Archived: Sevacare - Northampton

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 and younger adults, who have a variety of support needs. At the time of our inspection there were 133 people using the service.

Not everyone using Sevacare - Northampton 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 take into account any wider social care provided.

There was 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.

At the first announced comprehensive inspection on 5 and 6 March 2015, we found the service to be rated Requires Improvement as there was no registered manager in post and communication between staff and people regarding delays or other changes to the service had not always been timely.

At the second announced comprehensive inspection on 26 May, 1, 2, 3 and 13 June 2016 the service continued to be rated Requires Improvement and the provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements in relation to the governance of the service and the completion of medicines records. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations.

At the third announced comprehensive inspection on 18, 19, 20 and 26 July 2017 the service continued to be rated ‘Requires Improvement’. We found continuing concerns in relation to the governance of the service and completion of medicines records. We also found concerns regarding the timing of people’s care visits and the actions taken in response to people’s feedback and concerns. The service continued to be in breach of one regulation and we took enforcement action. The provider was required to be compliant by the 30 September 2017.

This was the fourth announced comprehensive inspection of the service and the service continues to be rated overall ‘Requires Improvement’. The provider had not taken sufficient action to meet the breach of regulation or to comply with the requirements of the enforcement action.

There were insufficient systems in place to assess, monitor and improve the service. Where the provider had identified issues with the quality of the service they had failed to implement the

changes required.

People were not always adequately assessed for their risks or have plans of care to mitigate their known risks. There was no system in place to assess people using current standards or evidence based guidance. People at risk of malnutrition did not have their nutritional needs assessed to ensure that they were supported to maintain an appropriate diet. People were provided with the support they required to prepare their meals.

People did not always receive their care at the times agreed. Staff did not always arrive at the time specified on the rota or stay the whole allocated time.

The principles of the Mental Capacity Act 2005 (MCA) had not been followed when developing people’s plans of care. People had not been involved in the assessments of their capacity, the least restrictive options had not been explored when developing people’s plans of care and there was no evidence of consideration to whether the strategies that were being used to support people were in their best interest.

People’s medicines were administered as prescribed; however, the medicines administration records were not always completed accurately to provide a clear account of the medicines administered to people.

There was no system in place to ensure that people’s feedback and concerns were reported to the appropriate person. This meant there was a risk that people's verbal complaints would not be analysed or resolved. Where people made written complaints there were systems in place to act on them.

The provider did not have sufficient end of life care plans in place to ensure that, people that chose to stay at home as they approached the end of their life, could be supported to have a comfortable, dignified and pain free death.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

People's care was provided by staff that had received appropriate training to carry out their roles.

Staff had been provided with safeguarding training to enable them to recognise signs of abuse and they knew the procedures for reporting abuse.

Staff treated people with kindness and compassion. They spent time getting to know people and their specific needs and wishes. People were involved in their own care planning and were able to contribute to the way in which they were supported.

People were protected from the risk of infection by staff that complied with the infection prevention policy.

There were systems in place to ensure people with a disability or sensory loss could access and understand the information they were given. These complied with the Accessible Information Standard.

At this inspection, we found the service to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. Full details regarding the actions we have taken are added to reports after any representations or appeals have been concluded.

The service provides support with personal care to people in their own homes. At the time of our inspection there were 140 people using the service.

The service is required to have a registered manager; there was no registered manager in post at the time of our inspection. The registered manager had recently left and a new manager was in post, they were aware that they would need to register as the manager for 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.

At the inspection on 5 and 6 March 2015 we found the service to be rated Requires Improvement as there was no registered manager in post and communication between staff and people regarding delays or other changes to the service had not always been timely. At the last inspection on 26 May, 1, 2, 3 and 13 June 2016 we found the service continued to be rated Requires Improvement; the provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements in relation to the governance of the service and the completion of medicines records. During this inspection we found that some of these actions had not been completed. This is the third inspection at which the service has continued to be rated as Requires Improvement.

The provider did not have all appropriate measures in place to assure themselves of the quality and safety of the service. People could not always be assured that their care visits would take place at the agreed time. The provider was aware of this and was currently working to improve the consistency and timing of care visits when people’s regular care staff were unavailable.

The systems in place for responding to people’s feedback required strengthening. People had mixed views regarding how the service had responded to concerns and complaints. Some people and their relatives were dissatisfied with the manner in which the provider had handled their feedback.

Medicines records were not always completed accurately and did not provide a clear account of medicines administered to people. The provider was aware of this and had taken action to ensure that all staff accurately recorded the medicines they had administered. It was evident that some improvements had been made.

There were systems in place to manage medicines safely. Staff were trained in the safe administration of medicines and people had specific assessments relating to the provision of their medicines.

People were protected from harm arising from poor practice or abuse as there were clear safeguarding procedures in place for care staff to follow if they were concerned about people’s safety. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns.

Recruitment procedures were sufficiently robust to protect people from receiving unsafe care from staff that were unsuitable to work at the service.

People were actively involved in decisions about their care and support needs as much as they were able. Staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA2005) and applied their knowledge appropriately.

People received care from staff that were kind and friendly. People had meaningful interactions with staff and looked forward to seeing the staff. People received care at their own pace and were treated with dignity and respect.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe. Care plans were written in a person centred approach and detailed how people wished to be supported and where possible people were involved in making decisions about their care.

People received care from staff who had the appropriate skills and knowledge to meet their needs. All staff had undergone the provider’s induction and the provider had a plan in place for on going training.

At this inspection we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this

report.

At the time of the inspection there was no 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. There was a manager in post who was in the process of applying to become the registered manager.

People told us that they felt safe. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed. The recruitment practice protected people from being cared for by staff that were unsuitable to work in their home. Staff were supported through the induction and training programmes in place, however formal supervision and spot checks of their practice was inconsistent.

Some aspects of the record keeping systems were in need of improvement; medicines records were not always completed accurately and failed to give a clear account of the medicines administered to people. Although people were involved in reviews of their care, risk assessments and care plans did not always provide sufficient detail to guide or support staff in the provision of consistent care and support. Reviews or changes to care plans were not always recorded and communicated as promptly as they needed to be.

People were supported to maintain good health and were supported to have access to healthcare services when needed and were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005.

Staff had good relationships with the people who they supported. Complaints were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to.

Quality monitoring processes needed to be strengthened to ensure that the provider fully understood the development needs within the service and to enable it to focus improvement activity to ensure required standards were met.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

When we inspected on 5 February 2014 we found that some people had experienced missed calls and this posed a risk to people's health and safety needs. The provider sent us an action plan setting out what needed to be done to put this right. During this visit we found that the provider had made, and sustained, the necessary improvements required. We saw that new monitoring systems were put in place to ensure people's health and safety needs were appropriately protected to keep them safe.

The registered manager had assessed each person to ensure their views were considered in the planning of people's care. People received regular assessments of their needs in order to identify any areas of risk in delivering their care. People's care records contained accurate information to ensure staff understood how to deliver care.

Is the service effective?

Effective systems were in place to monitor the management of the service. We saw that people's care plans and risk assessments were regularly reviewed and updated as and when their needs changed. Staff told us that these plans were detailed and provided them with good information in how to meet people's needs. The people and their representatives had signed the care plans to agree to how they wanted to be cared for by staff. They told us that their needs were being met. We found people's daily care notes were more detailed and showed what they did each day and the support they had received.

Is the service caring?

People were supported by kind and caring staff. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. We saw that the registered manager and care staff had a good understanding of people's needs and how to support and care for them.

Is the service responsive?

The provider took action from the outcome of our last inspection visit. We saw that they had worked with other agencies to help them improve their service to meet people's needs. We saw that the manager promptly investigated complaints and took appropriate action to resolve the situation and ensure people's needs were met. Telephone monitoring and three monthly assessments took place with people using the service to listen to their views about the service they received and suggestions made were acted upon by the manager

Is the service well-led?

We saw that the provider had immediately acted upon what we found when we inspected on 5 February 2014. We saw that the provider had systems in place to monitor the quality of services that people received. Staff received training, supervision and support from management, which helped them to provide safe and effective care.

We spoke with 18 people who had experience of the service. People gave us a mixed response with some having only positive comments about the service and others requiring improvements to their care. A common theme of negative feedback was carers not arriving on time, and rushing to leave. One person told us, 'When the carers have been asked to arrive earlier to get my relative ready, they usually arrive late and have to rush to get them ready. They rarely phone to say they will be late'. However another person told us, 'I have some of the best carers, no bad words to say'.

We found that carers arrived too early, too late, did not stay for the allocated time and sometimes missed people's care altogether. We found that care plans did not contain accurate information and people who used the service often experienced problems when they did not see the same carer on a regular basis. We found that safeguarding records were appropriately maintained and safeguarding investigations were conducted in a timely manner.

We found that improvements were required to how the service was assessed and monitored but found adequate improvements had been made to how complaints were handled.

The people we spoke with gave us a variety of feedback. Some people told us that they were happy with the care that they received and told us that the staff treated them with dignity and respect. However many people told us that their carers were frequently too early, too late, did not stay for the allocated time or did not arrive to provide care.

We found that people did not always receive the care and support they expected as it was not carried out as it was recorded in their care plan. We also found that the provider did not deal with safeguarding incidents appropriately and the systems that were in place to ensure people received good care and support were ineffective. We found that complaints were not recorded or responded to in accordance with the provider's policy.