Age Concern Home Care - South Manchester

Age Concern Home Care – South Manchester is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older people and younger adults with various needs, including people living with physical disabilities and dementia. At the time of this inspection 57 people were 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's medicines were not always safely managed and medicine recording systems were not robust. Risks related to people’s medicines were not always recorded.

Staff rotas showed there was no travel time between calls. Some people told us staff don't always arrive on time for their visits, and don't stay the full length because staff don't have time to do so. We also received mixed feedback from people about them receiving regular staff for their care visits.

Care plans did not always contain information about people’s culture or religion and how this impacted on their care needs. People’s communication needs were not always detailed in the care records.

Auditing systems were not always robust and auditing processes had not picked up on the discrepancies we found during this inspection. Governance systems required improvement.

Staff were recruited safely and had the necessary safety checks in place before starting work, including a criminal record check to confirm they were suitable to work with people. People were protected from the risks of abuse and staff were trusted to keep them safe. Staff had received training in how to safeguard people.

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; however, the systems in the service did not always support this practice. The provider had no specific mental capacity assessments in place. We have made a recommendation about the provider reviewing their systems in place to work within the principles of the MCA.

People's needs were assessed prior to starting with the service and care plans were developed according to people’s needs. Care plans reflected a good understanding of people's needs.

People's rights were promoted. Staff had received training in equality and diversity, and they were committed to ensuring people were treated well. Staff knew people's history and preferences and used this knowledge to support them in the way they wanted. People’s views and decisions about care were incorporated when their care packages. People were involved in making decisions about their day-to-day care. People were treated with dignity, privacy and respect.

Staff praised the registered manager and the wider management team within the service, they felt supported in their roles.

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 (published 16 October 2017).

Why we inspected

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

Enforcement and Recommendations

We have identified a breach in relation to good governance.

We have made a recommendation about the provider reviewing their systems in place to work within the principles of the MCA.

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

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 inspection of June 2016 the service required improvement for three breaches of the regulations. Regulation 11. The service had not gained the consent of people with regard to their care and treatment and mental capacity assessments had not been undertaken. Regulation 12. Risk assessments did not fully inform staff on how to mitigate any risks and medicines administration was not always safe. Regulation 17. Care plans were not always reviewed regularly and audits which should highlight these failures were not effective. The service sent us an action plan to show how they planned to improve the service. We found the service had made the improvements at this inspection.

The service had a registered manager. 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.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

There was a system to track that staff attended on time and stayed for the agreed duration of visits. People told us staff would let them know if they were running late.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The people we spoke with had capacity to make their own decisions and had signed to say they agreed to their care and treatment.

New staff received induction training to provide them with the skills to care for people. Staff files and the training system showed staff had undertaken sufficient training to meet the needs of people.

Staff received formal supervision regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

Records were held securely to protect people’s confidential information.

We saw that the quality of care plans gave staff sufficient information to look after people and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given information on how to complain with the details of other organisations if they wished to go outside of the service.

People were asked for their views about how the service was run.

Staff and people who used the service all told us managers were approachable and supportive.

Meetings with staff gave them the opportunity to be involved in the running of the agency and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

People were supported to attend suitable activities if it was part of their care package.

Age Concern is a domiciliary care agency providing personal care to 112 people in the surrounding areas of Wythenshawe. Care workers support the people using the service with a wide range of personal care needs and domestic duties, including assistance with shopping and making meals.

The service had a registered manager. 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 told us that they felt safe when using the service. Staff we spoke with could tell us about safeguarding and said they would report any concerns to their managers. Training records we saw confirmed that staff had undertaken this at induction and on refresher training.

People had an assessment prior to receiving a service and risks were identified before the commencement of care. Managing those identified risks was not always made clear for staff as risk assessments in place were basic and did not contain enough information.

The recording of medicines administration was inconsistent. Incorrect paperwork was used by staff on occasions and a medication error was not fully investigated. Due to the length of time since the last review of care plans, information on these was often wrong or out of date.

Staff told us that they found the training good and told us it prepared them for their caring role. The company employed a member of staff in a training co-ordinator role. They provided training to staff on a one to one basis at times. If an employee was identified as needing or benefitting from additional support then this was made available to build confidence and develop the staff member.

The provider had adopted a traffic light toolkit. This identified when staff required updated training in certain areas, such as administering medication or safeguarding. Additional training and experience was made available to staff that needed it in other company settings, including a day centre and a residential care home. This benefitted staff and gave them confidence in the caring role.

People and their relatives told us that care workers were caring and supported people’s privacy and dignity. Care workers we spoke with could give examples of how they promoted people’s independence and we saw examples of this during our visits to people’s homes.

Care workers could demonstrate that they knew people well as they could describe their likes, dislikes and preferences, although documentation of these in care plans was limited.

People’s personal information was stored securely however, information relating to staff was not always appropriately stored.

None of the people or relatives we spoke with had made a formal complaint. Records showed that the service acted upon the written complaints it had received in 2015 in accordance with their complaints policy.

Staff meetings were held and we saw minutes from these meetings. The service held two staff meetings on the same day, discussing the same agenda items. Staff were able to choose the most appropriate session to attend based on their working pattern and home life commitments.

The service had recently introduced spot checks of care staff but there were no completed records at the time of the inspection. Other audits of the service such as medication and care plan reviews were not done or were out of date.

Staff we spoke with felt supported by management and had no problems raising any issues or concerns with senior management.

We used all our findings to answer five core questions:-

' 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 evidence that supports our summary can be found in the full report.

Is the service safe?

With a service that provides care and support to people in their own homes, great responsibility falls on the individual carers to keep people safe. The staff we met were well trained. They understood about safeguarding, and knew how to report any incidents or suspicions that the people they were supporting were suffering any kind of abuse.

We considered that senior staff could conduct more visits and monitoring of the care that was being provided in order to ensure that the staff themselves were delivering safe care.

Is the service effective?

Rotas were well organised and missed calls were rare. People told us that carers sometimes arrived late, but they usually receive phone calls to let them know. The service conducted an annual questionnaire which offered people to comment on their level of satisfaction. In the last questionnaire 88% of people stated they were satisfied with the service.

Is the service caring?

People told us, with one main exception, that they liked their carers and appreciated the support and care they provided. One person said: "I couldn't have dreamed that anyone could be more helpful." Another person said: "I am very happy with my care."

We talked with several staff who explained that the reason they were in the job was that they had personal experience of caring for a close relative. This meant that they were able to empathise with the people who needed care. One staff member said: "I know my clients love me as much as I love them. I'm not just there as their carer, but as their friend."

Is the service responsive?

The questionnaire sent out last year had invited people to state whether they were happy with the care package they were receiving. The managers responded to anyone who stated they were unhappy by visiting to discuss any changes.

The registered manager had responded to findings in the Care Quality Commission's last report by improving the recording of medication administration and by improving the systems for monitoring the quality of the service.

Is the service well-led?

The service was going through a period of change. The registered manager was about to be replaced by the assistant manager, and another Age Concern Home Care service was due to be relocated and based in the same offices. We understood that these changes had to some extent distracted the management from some of their usual functions, such as conducting regular supervision and monitoring checks. It was clear that these would be reinstated as soon as the new arrangements had been finalised. The staff we spoke with said that they felt well supported to do their job, and would not hesitate to report any problems to the management.

The people we spoke with were generally happy with the service. We were told it was easy to contact the office and the service was flexible and able to respond when the needs of people who used the service changed.

We were told:

'It's very easy to speak to someone at the office.'

People said they observed that staff treated their relative with respect. We were told:

'Yes they absolutely treat my relative with respect, without a doubt.'

Relatives said they felt overall the staff provided met the needs of people. We were told:

'We know who's coming before hand and it's usually the same person and she knows what she's doing.'

We found people who used the service had assessments and care plans in place and staff were informed about meeting people's needs.

We found better systems were needed to ensure the health and welfare of people who used the service were protected when staff prompted or administered medication.

We found the service needed to further develop their quality monitoring systems.

At the previous inspection on 28 December 2012 we saw records were poorly maintained. At this inspection visit on 22 April 2013 we saw improvements had been made.

The people we spoke with were very happy with service. We were told staff were punctual and polite, comments included:

'All the ladies are very nice who come to see me. They make me laugh, none of them are nasty to you and they're very polite.'

'I know who the staff are. I get regular staff and they're pretty efficient'

We were told communication was good, the relative told us:

'They leave a book at my relative's house and there's a gap where we can leave our comments and the carers follow our instructions.'

We found that people who used the service had initial assessments and care plans in place and so staff were informed about how to meet peoples needs.

We saw that agreement and consent to care and support was obtained before this was provided.

We saw that care plans were reviewed so that staff had up to date information about how people wanted their needs to be met.

There were systems in place to deal with records concerned with managing the service but these needed to be improved.