Sevacare - Birmingham Central

¿Sevacare Birmingham Central is a domiciliary care provider supporting people in their own homes. Not everyone using Sevacare Birmingham Central receives a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection the service was supporting 252 people who were supported with the regulated activity of personal care.

¿ Following a visit from the local authority commissioners to the service in October 2018, the local authority stopped referring people to the service because improvements were required. The provider is currently working with the commissioners to make those improvements.

¿ At this inspection we found some improvements had been made. The service has improved in the key question of effective and caring which we now rate as good. Improvements have also been made under safe, responsive and well led, however, further improvements were needed and the ratings remain as ‘requires improvement.’ The provider has met the regulations.

People’s experience of using this service:

¿ People told us they had not experienced missed calls following the last inspection. However, people told us the timings of their calls were inconsistent.

¿ People told us that they felt safe when the staff were in their home with them and the provider had ensured that systems were in place to protect people from the risk of abuse.

¿ Risk assessments were in place to minimise any potential risk to people's wellbeing.

¿ People considered staff to have the correct skills to support them with effective care.

¿ Where the staff supported people to eat and drink and with their healthcare needs, this had been done to people's satisfaction.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the provider’s policies and systems supported this in practice.

¿ People told us staff treated them with dignity and respect whilst providing them with care and support.

¿ People told us they made decisions about the care and support they needed.

¿ People did not always receive care that consistently met their needs and preferences. This was particularly in relation to the times they received their care visits.

¿ People and their relatives knew who to speak with if they had any complaints or issues to raise.

¿ The provider had systems in place to monitor the quality of care. However, these were not always effective.

¿ People and relatives said the management of the service had improved since the last inspection.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (Published 24 November 2018).

Why we inspected: This was a planned inspection which took place on 08 and 09 April 2019. At the last inspection the service was not meeting the regulations and they were required to send us an action plan.

Enforcement: After our inspection in October 2018 we served a Warning Notice to the registered provider which required them to be compliant with Regulation 12: Safe care and treatment by 18 December 2018. A Warning Notice is one of our enforcement powers.

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.

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

Not everyone using Sevacare Birmingham Central receives the regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the last inspection in February 2016, the service was rated Good but required improvement in the key question, ‘Is the service Well-led?’ We identified issues around arrangements to mitigate identified risks to people and a lack of oversight in the governance systems to monitor incidents, late calls and missed calls.

This inspection took place on 02 and 03 October 2018 to follow up on our previous findings. The inspection was prompted in part by increased statutory notifications from the registered provider. From those notifications we identified potential concerns about the management of people's care provision and the management of risk in the service. Some of these concerns were being investigated under safeguarding procedure both at the time of and following the inspection. One of the incidents we had been notified about may be subject to a criminal investigation. We were confident that the service had taken the appropriate action. The local authority and commissioning teams were also monitoring the service. At this inspection we found the service had not sustained the overall rating of good and found each key question now required improvement. Despite previous inspections identifying shortfalls in governance systems, we found that insufficient progress or improvement had not been made to the systems and processes to audit and monitor the quality of care provided at Sevacare Birmingham Central and to meet the Regulations. We are considering what further action to take.

There was a registered manager in post at the time of the inspection. 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 told us they did not always receive their care in an informed, consistent and timely manner that met their preferences and needs. Not all known risks to people were being identified, and the arrangements to mitigate these risks were not always robust enough in order to keep people safe. Incidents of late calls were not robustly reviewed, investigated and followed up to ensure lessons were learned for the future. The management of medicines was not consistently safe. Staff were recruited safely to protect people from the employment of unsuitable staff. Staff understood their responsibilities to protect people from abuse.

Improvements were needed to ensure all staff had the right training and observational competency checks to carry out their roles in order to meet people's assessed needs and provide effective care. People told us that staff sought their permission before providing care and support. People received good support related to their eating and drinking, although guidance for staff could be clearer. People were supported to meet their health care needs, when necessary.

Whilst we received positive feedback about the care, kindness and compassion of most care staff, people did not always receive safe, respectful and responsive care because they were not always satisfied with the management of their call times and duration, how their concerns were managed, and risks to people's safety were not always identified and assessed. This meant the service was

not always caring.

People told us that the service were not consistently responsive to their needs. People told us they knew who to complain to. However, people told us their verbal complaints and concerns were not always taken on board, investigated thoroughly or had changed practice to improve their experience of the service. There was a system in place to identify, record and report on formal written complaints. Care was planned with people’s involvement but we found care plans were not always up to date with people’s changing needs. The staff we spoke with recognised the importance of people being able to observe and practice their religious, personal and cultural beliefs.

The provider had some systems in place to enable them to assess and monitor the quality of the service provided, but these systems were not being used effectively to manage all aspects of the service. The quality monitoring and assurance processes were not effective in ensuring that the risks to people's health and safety were appropriately assessed, monitored and mitigated. People expressed concerns about the management of the delivery of care, the response from office staff and the lack of effective or timely response to concerns. Staff felt well supported and valued in their roles.

We found that the provider was not meeting all of the requirements of the law. We found three breaches in regulations. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Sevacare-Birmingham Central are registered to provide personal care. They provide care to people who live in their own homes within the community. There were 253 people using this service at the time of our inspection.

There was a registered manager in post at the service but they were unavailable on the day of the inspection. 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. The registered provider advised us that they were in the process of applying to change the registered manager. The care manager (who was present during our inspection and who demonstrated a good understanding of the day to day management of the service) had been identified to take on this role.

People told us that they felt safe with the staff who supported them. Staff understood the different types of abuse people could experience and how to safeguard people. Staff knew how to support people with risks associated with their health. However this knowledge had been obtained over time, and not through the provision of risk assessments and risk management records produced by the registered provider. People told us that they received support from consistent staff. People told us they received their prescribed medicines. The management of medicines was safe.

People were supported by staff who were confident and equipped in their roles. People told us that staff only assisted them with their consent. People told us they enjoyed the food prepared for them and they chose what they preferred. People were supported to meet their health care needs when necessary.

People received support from staff who were respectful and caring. People told us they made decisions about how they wanted their care provided. Staff described people’s likes and dislikes. Staff maintained people’s privacy and dignity whilst supporting them to remain as independent as possible.

People told us that staff were aware of their needs and wishes. Most people received care and support that was flexible and that they felt met their needs in the way they preferred. The service had developed a complaints procedure. People could be confident their feedback would contribute to the improvement of the service.

People and staff expressed confidence in how the service was run. The care manager had systems in place which ensured they captured the views and experiences of people who used the service. Staff told us that the manager was approachable, understanding and had implemented changes to improve the service. There were some systems in place to help the care manager to monitor and review the quality of the care provided but improvement was needed. The care manager advised us that they had further plans in place to support them to have a clear oversight of the service.

Sevacare- Birmingham Central is registered to deliver personal care. They provide care to people who live in their own homes within the community. There were 243 people using this service at the time of our inspection.

The registered manager was present during our inspection. 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 and their relatives told us that the service provided to them was safe. Staff had been provided with knowledge to protect people from harm and knew what actions to take in line with safeguarding procedures. Whilst staff told us there were enough staff and did not feel under pressure, some people who used the service told us they had experienced delays in receiving their calls at the right time or for the right duration. We found that the management of medicines were effective and safe.

Staff told us they had access to a range of training opportunities to provide them with knowledge and skills to fulfil their role. Staff told us they felt supported and received regular supervision.

People told us that staff sought consent from them and asked their opinion of how they wanted care provided. Staff could not consistently describe how they should gain consent from people who were unable to make informed decisions in line with Mental Capacity Act (2005) guidelines.

People told us that staff supported them with the preparation of meals which they enjoyed. People told us they had access to health care professionals when necessary to maintain their health.

Staff maintained people’s privacy and dignity whilst encouraging them to be as independent as possible. On the occasions that people expressed their concerns about staff, the registered manager had responded in a timely manner. People told us they were involved in making decisions about their own care needs.

People and their relatives told us they were involved in the planning of their care. Care plans contained individual information about people’s preferences and support needs. Systems were in place for people to make a complaint.

People and staff spoke positively about the registered manager. The service actively sought feedback from people and those that mattered to them though questionnaires, home visits and phone contacts about the quality of the service.

The registered manager and provider undertook regular checks on the quality and safety of the service. The systems in place for recording and monitoring late calls required development to ensure people received their calls on time and for the right duration. Systems in place to identify accidents and incidents were not effective to reduce the likelihood of negative experiences for people recurring.