Archived: Care Central Limited (Walthamstow)

We also followed up findings of a previous inspection which found the provider non-compliant with management of medicines to check whether improvements had been made. Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with nine people using the service, four relatives and eight staff and looking at records relating to people's care and support and management of the service. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe in the service. We found sufficient staff were available to deliver people's care and support needs and they received the training required to provide safe, appropriate care and support. Appropriate checks were carried out before staff started working with people to ensure they had the appropriate knowledge, skills and experience to meet people's care and support needs.

People were protected from the potential for abuse and neglect as the provider had taken reasonable steps to ensure staff recognised the signs of abuse. Staff we spoke with demonstrated their knowledge in recognising signs and symptoms of abuse and how to report concerns. The registered manager demonstrated how concerns were investigated with necessary actions identified, taken and followed up.

We found that people's medicines were handled safely and appropriately in line with guidance. Records were accurately maintained, which meant the risk of people receiving unsafe care was minimised.

Is the service caring?

People told us they were treated with respect and dignity by the staff. We found people were supported appropriately and sensitively by kind and considerate staff. We spoke with staff who told us about how they provided care and support. People we spoke with were positive about the caring nature of staff members supporting them. One person told us, 'I have a carer who helps me with personal care. She is such a nice lady, very sensitive and gentle.' A family member of a person using the service told us, 'the carers are all lovely, friendly and approachable.' Another person told us, 'I wasn't feeling well once and the carer stayed longer than they were meant to, chatting to me and reassuring me until I felt better.'

Is the service effective?

People's health and care needs were assessed with them. We saw evidence to show people and their relatives or advocates had been involved in writing and agreeing their care plans. Specialist dietary and healthcare needs had been identified in care plans where required. People we spoke with and their relatives told us they received the support needed. People's care was subject to review so staff could ensure their needs were being met effectively.

Is the service responsive?

People we spoke with and staff we spoke with demonstrated they would report any concerns to the registered manager and were confident these would be addressed. This was confirmed by person using the service who told us, 'I had concerns about a carer once, I wasn't very happy with them. The agency was able to send a different person instead and I'm much happier now.'

We had concerns the provider did not have an effective system in place to analyse any incidents that occurred when providing care and support for people in their homes.

We saw there was an effective complaints procedure in place. One person told us, 'I've never had to make a complaint as such but I did have a little gripe once. I spoke with the people at the office and they dealt with it for me. I am sure they would address any complaint I had.'

Is the service well led?

People we spoke with, staff and relatives were positive about the management of the service. Staff told us they felt supported by the registered manager and other senior staff.

We found monitoring and reviews of the service were carried out periodically and highlighted actions were mostly completed in a timely manner.

We spoke to the manager and they showed us the measures they had put in place to ensure medication administration record (MAR) charts had no unexplained gaps. They now audited every MAR chart each month to check they were fully completed.

However, the service did not record all individual medicines on the MAR chart and had pre-typed "Blister Pack" which meant that the service could not monitor which medication people had taken or not.

At our last inspection in May 2013 we found that people's personal records were not accurate and fit for purpose. At this inspection, we found the provider had taken action to meet this standard and had reviewed the ways in which they kept records. However, although we found improvements had been made, we found there were still unexplained gaps in medication records.

Staff we spoke to showed an understanding of procedures for gaining people's consent and were aware of people's individual and cultural needs as set out in their care plans.

People who used the service and their relatives gave positive feedback about the care provided and about the staff themselves. One person told us that her carer was "excellent" and the service was "very, very good." Three people commented that they were pleased with the continuity of care provided by the same staff over a period of time. Another person said, "It has made a tremendous difference to my life. They are reliable and of good quality."

The provider was aware of action required in terms of assessing and monitoring the quality of the service they provided, and had taken appropriate action. The agency had recruited a full-time quality assurance assessor who was responsible for carrying out spot checks on care provided by staff, and any concerns had been followed up in staff supervision.

Staff files contained information that was appropriate, thorough and up-to-date. However, we found that information about people using the service and the care provided to them was missing or inaccurate in some areas such as visit logs, medication records and financial records. The service did not have a clear policy for the maximum times that records should be kept.

Staff we spoke to were suitably trained and understood their responsibilities in order to maintain people's privacy and dignity when delivering care.

People who used the service spoke very positively about the service and that they all felt safe with the care staff. One person who used the service said "It's brilliant. I've had care from three different agencies and this one beats the other two hands down" another person said "They are first class."

All the relatives told us that they were happy with the packages provided. One relative said "The office call me to see if everything is alright." One relative we spoke to told us that they would like the carers to focus more on individual client needs and ask.

Every one had a risk assessment but we did find that some people's risk assessments were not being correctly updated and reviewed at the agreed time to protect people. Also the the provider's quality assurance system was not identifying where this was happening or when other documents that needed to be audited where correct.