 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 and associated Regulations about how the service is run.

On this inspection we found a breach of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 with regarding to providing safe care. You can see what action we have told the provided to take on the back of the full version of this report.

People had not always received personal care at the assessed and agreed times to promote their health and welfare. Comprehensive risk assessments were not consistently in place to protect people from risks to their health and welfare.

Staff recruitment checks were not always in place to protect people from receiving personal care from unsuitable staff.

People and relatives we spoke with told us they thought the service ensured that people received safe personal care. Staff had been trained in safeguarding (protecting people from abuse) and staff understood their responsibilities in this area.

We saw that medicines were, in the main, supplied safely and on time, to protect people’s health needs.

Staff had not received comprehensive training to ensure they had the skills and knowledge to be able to meet people's needs.

Staff, in the main, understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives.

People and relatives we spoke with told us, with one exception, that staff were friendly, kind, positive and caring.

People using the service or their relatives had, in the main, been involved in making decisions about how and what personal care was needed to meet their needs.

Care plans were individual to the people using the service to ensure that their individual needs were met, though they lacked some personal information about lifestyles to ensure that a fully personalised service could be provided.

People and relatives told us they would tell staff or management if they had any concerns, they were, in the main, confident these would be properly followed up. However, not all issues had been responded to in a timely manner within the timescale set out by the complaints procedure.

People and their relatives were, in the main, satisfied with how the service was run and staff felt they were supported in their work by the senior management of the service.

Management carried out audits in order to check that the service was meeting people's needs and to ensure people were provided with a quality service, though robust systems were not fully in place to consistently achieve this.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People told us they felt safe with staff. Relatives also thought people were safe in the service. However, we found evidence in records that unsafe care had been provided to a person.

Not alll staff had been aware of how to report concerns to relevant agencies to protect people from harm.

Staff had been aware about care plans, and support plans had been written for people with particular needs. Some plans did not contain sufficient detail to promote people's welfare.

We saw evidence that all people had not always received medical treatment when they were ill or had unexplained bruising.

This meant that people were not fully safe in the service.

Is the service effective?

People's health and care needs had been assessed and care plans were in place.

We found that more detail was needed in some plans to ensure people got the right care. One person said he could not communicate with staff properly due to language problems. Another person said it took head office a long time to agree proper care for his night-time call. He said he was left without a night time call on one occasion, as the on-call system had not operated properly as it had not been switched on.

A number of people and their relatives told us that calls had not been on time and that staff did not stay for the full contracted time.

This meant the service had not always been effective in meeting people's needs.

Is the service caring?

All the people we spoke with told us that staff were friendly and caring. One person said, 'staff are wonderful.' The relatives we spoke with also said that staff were kind and caring. One relative said, 'yes, staff are excellent.'

People told us they had received an annual satisfaction survey to complete. This meant they were able to comment on the service provided. However, this had not been provided to relatives, staff or relevant professionals. This meant these groups of people had not been able to make their views known and appropriate action taken as needed to help provide a better service for people.

We saw no evidence of an action plan produced from surveys. This meant there was no evidence that the provider had acted upon what people had said. This would have helped to ensure people were not at risk of receiving inadequate quality care.

Is the service responsive?

Most people said they had never needed to make a complaint. Two people told us no one had got back to them when they made a complaint. One person said; 'What's the point of taking it further? Nothing ever gets done. '

Relatives told us that when they told management about anything that had concerned them, it had been put right. However, we found evidence that not all issues of concern had been fully followed up. This meant people were at risk of being provided with poor care when action could have been taken earlier to prevent this.

Is the service well-led?

The service had some systems to check that care was of good quality. Some important aspects of the service had not been fully checked. This included issues of concern that were discussed in early 2014 between the provider and the local authority.

Staff received supervision to check their competence and provide them with support. However, we found that some sessions had limited discussion about important features such as staff training, the provision of care to people and whether staff had any concerns. On the positive side, staff told us that management had been supportive to them.

There was no system in place to give staff, relatives or relevant professionals the opportunity to provide feedback their views of the quality of the service to management, so their knowledge and experience may not have been fully taken into account.

On the positive side, staff told us that management had been positive and supportive to them.

People told us staff wore a uniform and a name badge. In this way they felt happy to allow them in to their home as it made them feel safe and secure. They told us they were never sent a stranger who they had not met before. People told us staff listened to them and learnt to understand their needs. They told us staff carried out their tasks well. People who needed assistance with medicines were provided with this. People told us they thought care workers were well trained.

People using the service confirmed that staff used personal protective equipment when providing specific care roles. People told us they were satisfied with the service they received and would feel able to contact the office staff if they had any concerns.

We found that most people were receiving the care and treatment that they needed in line with their care plans.

Staff we spoke with told us that they received regular training and supervision to support them in their roles. All of the staff we spoke with told us they felt supported by the provider.

We found that the provider had systems in place to assess and monitor the standards at the agency and action plans showed that they address items that came to their attention.