Solitaire Homecare Services Limited

Solitaire Homecare Services Limited is a domiciliary care agency providing the regulated activity of personal care to people. The service provides support to older adults with a range of needs including people living with dementia, people with mental health needs and physical disabilities. At the time of our inspection there were 80 people using the service.

Not everyone who used the service received personal care. 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.

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

People often did not receive their calls at the agreed times and calls could take place hours later than planned. People’s risks and medicines were not always effectively managed. People were not protected by clear safeguarding policy and process and the service did not always identify safeguarding concerns and shortfalls in the service. People told us they felt safe and raised no concerns around staff practice.

People’s needs were not always fully assessed, and staff were not always provided with the training and guidance about their individual needs. People were supported to eat and drink by staff and to access healthcare support. 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; although the policies and systems in the service did not always support this practice as far as possible.

People and relatives described positive relationships with staff and told us they were caring and friendly. People told us they were involved in decisions and choices about their care, and felt well supported. We found however the service was not consistently caring based on the impact of late calls and where concerns had been raised about some people’s care, these were not addressed to drive out poor care experiences.

People’s feedback showed that they did not feel the need to complain, but if they did, concerns were addressed quickly. Managers could not demonstrate the learning and analysis taken from complaints, and how this had been used to improve the service.

We identified a breach in relation to good governance at the service. This was because the systems and processes built around meeting people’s needs were not effective, including around training oversight, risk management and learning from information of concern. People and relatives spoke positively about the service overall and managers recognised improvements were required and attributed this to staffing issues at the service and within the sector.

Rating at last inspection

The last rating for this service was Good (published in September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Response and Well-Led key questions sections of this full report. The provider has taken some action to mitigate risks, and further improvements will need to be made and embedded in practice. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified 5 breaches in relation to safe care and treatment, good governance, staffing, complaints and safeguarding processes at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last rating inspection in January 2016, the service was rated Good. A subsequent focussed inspection in the area of Well Led, in May 2017, identified that there were areas for improvement regarding call times and management of concerns/complaints however, the rating remained as Good.

At this inspection we found the service remained Good.

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.

People were kept safe and secure from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider. People received their medicines safely and as prescribed and were supported by sufficient numbers of staff to ensure that risk of harm was minimised.

Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual care and support needs.

Staff sought people’s consent before providing care and support. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were treated with kindness and compassion. People’s rights to privacy and confidentiality were respected by the staff that supported them and their dignity was maintained. People were supported to express their views and be actively involved in making decisions about their care and support needs.

People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs. People received care from staff that knew them well.

People using the service, their relatives and staff were confident about approaching the registered manager if they needed to. The provider had effective auditing systems in place to monitor the effectiveness and quality of service provision. People’s views on the quality of the service were gathered and used to support service development.

We undertook a focused inspection of Solitaire Home Care because we had received some concerns about the provider not responding to complaints or concerns, call cramming and the unprofessional conduct of the provider. Call cramming means that staff are required to attend more calls than time would allow, so each person’s allocated time would be shortened.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Solitaire Home Care on our website at www.cqc.org.uk’

The provider is required to have 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post at the time of our inspection.

During this inspection we only looked at the whether the service was well led. Therefore we have not reassessed the overall rating of the service.

Staff felt supported by the management team and received training to ensure that they had the skills to support people with their care.

People felt that timing of call could improve to ensure that at weekends a consistent service was provided. Records of staff rotas were not always clear about the time of calls and where staff should be. On occasions rotas showed that staff were meant to be in two places at the same time. People did not always have their call on time and were not always notified if staff were going to be late.

The quality of the service was regularly monitored through a series of audits and checks. However some people felt that complaints were not always addressed to their satisfaction to ensure that people felt that their concerns were listened to.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that they were treated with respect and dignity by the staff and that they felt safe. Staff had received training in safeguarding and staff understood how to safeguard the people they supported. There was a current safeguarding notification and this had been managed according to the policies and procedures of the provider.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risk to people and helped the service to continually improve. Risk assessments were in place in individual care plans in relation to all activities of daily living to ensure that support provided met people's needs.

Staff personnel records contained all the information required which meant that the provider could demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to care for people supported by the service.

Is the service effective?

People told us that they were happy with the care they received and felt that their needs were met. When we spoke with staff we found that they understood people's care and support needs and they knew them well. One person we spoke with told us, "It's the most fabulous service, it feels like we've got a friend come in, a professional friend." We saw from support plans that people's health and care needs were assessed with them and they were involved in writing their plans of care. The care plans had been signed by most people and where people had not signed the plans they had been signed by a relative. Specialist mobility and lifting and handling equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We were told that support workers were patient and gave encouragement when caring for people. People told us they were able to do things at their own pace and were not rushed. One person we spoke with told us, "The carer says, 'take your time, don't rush." Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

People who used the service understood how to contact the managers of the service if they had any concerns and knew how to make a complaint if they were unhappy. We saw evidence of 'spot checks' which were carried out throughout the service by the manager and we saw that issues identified from these were addressed in a timely way. We saw evidence that people's changing needs were reviewed and their plan of care amended to meet their new requirements for support and care.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way.

The service had a quality assurance system which included planned audits which were undertaken at regular intervals with clear actions. Records seen by us showed that identified shortfalls were addressed promptly and as a result the service was constantly improving.

Staff told us that they felt well supported by managers and communication systems for ensuring that staff were up to date with any changes were in place.

People's care and health needs were planned and met in a personalised way. All staff spoken with told us they had the information they needed to care for people safely.

Staffs were clear about the action to take should they become aware of an allegation of abuse. All eight people spoken with told us they felt secure and knew who to tell if they had concerns and were confident that these would be acted upon.

Staff spoken with told us they felt supported by the manager, and had regular training opportunities. This meant staff had the skills to care for people safely.

There were systems in place to monitor how the service was run, and action was taken where feedback from the people using the service would improve the service provided to them.

We found that clear systems were in place to investigate and respond to people's concerns.

All Staff spoken to were knowledgeable about people's care needs so that they were cared for appropriately.

We saw that systems were in place to keep people safe from harm.

Staff received a range of training so that they had up to date knowledge and skills in order to support people safely.

There were systems in place to monitor and seek feedback from the people using the service to ensure people received a quality service.