Archived: Complete Care Services (Preston)

Complete Care Services (Preston) provides personal care to people living in their own homes in the community. Not everyone who used the service received personal care. Care Quality Commission (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. At the time of our inspection the service was providing personal care to 80 people.

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

People did not always receive consistent and reliable care and treatment. We received mixed responses in relation to the safety of the care provided with overwhelmingly negative feedback. The providers’ risk management practices were not robust, this included the assessment of risks associated with financial abuse, self-neglect and infection prevention. People’s medicines were not always managed safely. Safeguarding procedures and staff disciplinary procedures were not always followed to ensure allegations were robustly investigated. The provider had not implemented safe recruitment practices needed to protect people from unsuitable staff.

People’s human rights were not always upheld. People and their relatives gave us mixed responses regarding staff’s attitude. Some told us they were not always treated with dignity and respect, some staff were impatient, rushed them and were always in a hurry. Planned delivery of care had not always been carried out. Some staff had visited but not assisted people as planned this included meal preparation, leaving them in soiled bedding and not summoning for medical assistance where a person had deteriorated. Staff visited people late and at times assisted them to bed too early against their wishes.

The provider’s governance systems did not support the delivery of safe care and compliance with regulations. Systems for monitoring care visits, maintaining care records, risk management, auditing, staff and supervision were inadequate. The registered manager was not adequately supervised to check how they were managing the service and managing the delivery of care. People and staff did not always feel listened to by management. We made a recommendation about engaging people.

People’s care plans were not always followed to show a person-centred approach to care. Records of care completed were not always an accurate reflection of the actual care provided. People’s complaints were not dealt with effectively to improve people’s experiences. Comments from people included; “There is no point of complaining, nothing is done about it” and, “We have raised concerns a number of times, but nothing changes.”

People’s care was not always delivered in line with guidance. Staff did not always visit people as planned or stayed the duration of the planned visits to effectively support people. People were not adequately supported to meet their dietary needs. We made a recommendation about dietary support. The registered manager had supported staff with a range of training; however, improvements were required to ensure staff received training on the use of personal protective equipment.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At the last inspection the service was rated good (published 4 August 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, safeguarding people, person-centred care, dignity and respect, good governance, complaints management, record keeping at this inspection. 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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Complete Care Services (Preston) is a domiciliary care agency providing practical and personal care to people living in their own homes in the Preston and surrounding areas. The agency includes supports for older people, dementia, mental health, physical disability and younger adults. In addition the agency provides support for people who misuse drugs and alcohol, learning disabilities and people detained under the mental health act. The agency is part of a private company that has three branches in the north west. Parking is provided outside the office building.

At our last inspection on 28 September 2017 we asked the provider to take action to make improvements because we found breaches of legal requirements. This was in relation to their lack of auditing systems to identify and act on any issues. The service was rated Good overall during the inspection. At this inspection we found the provider had made improvements to ensure they met legal requirements. We found their auditing systems had improved to ensure the service was monitored in a timely manner and improvements made when required. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was not registered manager in place. 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. However, they were in the process of recruiting a suitable candidate as the previous registered manager had only recently left the service approximately two months ago.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People we spoke with and visited told us the service they received was provided by caring, polite and respectful staff. For example positive comments we received included, “Love the staff I have to say they are caring and nothing is too much trouble.” Also, “The carers close the blinds because I’m at the front of the house.”

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and confirmed this when we spoke with them.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified care and support people required to suit their individual needs. We found they were informative about care people had received. They had been regularly reviewed and changes made when required so they were up to date. Staff had the right information to reflect people’s changing needs and tasks required when visiting people in their own home.

The service had the same good systems for recruiting staff in place from the previous inspection.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People's care and support was planned with them. One person said, “Staff from the service came when I was in hospital and did the plan it’s been reviewed.”

Staff supported people to have a nutritious dietary and fluid intake. Assistance was provided in preparation of food and drinks as people needed.

People were supported to have access to healthcare professionals and their healthcare needs had been met. They were supported by the agency if required.

People who used the service and relatives we spoke with said staff and the manager who visited them treated them with respect and dignity.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The service had kept a record of complaints received and these had been responded to appropriately.

The service used a variety of methods to assess and monitor the quality of the service. These included, staff meetings, spot checks by senior staff, quality assurance visits, satisfaction surveys and care reviews.

The manager and staff were clear about their roles and responsibilities and were committed to providing a good standard of care and support to people in their care.

Further information is in the detailed findings below.

Complete Care Services (Preston) is a domiciliary care agency providing personal care to people in the Preston and surrounding areas, living in their own homes. The agency covers a wide range of dependency needs including older people with a physical or learning disability and older people living with dementia or mental health problems. The agency's office is located on Preston’s Dockland, Riversway. At the time of our inspection there were 140 people receiving a service from Complete Care Services (Preston).

The service had a registered manager in place. 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 on 23, 24, 27,28,30 April & 01May 2015, we asked the provider to take action to make improvements related to consent, the administration of medicines and training. We requested there was a registered manager in post and all incidents requiring notification to commission were completed. We noted all these actions had been completed.

At this inspection, we noted auditing systems in use did not identify when staff had failed to document the care and support delivered.

This was a breach of Regulation 17 HSCA (RA) Regulations 2014 (Good governance).

Staff had received safeguarding from abuse training. They understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure. One staff member told us, “We did safeguarding training, it was very detailed.”

The provider had procedures around recruitment and selection to minimise the risk of unsuitable employees working with vulnerable people. Required checks had been completed prior to any staff commencing work at the service. This was confirmed during discussions with staff.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service. The number of people being supported and their individual needs determined staffing levels. Staff members we spoke with said they were allocated sufficient time to be able to provide the support people required.

Staff responsible for assisting people with their medicines had received training to ensure they were competent and had the skills required. Documentation indicated people were supported to meet their care requirements in relation to medicines.

Staff members received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. One staff member told us, “We get quite a lot of training.”

People and their representatives told us they were involved in their care and had discussed and consented to their care packages. We found staff had an understanding of the Mental Capacity Act 2005 (MCA).

When required, people were supported to maintain a balanced diet to prevent the risk of malnutrition and dehydration. This included staff preparing snacks and drinks for people in their own homes.

The registered provider worked with other health care services to meet people’s health needs. Care records contained information about the individual’s ongoing care requirements.

People spoke about care staff who visited in a warm, compassionate manner. They told us they were treated with kindness and staff who visited them were respectful and caring. Care records we checked were personalised around people’s likes and preferences

A complaints procedure was available and people we spoke with said they knew how to complain. We saw examples where a complaint had been received, responded to, investigated and the outcome documented.

Staff spoken with felt the management team were accessible, supportive and approachable and would listen and act on concerns raised.

We had received information that some care staff were not tuning up at people's homes at the scheduled time. Also that care staff were not staying for the allotted time period to provide care and support to people who used the service.

People told us they were happy with the level of care and support received from the care staff. People told us staff were helpful and friendly.

We spoke with six people who used the service. Two people we spoke with told us they had not encountered any problems around the timing of visits.

Four people we spoke with told us they had problems with care staff not turning up on time and leaving before the allotted time for the visit had ended. We were able to evidence this happening ourselves. Which meant the planning and delivery of care did not meet the needs of people who used the service.

The provider had systems and checks in place to monitor the quality of the service provided. People told us their views were sought and acted on. We did find that one of these checks may not have been effective as it had not picked up on the issues of care staff not arriving on time.

Policies and procedures were in place around complaints. People we spoke with knew how to make a complaint. However people we spoke with told us they were reluctant to make formal complaints about the timing of visits as they felt sorry for the care staff.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People and their relatives told us they felt safe and comfortable when they received support from Complete Care Services. One relative told us, 'I feel my husband is very safe in their hands. I have absolutely no worries about that'.

Our discussions with staff confirmed they were trained in the use of equipment utilised to support people in their care. This meant the provider had protected people from unsafe care by ensuring staff were adequately trained.

We saw evidence that people were supported with their medication appropriately. One relative told us, 'I am satisfied the carers are well-trained and know what they're doing with mum's medication'. This showed people were protected against the risks of unsafe management of medicines because appropriate protocols were in place.

Records we reviewed confirmed staff were recruited safely. One person told us, 'I am confident that the company recruits and trains staff properly. A new worker started this week and she was very good'. This meant the provider had ensured people were protected against unsafe care because staff were properly recruited and trained.

Is the service effective?

We observed that staff respected people and enabled them to make decisions about their care. One relative told us, 'They have involved us in my husband's care plan. We agreed and discussed some changes around his reduced mobility'. This meant people were safeguarded against inappropriate care because the service was effective in consulting people about their changing needs.

People told us where their needs had changed the agency was effective in acquiring appropriate equipment to support them. People's social, health and support needs were assessed and regularly reviewed. Support plans were individualised and risk assessments were in place. This meant people were protected against ineffective care provision because people's changing needs were monitored.

Is the service caring?

We spoke with people and their relatives to gain an understanding of their experiences of the support they received. Their response was very positive. One person explained, 'The carers are like my angels. I wouldn't want to change a thing'. A relative told us, 'They're very polite and they advise rather than take over. They treat mum as an individual'.

Staff explained that they worked in a caring and friendly manner. They described being respectful to and working with people to understand their needs. One staff member told us, 'The company are fantastic at keeping us up-to-date with training. It adds to my experience and understanding, especially in the specialist care we provide for people'. This showed people were safeguarded against inappropriate care provision because staff understood people's individual needs.

Is the service responsive?

People's needs were properly assessed, monitored and reviewed. This meant the provider had continuously assessed whether the service was able to maintain people's care levels. One staff member told us, 'We look at people's changing needs with our supervisors, who will then amend the care plan'.

People told us they were involved in the review of their care. One person said, 'They have involved us in my husband's care plan. The manager saw us recently and we agreed some changes around his reduced mobility'. This demonstrated the provider had minimised the risks of unsafe care because the service had responded to people's changing needs.

Is the service well-led?

Complete Care Services had a range of quality audits in place. Other regular processes underpinned this, such as staff supervision and team meetings. People who accessed the service were given the opportunity to feedback about the service. This meant people were protected against inappropriate care because the manager had systems to check the quality of care.

One staff member told us, 'Managers will regularly contact service users directly to check how I'm doing and the care they've received. I get feedback from my manager, which is very useful in my work'. This showed the manager ensured people received appropriate care because their views were actively sought and acted upon.

Care assessments and care plans were in place and these were followed in practice. We found that people usually had the same team of carers and they arrived on time for their visits. One person said, 'My mum has four visits a day, seven days a week and she has the same team of carers. It seldom changes, only for holidays and illness'.

We found that safe and effective recruitment processes were in place and that the service had a staff team that was appropriately qualified and experienced to provide a safe and effective service. A staff member said, 'The training is fine and its always being updated. We aren't asked to do anything we don't feel able to do'.

People who used the service were able to give their views about the service. Systems were in place to assess and monitor the quality of the service that people received. An effective complaints system was in place.

"All the people are polite and caring."

"The staff are always on time and know exactly what to do when they get here. They provide me a lifeline."

"I need a lot of help to get washed and dressed, they never get impatient with me and treat me with respect and dignity."

"We have had one or two agencies but these are definitely the best. The carers are well presented, competent and the manager always checks up with me to see if everything is ok."

One person we spoke with told us they were satisfied with the level of care and support they receive from the agency. Comments included, "The staff went through everything with me."

We spoke with five people who use the service, about their experiences being supported by the agency. They told us the staff and management provided sensitive and flexible personal care support and they felt cared for.