Compassionate Care Ltd

Compassionate Care Ltd is a domiciliary care agency that provides personal care to people living in their own homes. The service provides support to adults, people with dementia, people with mental health conditions and learning disabilities and people with physical disabilities and sensory impairments. At the time of our inspection there were 22 people receiving personal care at the service.

People’s experience of the service and what we found:

The service had effective systems to monitor quality and drive improvements . The provider was proactive in addressing concerns and where things had gone wrong. People told us they were supported by a regular staff team. The service had an effective system to monitor care delivery. Staff and people using the service told us they felt able to speak to the management team at any time. Staff felt supported by the new management team.

Care plans were personalised and contained sufficient detail to support people with any identified risks. The service raised safeguarding concerns appropriately and supported people throughout. Staff were recruited safely.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

The last rating for this service was good (published 9 June 2018.)

Why we inspected

The inspection was prompted in part due to concerns received about staffing, call times and the relationship between staff and the management team. A decision was made for us to inspect and examine those risks.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Compassionate Care Ltd provides personal care to people living in their own homes and to people within supportive living settings. At the time of our inspection the service was providing personal care to 52 people.

Why we inspected

The Care Quality Commission (CQC) have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about complaints handling and management of the service. A decision was made for us to inspect and examine those risks.

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

The culture and ethos within the service was one of continuous learning that placed people at its heart.

The registered manager and wider leadership team conducted their business in an open, honest and transparent manner.

Complaints or concerns raised with the service were managed effectively. A complaints log was maintained which recorded details of the complaint, management action taken, and details of the outcome.

Regular reviews would be conducted with people who used the service. The outcome of a particular review would be used to help shape people’s care plan and to ensure quality standards were being maintained.

Staffing structures within the service were clear and unambiguous. It was evident during our inspection visit that staff worked well together.

We found no evidence of wider systemic issues related to complaints handling or leadership and management of the service.

Rating at last inspection

The last rating for this service was good (published 11 June 2018).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Compassionate Care LTD 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.

This inspection took place on 15, 16 and 18 May 2018 and was announced. The provider was given 24 hours' notice because the location provides a service to people in their own homes and we needed to be sure staff would be available at the location to speak with us.

Compassionate Care Ltd is a domiciliary care service. It provides personal care to people living in their own homes in the community. They provide a service to people with dementia, mental health needs, a learning disability or autistic spectrum disorder, physical disability, sensory impairment, older adults and younger adults.

The service also provided support in a ‘supported living’ setting, so that people can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support. One location was situated in the Sheffield area for six adults with learning disabilities. The second supported living setting had been recently established for two people in the Macclesfield area who both had mental health needs.

Not everyone using Compassionate Care Ltd receives a regulated activity. The Care Quality Commission 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 our inspection the service was providing personal care to 54 people in their own homes in Trafford and Cheshire East.

At the previous inspection in April 2017, the service was rated as ‘Requires Improvement’ overall. This was because, although significant changes and improvements had been made to the service, these had not yet been fully embedded in respect of the requirements of the Mental Capacity Act 2005. During this inspection, we found the improvements had been made.

There was a registered manager at 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.

People's human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA). People's nutritional needs were met because staff followed people's support plans to make sure people were eating and drinking enough, and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing.

Staff knew people's individual needs and abilities. People told us their needs were met by well trained staff. Staff told us they received regular and adequate training and supervision to deliver effective care. People told us staff gave them choices and asked their permission before supporting them. Staff knew people's right to choice.

There were sufficient staff to meet people's needs. People told us staff generally arrived on time and contacted them if they were running late. Staff told us they had sufficient time between care visits.

People's medication was stored in their own home in line with their wishes and choices. A medication assessment was completed with each person and they were required to sign the consent agreement to enable staff to support them with medication needs. People were only supported by staff who were trained by the service and had passed competency assessments.

Staff were recruited safely. We saw that staff were only offered positions in the company once all satisfactory checks had been completed and references had been obtained.

Risk assessments were completed and reviewed every six months or when there was a change in people's needs. Risk assessments were completed for various aspects of people's clinical and emotional needs.

Information contained in people's care plans was person centred and reviewed regularly to ensure it was up to date and relevant. Information about people's likes, dislikes and life history was recorded and reviewed. Staff we spoke with demonstrated that they knew the people they supported well and enjoyed the relationships they had built with people.

Complaints were well managed and documented in accordance with the provider's complaints policy. The complaints policy contained contact details for the local authorities and commissioning groups.

Staff worked well together and felt supported by the management team, which promoted a culture for staff to provide person centred care. The provider's monitoring process had improved and looked at systems relating to the care of people, identified issues and staff took the appropriate action to resolve these. People's views were sought and changes made if this was needed.

Compassionate Care Ltd is a domiciliary care agency providing personal care and companionship in Trafford and Cheshire East. Care workers support the people using the service with a wide range of needs, including assistance with washing and dressing, accessing activities, attending health appointments, cleaning and making meals. Information provided by the registered manager indicated that the service was providing personal care for 58 people in total.

The service also provided support in the in a 24 hour supported accommodation for six adults with learning disabilities. This was located in the Sheffield area.

The service had a registered manager who was also the company's managing director. 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.

At the last inspection we found the provider was not fully adhering to Mental Capacity Act (MCA). At this inspection we found the provider still needed to address this area as we found there was no direct reference to the MCA in people’s care plans. We saw no capacity assessments, records of best interest meetings, or exploration of whether people using the service had devolved decision-making responsibilities to other people such as through a Lasting Power of Attorney.

At the last inspection we found care plans were person-centred, but did not always address people's identified care and support needs. At this inspection we found a number of improvements had been made and care plans now recorded people’s assessed needs.

People told us they felt safe when using the service; their relatives also said they felt people were safe. Staff we spoke with understood about safeguarding vulnerable people, they had received safeguarding training and said they would report any concerns appropriately.

People receiving support and their relatives complimented staff for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able.

The service had enough staff to attend the care visits scheduled. People receiving support and their relatives said care workers arrived on time and stayed for the duration of their allotted visits.

Some people using the service were assisted with their medicines; we saw these were well managed by the service. Care staff administering medicines received training.

The service undertook risk assessments for all aspects of the care and support people received in their homes. Care workers had been trained in infection control and used personal protective equipment when they supported people with personal care.

Staff received the training they needed to care for the people safely. New care workers who had not previously worked in health and social were undertaking the Care Certificate. The care certificate is a nationally recognised set of induction standards for people new to working in care.

Care workers had received regular informal supervision and had a documented annual appraisal. They also attended regular team meetings.

People receiving support and their relatives told us that care workers respected their privacy and dignity and promoted their independence. Care workers we spoke with could provide examples of how they did this.

Care workers could demonstrate that they knew people's likes and dislikes and the service tried to match people with care workers they would get on with.

People receiving support and their relatives (when appropriate) were involved in developing their care plans. They told us the service was flexible and they could change their care plans if they wanted to. Daily records reflected people's care plans and people told us the content was accurate.

We saw the service acted upon feedback and had dealt with complaints in a timely way in accordance with their complaints policy. None of the people receiving support or relatives we spoke with had ever made a formal complaint.

The provider had arrangements in place to receive feedback from people who used the service, their relatives, and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture and relatives and staff were comfortable to speak with the registered manager if they had a concern.

The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We found one breach in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 11: Need for consent.

You can see what action we told the provider to take at the back of the full version of the report.

Compassionate Care Ltd is a domiciliary care agency providing personal care and companionship to about 50 people in Trafford and Cheshire East. Care workers support the people using the service with a wide range of needs, including assistance with washing and dressing, accessing activities, attending health appointments, cleaning and making meals.

The service had a registered manager who was also the company’s managing director. 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.

At this inspection we found that not all care workers had not received training on the Mental Capacity Act (MCA). It was not clear from care records which people had relatives with lasting power of attorney to make decisions on their behalf. Some relatives had signed consent forms for people who had not had an assessment to determine whether or not they could make their own decisions.

Care plans were person-centred but did not always address all of people’s identified care and support needs.

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

People told us that they felt safe when using the service; their relatives also said they felt people were safe. Staff we spoke with understood about safeguarding vulnerable people, they had received safeguarding training and said they would report any concerns appropriately.

The service had enough staff to attend the care visits scheduled. People and their relatives said that care workers arrived on time and stayed for the duration of their allotted visits.

Some people using the service were assisted with their medicines; we saw that these were well managed by the service. Care staff administering medicines received training.

The service undertook risk assessments for all aspects of the care and support people received in their homes. Care workers had been trained in infection control and used personal protective equipment when they supported people with personal care.

Staff received the training they needed to care for the people safely. New care workers who had not previously worked in health and social were undertaking the Care Certificate. The care certificate is a nationally recognised set of induction standards for people new to working in care.

Care workers had received regular informal supervision and had a documented annual appraisal. They also attended regular team meetings at which the vision and values of the service were discussed.

The people who needed help to buy food or prepare meals were happy with the support they received from care workers. The service also rearranged visit times in order to accompany people to healthcare appointments.

People and their relatives told us that care workers respected their privacy and dignity and promoted their independence. Care workers we spoke with could provide examples of how they did this.

Care workers could demonstrate that they knew people’s likes and dislikes and the service tried to match people with care workers that they would get on with.

People and their relatives (when appropriate) were involved in developing their care plans. They told us that the service was flexible and that they could change their care plans if they wanted to. Daily records reflected people’s care plans and people told us that the content was accurate.

We saw that the service acted upon feedback and had dealt with complaints in a timely way in accordance with their complaints policy. None of the people or relatives we spoke with had ever made a formal complaint.

The service had an audit and monitoring system in place for care plans, medicines and accidents and incidents. People and staff received annual surveys asking for feedback on various aspects of the service so that improvements could be made. We saw that the registered manager had acted upon feedback received in the November 2015 survey.

Care workers were actively encouraged by the registered manager to get involved with service improvement; they also understood the vision and values of the service. The registered manager gave recognition to staff members and they felt valued as employees.