Care with Pride

Care with Pride is a domiciliary care service providing personal care to people living in their own homes. The service provides support to people living with dementia, older people, younger adults and people living with physical disabilities and sensory impairment. At the time of our inspection there were 28 people using the service.

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.

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

People were at risk of poor care and support because governance systems were not effective and needed strengthening. Although audits were taking place they had failed to identify the issues we found during our inspection, in relation to: poor staff recruitment practices, an incomplete log of incidents, a lack of personalised care plans, risk assessment and medicine records.

Risks associated with people's care was assessed but the provider needed to ensure risks regarding specific health conditions, were assessed fully and staff had the correct information to care for people in a safe way.

There were enough staff to meet people’s care and support needs.

People felt safe with the care and support provided by the service. All staff had received safeguarding training and knew how to protect people from harm.

The services infection prevention and control policies and protocols were being adhered to, ensuring both staff and people using the service were protected from cross contamination.

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.

Staff had completed core training. Observational checks of staff practice were taking place.

Feedback was sought from people and their relatives about the quality of the care, and action taken to improve the service.

The service worked with a wide range of key organisations who were also involved in people’s care.

People and relatives were positive about the registered manager. Staff felt supported by the manager who they found approachable.

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

Rating at last inspection

The last rating for this service was good (published 16 January 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care with Pride on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified a breach in relation to the management oversight of the service at this inspection. We have also made recommendations that the provider considers guidance in relation to recruitment of new staff and ensuring information relating to risks and safety is up to date.

Please see action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

The service has a registered manager. 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 were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure that people were protected from the risk of acquired infections. People’s medicines were managed safely, and there was evidence of learning from incidents.

People’s needs had been assessed regularly and they had care plans in place that took account of their individual needs, preferences, and choices. Staff had regular supervisions and they had been trained to meet people’s individual needs effectively. The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services when families were unable to provide support.

People were supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives, and the policies and systems in the service supported this practice.

Staff regularly reviewed the care provided and were guided through regular input by the person receiving care to ensure the care provided continued to meet their individual needs, in a person centred way.

The provider had an effective system to handle complaints and concerns. Where people were able to remain in their own homes, staff ensured that they remained comfortable, dignified and pain-free at the end of their lives.

The service was well managed and the provider’s quality monitoring processes had been used effectively to drive continuous improvements. The registered manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service. Collaborative working with people, their relatives and other professionals resulted in positive care outcomes for people using the service.

Further information is in the detailed findings below.

The service had 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.

There were systems in place to keep people safe from harm. People we spoke with felt that staff knew how to keep them safe. The provider had undertaken risk assessments which were regularly reviewed to minimise potential harm to people using the service. There were appropriate numbers of staff employed to meet people’s needs and provide a safe and effective service. Staff we spoke with were aware of people’s needs, and provided people with person centred care.

Peoples care records were regularly updated to reflect changes to their circumstances and the provider kept abreast of those changes to ensure that any further support people may require was acted on. People were supported and encouraged to eat and drink well and where required the service supported people to make appointments with or attend health care services.

People confirmed that their privacy and dignity was respected by staff and that they were encouraged to do as much as possible for themselves in order for them to retain their independence and life skills. People were supported to make decisions for themselves. Where the provider had reason to believe that people were not able to make decisions for themselves, the provider had a system in place to ensure that referrals were sent to the local authority for assessment.

The provider did not have a robust recruitment process in place which ensured that staff were suitable to work in people’s homes. Staff had undertaken appropriate training, however we found that staff did not always received regular supervision and an annual appraisal, which would enabled them to meet people’s needs. Medicines were administered safely by staff who had received training. The provider had a system in place to ensure that complaints were recorded and responded to in a timely manner as well as an effective system to monitor the quality of the service they provided.