K2 Care Limited

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

The provider had systems in place to check the quality of the service provided. However, these were not sufficiently robust and had not identified the shortfalls we found during this inspection in relation to medicine records, and investigations. People received support to receive their medicines as prescribed. However, records did not always give staff clear guidance on what medicines they should administer, or what medicines people had taken. Senior staff did not always carry out robust investigations or take prompt action to reduce the risk of incidents recurring. However, the provider had recognised they needed to improve their governance systems and were receptive to feedback and responded quickly to address the shortfalls we found.

Staff knew the people they cared for well and understood, and met, their needs. People were protected from avoidable harm by a staff team trained to recognise and report any concerns. Staff assessed and minimised any potential risks to people. Staff followed the provider’s procedures to prevent the spread of infection and reduce the risk of cross contamination.

The provider had systems in place to make sure they only employed staff once they had checked they were suitable to work with people who used the service. There were enough staff to meet people’s needs safely. The registered manager reviewed staffing levels and people needs regularly. People received care from staff who were trained and well supported to meet people’s assessed needs.

Staff supported people to have enough to eat and drink. They worked with external professionals, following their guidance, to support people to keep well.

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 were involved in making decisions about their care and support.

Staff were respectful when they spoke with, and about, people. They supported people to develop their independence. Support was person-centred and met each person’s specific needs. People and their relatives were involved in their, or their family member's, care reviews. The registered manager sought feedback from people about the quality of the service provided.

People’s care plans provided staff with guidance on how to meet each person’s needs. The service did not provide specialist end of life care but would continue to care for people at the end of their life with support from external health professionals. The registered manager told us they were looking to further develop end of life and future wishes care plans to ensure people’s wishes were known to staff. Staff worked in partnership with other professionals to ensure that people received care that met their needs.

Systems were in place to deal with any concerns or complaints. The registered manager told us they tried to address any concerns at an early stage, thereby resolving issues before they became complaints.

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 (the last report was published 12 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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 announced inspection took place on 13 October 2016.

At the last inspection on 21 and 22 January 2016 breaches of legal requirements were found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to improvements to care plans which had not been updated when changes in people’s health and welfare had occurred; identified risks that had not been recorded and information about restraint had not been recorded or authorised. The provider sent us an action plan telling us how they would make the required improvements.

During this inspection we found that the provider had made the necessary improvements and all legal requirements were now being met.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 scheme is run.

People had their needs assessed and reviewed so that staff knew how to support them to maintain their independence. Peoples care plans contained person focussed information. The information was up to date and correct.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and could describe how people were supported to make decisions. Children and adults were protected against unlawful restraint.

People were assisted to be as safe as possible because risk assessments had been completed for all assessed risks. Staff had the necessary information they needed to reduce people’s risks and knew what to do in the event of the incident occurring.

The risk of harm for people was reduced because staff knew how to recognise and report abuse.

The provider’s recruitment process was followed and this meant that people using the service received care from suitable staff. There was a sufficient number of staff to meet the needs of people receiving a service.

People’s privacy and dignity was respected by staff and staff treated them with kindness. People were aware that there was a complaints procedure in place and felt confident to use it if they needed to.

Systems were in place to monitor and review the safety and quality of people’s care and support. People said they had been contacted for their comments about the service provided.

Staff meetings and individual staff appraisals were completed regularly. Staff were supported by the office staff and the registered manager during the day and an out of hours system was in place for support in the evening.

Systems were in place to monitor and review the safety and quality of people’s care and support. People said they had been contacted for their comments about the service provided.

Staff meetings and individual staff appraisals were completed regularly. Staff were supported by the office staff and the registered manager during the day and an out of hours system was in place for support in the evening.

Our last comprehensive inspection took place on 24 June 2013 where we found the provider was meeting four of the three of the six regulations we looked at. These were concerns about medication, recruitment and quality assurance. A follow up inspection, took place on 13 January 2014 when we found K2 Care Limited was now meeting the regulations. This announced inspection took place on 21 and 22 January 2016.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 scheme is run.

People had their needs assessed and reviewed so that staff knew how to support them to maintain their independence. Peoples care plans contained person focussed information. However the information was not always up to date or correct, which meant people could be at risk of poor or inadequate practice from staff.

Staff were not trained in the principles of the Mental Capacity Act 2005 (MCA) although some could describe how people were supported to make decisions. People were controlled and restrained without the required authorisation under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards.

People were not always supported to be as safe as possible because risk assessments had not been completed for all risks. This meant staff did not always have the information they needed to reduce risks. The risk of harm for people was reduced because staff knew how to recognise and report abuse.

The provider’s recruitment process was followed and this meant that people using the service received care from suitable staff. There was a sufficient number of staff to meet the needs of people receiving a service.

People’s privacy and dignity was respected by staff and staff treated them with kindness. People and their relatives were aware that there was a complaints procedure in place and felt confident to use it if they needed to.

Systems were in place to monitor and review the safety and quality of people’s care and support. People and their relatives said they had been contacted for their comments about the service.

Staff meetings and individual staff supervision were completed regularly. Staff were supported by the office staff and the registered manager during the day and an out of hours system was in place for support in the evening.

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

We reviewed the provider's staff files and found that any gaps in a staff member's employment history had not been explained. We also saw that references for one staff member did not match those listed on their application form. The provider had no record to explain this. This meant that the provider had not been able to evidence that they had taken all the necessary safety checks when employing new staff.

The provider could not demonstrate that they had an effective quality monitoring system in place. This was because we were unable to evidence that the provider was monitoring their medicines management and recruitment practices.

During this inspection on 13 January 2014, we found that the provider had taken the remedial action required.

The provider had made the required improvements to the care plans to instruct staff on how to prompt people's medication.

Effective staff recruitment was now in place to make sure that people received safe care from suitable and knowledgeable staff.

The provider had improved their quality monitoring of the service they provided through audits and action plans.

People's standard of care and welfare was maintained. Staff had access to care records to ensure that they provided safe care and support to people. One person told us that K2 Care Limited supported them to retain their independence.

People were protected from the risk of abuse because the provider had put appropriate measures in place.

When reviewing Medication Administration Records we did not see evidence that care plans contained adequate guidance for staff members. Records indicated that staff were administering medicines which was against the provider's policy. This meant that the provider could not ensure that people were protected against the misuse of medication.

When we reviewed the provider's staff recruitment files we found that employment history gaps had not always been documented as part of the safety checks undertaken.

We did not see that the provider had an effective quality monitoring system in place. This was because we were unable to evidence that the provider was adequately monitoring their medicines management and recruitment practices.

We found that the provider had good staff and care records which were kept in a secure location.

Two relatives of people who used the service that we spoke with said that they were confident to raise any issues or concerns with the provider. They also told us that they were confident it would be taken seriously and resolved.

All three staff could tell us the external agency they would contact if they had a concern and wished to remain anonymous. However, we found that people were placed at risk as two out of three staff who we spoke with were unable to define the different types of safeguarding abuse.

We found that staff had undergone training to ensure they could deliver a good standard of care and support to people who used the service.

We also saw that an effective complaints system was in place and that meant that people's feedback was listened to and reviewed to improve the service where appropriate.

We found that people were placed at risk of unsafe or inappropriate care and treatment. This was because during our visit we found evidence that the provider did not have an accurate record of each person using the service which included appropriate information and documents in relation to the care and treatment provided.