Carrington Home Care

Carrington Homecare is a domiciliary care agency providing personal care and support to people in their own homes. At present the service is supporting 36 people who live in and around the Barnstaple area.

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 and their relative said they were happy with the care and support they received from this service. One person said, “I have used them for a long time, and they are reliable and very good.”

Since the last inspection the provider had introduced electronic care planning and recording of all care delivery. This had been a positive improvement. The system allowed the service to better track whether care and support was being delivered in line with people’s agreed and assessed needs. This included whether they received their medicines on time.

Improvements had been made in respect of recruitment processes. This ensured only staff who were suitable to work with people who may be vulnerable were employed.

Improvements had been made to the quality systems and auditing processes. This ensured the provider was reviewing and monitoring the quality of care provided as well as the records and policies.

There were enough staff with the right skills and support to meet people’s needs. People said their care workers arrived on time and provided care in a way they wished.

Staff were given supplies of PPE (personal protective equipment) and there were spot checks completed to ensure staff were using this appropriately.

Staff had received training in infection control, use of PPE and COVID-19. There was also a range of training being planned to cover areas of health and safety and to update staff where training may need to be refreshed.

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 31 March 2020).

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

We carried out an unannounced comprehensive inspection of this service on 4 February 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve on regulation 19 – fit and proper persona employed.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

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

We found improvements were still needed in respect of safe and robust recruitment. We identified this as an area for improvement at our last inspection.

Improvements were still needed in respect of how the registered manager who is also the owner of the service, ensured quality assurances processes were checking the quality of care and records. Some improvements had been made since the last inspection. This included more regular spot checks on the care workers doing visits, ensuring staff had one to one supervision

to discuss their training needs and updating care plans and risk assessments. Further work is needed to ensure this is fully embedded.

People and their relatives said Carrington Care was a reliable, friendly and responsive service. People praised the caring and compassionate nature of support workers who visited them. Most people said their visits were usually on time and care workers were flexible and completed tasks as detailed in their care plan as well as anything additional people asked for. For example one person said, “The girls always ask if I need anything before they leave.”

People said they were supported to take their medicines at the right time. Staff had received training to ensure their competencies in this role. Records of administration of medicines were held at the registered office. These were checked, but there was no record of what they checked for and any actions taken to rectify any issues that may have been identified.

People received safe, consistent and person-centred care. This was because there were care plans and risk assessments for individuals. The senior staff had recognised that some of these needed updating and enhancing. This was being completed at the time of the inspection.

Staff said they were supported and more training had been offered and further training organised for this coming year. Staff said they enjoyed working for a small agency. One said “It’s good because we are small, we get to know our clients well. We cover each other’s shifts if needed. It’s very friendly.”

There was sufficient staff to meet people’s needs. The agency had developed a good reputation locally and there were no missed visits. People and relatives said they would be confident to raise any concerns or complaints with the office if needed.

Staff said their views and opinions were listened to and they all worked well as a team to ensure people had good outcomes.

There was good partnership working with healthcare professionals to ensure people’s health was closely monitored and people were supported to get the right help when they became unwell.

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.

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 (report published 28 February 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of our inspection, the service was providing personal care and support to 38 people living in their own homes. The last CQC inspection took place in June 2016 when it was rated as Good. However, on this inspection we judged improvements were needed in how the provider managed and ran the service. The provider has registered with CQC as an individual and therefore does not require a registered manager.

There were aspects of the service which were not well led. The registered provider had not carried out regular quality assurance audits to ensure the service was providing good quality care.

During our inspection, we found a number of areas needed to improve to maintain the safety and well-being of people; these had not been addressed by the provider. Quality assurance systems were not effective in recognising areas for improvement and there was not a timely response to initiate changes.

People were supported by staff who treated them with kindness, respect and compassion. Staff had a good understanding of the people they cared for and supported them in decisions about how they liked to live their lives. People were supported by staff who respected them. However, there were gaps in staff training and records relating to observations of staff practice and supervision.

People said the staff made them feel safe because they were kind and reliable. The management team understood their safeguarding responsibilities. Staff ensured there was a consistent approach to involving people with their care plans.

Systems in place for the recruitment and selection of staff were poorly managed by the provider. They did not ensure new staff had appropriate documentation in place to confirm they were suitable to work with people using the service. Recruitment checks were not routinely carried out before staff started their employment at the agency.

Action was needed to improve medicine training and auditing staff practice to ensure they worked in a safe manner. Potential risks to people’s health and well-being were assessed and documented.

Equality and diversity was understood to support people’s individuality. There were systems in place to gain people's views and to address concerns and complaints. People were supported to access health care professionals to maintain their health and wellbeing. The service was reliable and staff understood the importance of good infection control practice.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

When we inspected in January 2015, we found staff had not always had the right support to do their job effectively. At this inspection, we found this had improved but further training was still needed to ensure all staff had the right skills to do their job safely and effectively.

The service has a registered manager who is also the registered provider. 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 were happy with the service they received from the agency. Comments included ‘‘I am quite happy, the girls who visit are all lovely.’’ And ‘‘I am happy with the service; they are usually on time and do what they need. Some offer to do more than required and I appreciate that.’’

People confirmed the visits were for the expected timeframes, unless staff were running late due to an emergency or traffic. People said they were usually informed if there would be a delay in their visit. People said they were aware of which staff would visit and usually this information was available via a written rota. People said they could make any concerns known to the agency and were confident that issues would be addressed. One person said ‘‘I complained about one particular carer and they were removed from visiting me…so quite happy the office listened to me.’’

Staff had support via meetings, one to one supervisions and weekly newsletters. Staff confirmed they felt supported and had enough information to understand people’s changing needs. There were some improvements needed to ensuring staff had regular updated training in key areas. The registered manager was aware they had needed to improve this. He had arranged a meeting with a training provider and gave assurances that any gaps in training needs for staff would be addressed.

Care and support was planned with the person and their relatives where possible. Where commissioning teams had contracted the support package for an individual, their care plan was available. This was used to develop the agency care plan for staff to follow. Plans were simple, clear and gave instructions to staff about how and when to deliver care and support. Risks had been identified and included details for staff about how to mitigate such risks. For example where people had moving and handling risk assessments, the plan included what equipment and how many staff were needed to ensure safe moving and handling of the person.

Recruitment of new staff ensured they were only employed once all checks had been completed to ensure they were suitable to work with vulnerable people. Staff were aware of how to protect people from potential abuse. Staff knew what types of abuse to look for and who they should report and concerns to.

The agency had auditing systems to review how the care was being delivered and how well this was recorded. People had access to the complaints policy and those we spoke with were confident their views were listened to.

We gave short notice of this inspection as the agency is only small and we wanted to ensure we would have access to staff and to documents held within their registered office. We visited the office on 25th September and spoke with the registered manager and two office staff. We also looked at key documents during this visit. These included care plans, risk assessments and staff recruitment files. On 8 October 2014 we spent time talking with six people who use the service and with eight staff members. We also asked the registered provider to send us some additional information.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff 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?

We found the service was not always safe because staff had not always received the training they needed to ensure they could do their job safely and effectively. The provider was in the process of taking actions to address these gaps. We saw for example, gaps in staff learning in areas of health and safety. We have been informed more training dates had been set in moving and handling to ensure all staff had up to date training in this area.

We spoke to six staff following the inspection, and two said they had not had updated training to help them in their work. One told us ''I have had very little training since joining this agency, most of it has been via brief handovers in the office or on line training''.

There were sufficient staff to meet the needs of the people using the service. However one person told us they did not always like all of the care staff who supported them and had asked for some changes which could not always be accommodated due to the limited number of staff available during the times needed.

Is the service effective?

We found the service was not always effective because there were no systems in place to ensure gaps in training were clearly identified. The provider did not have an effective system in place to ensure care plans and risk assessments were in place in a timely way to help protect people using the service and staff. We are taking further action in respect of this serious breach in regulation.

Is the service caring?

We found the service was caring as all six people we spoke with said their care staff worked with them in a way which ensured their dignity and respect was upheld. Comments included. ''I am happy with the service.'' ''They are very good, I would not wish to change agencies.''

One person told us they had made the provider aware they did not get on with a named care staff member and that the staff member had continued to visit although not as frequently.

Is the service responsive?

We found the service was responsive to people's needs as they tried to ensure visit times were planned around people's needs and wishes. For example for one person who had a large package of care, we heard how the staffing was planned so that care staff who could drive were allocated on duty when the person wanted to shop or access the local community. When we raised an issue one person had informed us about, the person organising the rotas immediately agreed to look into the issue identified and ensure staff were aware of the time they needed to start their evening shift with this person. They also agreed to call the person to offer reassurance.

Is the service well-led?

We found the service was not always well-led because there was no clear audit in place to show how complaints had been resolved and there was no audit to show how any incidents such as medication errors were addressed.

We saw that surveys had been sent out to people who used the service but these had not been collated to help improve the quality of care and support provided.

The purpose of this inspection was to follow up the warning notice issued to the provider. This required improvement with planning care in line with people's needs and assessment of risks to ensure people's care and support was being delivered safely.

During this inspection we spoke with two staff and the provider at the agency office. We looked at the care records for four people. We spoke with three people who use the service and a relative over the telephone.

People using the service told us the staff delivered the care and support they needed. For example, one person commented 'They know very well what my needs are' and 'A team leader came and asked a lot of questions. They left a folder for staff to follow, which has all the information about my medical condition and other information in it'. Another person said 'We had a talk about my care plan'. The same person told us potential risks such as falls had been discussed and staff followed the agreed plan, which they found 'Very reassuring'.

In four care files, we saw needs assessments had been carried out at recent reviews. This covered risks to the person and care workers in the home environment, moving and handling, a 'pen picture' about the individual and a daily task sheet.

We found the service compliant with the warning notice because improvements had been made with risk assessing and care planning processes. Staff were following the information in care files when they delivered care and support for people. This meant the potential risk of people receiving unsafe care and support was reduced. We have made a compliance action specifically about records to further promote improvement of person centred care planning. We will carry out a further visit to check whether the provider has complied with this compliance action and others made at the last inspection regarding recruitment practice and quality assurance systems.

We gave short notice of this inspection as the agency is small and we wanted to be assured we could have access to their registered office. We visited the agency's registered office on 17 January 2014. We looked at the care files and care plans of five people who recieved services. We also looked at the recruitment files of three staff as well as staff meeting minutes, surveys completed by people and records relating to complaints.

Following the office visit we rang six people who received services and spoke with four staff. People were generally positive about the care and support they received. One person told us ''I am completely satisfied, the staff are lovely.'' Another person said ''You do get the odd one (staff) who you don't get on with, but mostly they are good, very kind.''

We found the agency had not planned care in line with people's needs and had not assessed risks to ensure people's care and support was being delivered safely. We also found non-compliance in their quality assurance systems, which had failed to pick up the fact there were gaps in their risk assessing and care planning processes. This meant people were at potential risk of receiving unsafe care and support.

Although we found the agency had sufficient staff, recruitment processes were not robust. This meant people may have been at risk of being cared for by staff who were unsuitable to work with vulnerable people, because the agency recruitment processes did not make the relevant checks.

Some people's comments about the agency as a whole were 'I can't fault it', 'they're very good', 'I'm pleased with them' and 'generally ok'.

In particular people were complimentary about the care staff who visited them. People told us they were 'very kind' and 'always offer to go beyond the call of duty'. People told us staff did not always have sufficient time to travel between appointments.

People told us how staff worked with them to meet their needs. One person told us "they come in, shower, dress me, help me with breakfast. My health's deteriorated and they help me with whatever I need that day".

We found inconsistency in the way people's care was planned and in how staff planned to manage risks.

People told us that staff offered them choices and staff did 'anything I want them to do'.

There was a clear safeguarding procedure in place and people told us they felt safe with the 'trustworthy' staff who visited them.

We did not see evidence of a quality assurance system being in place to monitor the quality of care provided. People felt able to approach staff at the office with concerns but had mixed feelings about whether they felt the agency responded to their views and requests.