Archived: HomeLife Carers (Plymouth)

HomeLife Carers (Plymouth) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to predominantly older adults, some of whom may have a physical disability or be living with dementia.

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 told us they felt safe using the service. They told us they received their medicines on time and staff understood and met their needs. Information about people’s needs, preferences and any related risks were recorded. The provider planned to include more personalised information in the future.

Some people and staff told us they still had concerns about call times and communication of any changes; however, the provider was in the process of introducing a new electronic system which enabled calls and call data to be monitored at all levels of the organisation. Call data at the time of the inspection showed 90% of calls were delivered on time.

People were positive about the staff and their skills and knowledge. Staff understood people’s health needs and any needs relating to food and drink. Any concerns were reported promptly and action was taken to help ensure people stayed safe and healthy.

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 told us staff were caring and treated them with dignity and respect. Information about people’s diverse needs were included in their care records. People told us they were able to express their views to staff and felt listened to.

Complaints were taken seriously, and staff understood how to report any complaints people had. Themes from previous complaints had been incorporated into the service’s action plan, so improvements were made.

Since the last inspection the provider had implemented new systems and processes for running the service. This included the service being overseen by a new operational manager, who was supported by other senior staff who worked on behalf of the provider to monitor the service. Thorough audits and spot checks had been completed to identify where improvements were required and a clear action plan was in place to ensure the improvements were made.

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 14 November 2018) and there was a breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We told the provider to report to us each month what actions they had taken to improve the service. 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.

The inspection of HomeLife Carers (Plymouth) (“HomeLife carers”) took place between the dates 25 and 30 July 2018 and was announced 48 hours before. We last inspected the service between 9 and 21 June 2017. We rated the service as Requires improvement overall. This was because we found concerns in whether the service was safe, responsive and well-led. We judged the service was not meeting the legal requirements of ensuring the service was appropriately governed and requested the provider submit an action plan to tell us how they were going to put this right. However, we found on this inspection some of the issues were ongoing.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger adults and, people living with dementia, mental health, a learning disability, physical disability and/or sensory impairment. At the point of this inspection 32 people were receiving personal care from the service. Some of those also had staff from the service who were responsible for ensuring they were given their medicines safely.

Not everyone using HomeLife carers receives 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 consider any wider social care provided.

A registered manager was not in place to manage the service locally. A manager had been employed since the previous registered manager left, but left the service before this inspection. The operations manager advised on inspection that a new experienced manager had been appointed and was due to start at the service on the week commencing the 30 July 2018. The 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 operations manager supported this inspection.

We have continued to rate the service as requires improvement as not all of the concerns we found at the last inspection had been addressed.

People and families continued to report concerns about their not knowing which staff were coming to support their care and when. People told us the evenings and weekends had always been an issue. Staff also raised concerns about not knowing who they were working with and when, even up to the night before. Some people had continuity of carers but they had experience the staff they knew well being taken away from them at short notice. People and staff raised questions about the staffing of the service. However, we found visits were never missed and a backup team was available to ensure people received the support they needed. The service was managing a high level of staff sickness compounded by planned leave for other staff. Rotas to people and staff were being affected. This meant there were fewer staff to go around, and people were experiencing higher levels of disruption and not knowing who would give their care and when.

People and relatives told us they had to be assertive and persistent with the service to ensure they had a continuity of care staff. Even then, this could be changed suddenly and they were back phoning the office to find out why their care staff had been changed. People also told us they did not always receive a visit at the times they preferred.

The office had undergone changes in management since the last inspection. Two managers had left and another one had now been employed. People told us the organisation and running of the office needed to be improved. They also told us their complaints about the organisation and running of the office had not been heeded.

People spoke of the care staff with fondness and felt they were caring, trained well and would act if they were poorly and/or unsafe. People were keen to say they were grateful for the staff role in their life and that despite the time demands on them, staff never rushed their care. People’s medicines were safely administered. Staff made sure people had enough to eat and drink. People looked forward to the staff coming and felt they were always respectful and protected their dignity.

Staff were recruited safely, underwent a detailed induction and completed a 12-week probationary period before their employment was confirmed. Their training was updated yearly and they had regular supervision to check on their professional development. Staff felt they were trained to the right level to effectively work with people. Checks were made on the ongoing competency of staff and staff felt they could ask for extra training and support at any time.

People had detailed, personalised care plans in place which ensured any risk was reduced. People and families spoke about being involved in the process of writing and reviewing the plans. Staff also said they could raise a question about the care plan being accurate and this was quickly addressed. All staff were kept up to date with changes in people’s care by secure email and text. The service was putting new processes in place to support people at their end of life.

Staff ensured people’s capacity to consent to their care and treatment was considered. They made sure people gave consent and understood when they were being asked to act in the best interests of people who could not consent.

Staff followed safe infection control guidelines in respect of personal safety and food preparation.

We found a breach of the regulations. 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.

HomeLife carers provide care to people in their own homes. They could be older or younger adults with a range of needs such as living with dementia, a sensory impairment, a physical disability or a mental health diagnosis. The service was providing personal care to 116 people in their own homes when we inspected.

This was the service’s first inspection since their registration with us on the 11 September 2015.

A registered manager was employed to manage 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 2008 and associated Regulations about how the service is run.

Prior to the inspection we received information of concern about the service. Concerns included staff training, new staff working without the training needed, staff not being introduced to people, poor management at the office, and people being placed at risk by not following safeguarding procedures. Also, staff were told to visit the next person or not being given enough time to travel to appointments and, staff were not speaking out in case they lost their employment. We highlighted we had these concerns to the registered manager and looked at them as part of the inspection.

We found most of the people and family carers we spoke with were frustrated with how their visits were organised. This had been an issue for some time and although their concerns had been shared with the service, it had not been successfully resolved. People told us they did not know who was coming to their home and when. The providing of staff rotas to people so they knew who would be visiting, had been inconsistent and at times the staff member who did visit people was not on people’s list or known to them. Staff told us they had at times been given unrealistic travel times which had made them late.

People had mixed experiences of having a familiar, known number of staff meeting their needs. They also had different experiences of how new staff were introduced into their team. Some people were very happy with how this was done; others expressed a deep dissatisfaction with this. We found the service had not always recorded people’s complaints and concerns and ensured these were met.

The registered manager was not reviewing parts of the service to ensure the quality of the service. For example, a range of audits were not taking place in addition to the annual satisfaction questionnaire. Staff attended regular staff meetings and felt they could give ideas. Staff told us if they asked for changes these were often changed for them as individuals.

People told us they were cared for by staff who were kind, considerate and respectful. Visits were never missed. People’s privacy and dignity were assured. People were involved in planning their care and staff made sure people controlled how they wanted their care needs met. People’s records were up dated but this was not always recorded. The registered manager reviewed this during the inspection and put new systems in place.

Where staff were responsible for making sure people were given their medicines as required this was achieved safely. People were also given enough to eat, drink and had their health needs responded to. Risk assessments were in place to keep people safe. Some issues that had been identified as risks in the care plans were not recorded as individual risks. For example, the risk of choking for one person. The registered manager addressed this immediately following the inspection.

Staff were recruited safely and in sufficient numbers to meet the needs of the service. Staff were trained and supported to be effective in meeting peoples’ needs. The provider has acted to improve aspects of the training, such as the staff induction and Care Certificate, following the inspection.

We found breaches of the regulations. You can see at the end of the full report on our website what action we have told the provider to take.