Classic Home Care Services Limited

Classic Home Care Service Limited provides a domiciliary care service to people living in Epsom and the surrounding area. Care and support is provided to people living in their own homes and flats. Support is provided to people living with dementia, learning disabilities, younger adults and people living with mental health needs. At the time of our inspection the service was providing support to 57 people receiving the regulated activity.

Not everyone using a domiciliary care agency 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, such as supporting people to access the community.

People's experience of using this service:

People told us they felt safe and well supported in their own homes. People and relatives told us they thought the staff supporting them were well trained and knew all about their needs.

The provider had made improvements following the last inspection with regards to how individual risk was identified and assessed for people. Potential risks to people had been assessed and measures put in place to mitigate these. The registered manager sent us additional examples of how they are continuing to identify risk for people and continuing to think of new ways to adapt risk assessments. If accidents or incidents occurred, staff acted to reduce the risk of similar incidents happening again.

The provider had improved the management and oversight of people’s medication. The provider had introduced a new electronic system for people’s medicines which had allowed improvements to be made from the previous inspection and the registered manager told us this had really supported and driven change within the service to safely manage people’s medicines.

People and relatives told us staff maintained appropriate standards of hygiene and infection control and supported them appropriately through the COVID-19 pandemic. Staff supported people to maintain good health and worked effectively with any professionals involved in their care.

The provider took great care when recruiting new staff to ensure they met the values of the service. Staff understood and practised their responsibilities to keep people safe from harm.

The provider had made improvements to the way the principles of the Mental Capacity Act 2005 (MCA) were adhered to. Where relatives had signed on behalf of the person to consent to care the provider had in place the correct legal authority documents. 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 supported by staff who promoted their independence as much as possible. People and relatives told us carers were motivated to make a difference and that they made them feel happy, safe and gave them confidence.

People and relatives reported that they were very satisfied with the quality of care and support they experienced, and they had been able to give feedback to the provider.

People and relatives told us they felt the service was well run and that they could contact the registered manager or office team whenever they needed. People and relatives said they felt listened to and able to offer their opinions on the care and support in place.

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

Rating at last inspection and update.

At our last inspection, the service was rated "Requires Improvement". Our last report was published on 04 June 2019.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we Inspected:

We carried out an announced comprehensive inspection of this service on 10 May 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Need for Consent.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection

Follow up:

We will continue to monitor intelligence 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.

Classic Home Care Service Limited provides a domiciliary care service to 90 people living in Epsom and the surrounding area. Care and support is provided to people living in their own homes and flats. Support is provided to people living with dementia, learning disabilities, younger adults and people living with mental health needs. Live-in care was also provided to five people at the time of the inspection.

Not everyone using a domiciliary care agency 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, such as supporting people to access the community.

People’s experience of using this service:

People and their relatives told us they were happy receiving care and support from Classic Home Care Services Limited. People received their medicines on time and care worker’s competency to safely support people to take their medicine had been assessed. However, best practice guidelines around the safe management of medicines had not consistently been followed. Risk assessments were not in place when medicines were left out, protocols were not in place for the use of ‘as required’ medicines and Medication Administration Records (MAR charts) had not consistently been amended following changes in prescribing instructions.

Further improvements were needed to ensure that risk assessments and care plans were sufficiently detailed, so care workers had clearer guidance.

The principles of the Mental Capacity Act 2005 (MCA) were not consistently adhered to or followed. For example, some people’s care plans were signed by their relatives. Consideration had not been given to establishing whether the person was unable to sign and consent to their care plan and whether their relative had the legal authority to sign the care plan.

Auditing processes were in place but failed to consistently identify shortfalls and drive improvement. We have made a recommendation about the quality assurance and audit process.

Care workers treated people with dignity and respect and helped to maintain people's independence by encouraging them to care for themselves where possible. One person told us, “They encourage us to be independent.” Another person told us, “The girls are lovely.”

People were supported to maintain a balanced diet where care workers were responsible for this. People received the support they needed to stay healthy and to access health care services as and when required.

Relatives spoke positively about care workers supporting their family members and told us they were kind, caring and patient and treated them with dignity and respect.

A complaints policy was in place and people told us they felt confident in approaching the registered manager with any concerns or queries. Feedback was regularly sought from care workers, people and their relative and used to drive improvement.

Rating at last inspection:

At our last inspection, the service was rated "Good". Our last report was published on 29 November 2016.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. Action we told the provider to take is outlined at the back of the report.

Follow up:

We will speak with the provider following the publication of this report to discuss how they will make changes to ensure the rating of the service is increased to at least Good. We will continue to monitor intelligence we receive about this service until we return to visit as per our re-inspection programme. An action plan from the provider will also be requested. If any concerning information is received, we may inspect sooner.

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

Classic Home Care Services Limited provides a range of services to people in their own home including personal care. They covered two geographical area of Surrey, one included Epsom and Cheam, and the other Ashtead, Leatherhead, Bookham and Fetcham. People using the service had a range of needs such as learning and/or physical disabilities and dementia. The service offered support to people over the age of 18 years old. At the time of our inspection 100 people were receiving personal care in their home. Most people were paying for their own care, but five people were funded by their local authority.

The service was last inspected on 12 November 2013, where we found that the provider was meeting all the standards we inspected.

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.

The risks to people's wellbeing and safety had been assessed, and there were detailed plans in place for all the risks identified.

There were procedures for safeguarding adults and the care workers were aware of these. Care workers knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

Feedback from people and their relatives was positive. Most people said they had regular care workers visiting which enabled them to build a rapport and get to know them.

People's needs were assessed by the provider or, in some cases, by the local authority prior to receiving a service and support plans were developed from the assessments. People had taken part in the planning of their care and received regular visits from the care managers.

People we spoke with and their relatives said that they were happy with the level of care they were receiving from the service.

The registered manager was aware of their responsibilities in line with the requirements of the

Mental Capacity Act (MCA) 2005 and told us that all staff had received training in this. People had consented to their care and support and had their capacity assessed prior to receiving a service from Classic Home Care Services Limited. Nobody was being deprived of their liberty unlawfully at the time of our inspection.

There were systems in place to ensure that people received their medicines safely and the care workers had received training in the management of medicines.

The service employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff absence. Recruitment checks were in place to obtain information about new staff before they supported people unsupervised.

People's health and nutritional needs had been assessed, recorded and were being monitored.

Care workers received an induction and shadowing period before delivering care and support to people. They received the training and support they needed to care for people.

There was a complaints procedure in place which the provider followed. People felt confident that if they raised a complaint, they would be listened to and their concerns addressed.

There were systems in place to monitor and assess the quality and effectiveness of the service, and the provider ensured that areas for improvement were identified and addressed.

People, staff and relatives told us that the registered manager and senior team were approachable and supportive. There was a clear management structure, and they encouraged an open and transparent culture within the service. People and staff were supported to raise concerns and make suggestions about where improvements could be made.

We spoke with a young person with high needs and they told us about the service, ' they are the best.'

Another person told us that they had a lot of visits a day and 'sometimes I get a complete stranger to the door but the carers themselves are very good'.

A relative we spoke with told us ' the carers know exactly what to do, I'm quite happy .. it's very safe'.

Another relative told us the person they cared for chose the provider and employed them direct- 'they are doing very well'.

A member of staff told us that they got to understand about people's choices and preferences by listening to them, ' most people can communicate their needs, I also observe body language. I get to know people, their habits and routines. I can tell if they are in distress.'

Another member of staff told us that 'the matching is good here -they try to match the person with the right carer'.

We spoke with a person in receipt of a live in package who told us 'the service is very good and when the carer has a holiday everything still runs very smoothly'.

One member of staff told us 'things in the care world often change and the training is very helpful'.

We found that supervision and support for staff was readily available. The service was monitored and checked to assure quality and safety. People's views and experiences were important to the service.

We looked at how the provider ensured that people who used the service and their relatives were able to give their consent to care and treatment. We found that people led the care process and that carers would always respect their wishes.

We looked at how the provider ensured people's care was being planned and managed effectively, and whether people were happy with the quality of care they were receiving. We found that people who used the service and their relatives were happy with the quality of the service, and an effective care planning process was in place.

We found that staff were able to identify abuse and able to report it without fear of recrimination.

There were enough suitably qualified people to provide a safe and effective service. We found that over 50% of the staff had a relevant care qualification and that there were effective staffing schedules in place.

The provider conducted annual quality assurance surveys and had regular staff meetings, but did not appear to conduct regular whole service reviews.