Community Caring Limited

Community Caring is a domiciliary care agency providing personal care and other types of support to people living in their own homes. At the time of the inspection 146 people received help with their personal care. The Care Quality Commission only regulates personal care.

People’s experience of using this service

At the last inspection, the provider was rated requires improvement. At this inspection, we found the service overall had improved to good.

At the last inspection, the way the service managed the administration of medication was unsafe. At this inspection, although further improvements were still required the management of medication had significantly improved.

After the last inspection, people’s care plans had been reviewed, updated and improved upon. Staff had information on people’s needs and risks but some risks required further assessment. We spoke with the manager about this. They told us they were in the process of using a new system with more advanced assessment tools for this purpose.

At the last inspection, the support people received was not always in accordance with what had been planned or agreed. At this inspection, records showed the majority of people’s visits were completed within agreed and sufficient timeframes. The management team’s oversight had improved and as a result people’s experience of care was more positive.

Staffing levels, staff recruitment and support were all satisfactory and well managed.

People told us staff were kind, caring and compassionate. They said their privacy and dignity were respected and that staff knew them well. Most people told us they had the same regular carers and that if they had any concerns, the management team were approachable and resolved them efficiently.

Improvements to the implementation of the mental capacity act had been made. Where there were concerns over a person’s ability to consent to their care, best interest discussions with the people closest to them had taken place to ensure any support provided, was in their best interests, and as least restrictive as possible.

The systems and governance arrangements in place to monitor the quality and safety of the service had been reviewed. More comprehensive checks on the quality and safety of people’s care were not in place. The management team’s oversight of the service had increased. It was obvious they had taken on board our concerns at the last inspection and had worked hard to address them. As a result, the service had improved and people’s feedback was very complimentary.

Rating at last inspection

At the last inspection the rating of the service was requires improvement (Report published 18 September 2019) and there were multiple breaches of regulation. After the last inspection, the provider was issued with a warning notice. They completed an action plan 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

This was a scheduled inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit. If we receive any concerning information we may inspect sooner.

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

People’s experience of using this service:

The way the service managed and monitored the administration of medication was unsafe. Information on the medication people needed and the guidance given to staff with regards to their administration was inadequate. As a result, some people did not receive the correct amount of medication they needed to keep them safe and well. There were no adequate systems in place to monitor the safety of medication administration in order to protect people from avoidable harm.

Risks to people were not properly assessed and planned for and staff did not have sufficient guidance on how to care for people safely. People’s assessments and care plans regarding their care and support needs lacked important information and were not always accurate or kept up to date. This placed people at risk of receiving inappropriate and unsafe care.

The support people received was not always in accordance with what had been planned or agreed. For instance, the timing and duration of some people’s visits did not always correspond with their care plans or their agreed timetable of visits. This meant there was a risk that people did not always receive the level of support they needed. Where people needed nutritional support, their dietary records did not always show that they received adequate support to maintain their nutritional well-being.

Where people had communication needs or struggled to understand the care choices available to them staff had little guidance on how to communicate with them effectively. Information about the service was also not always available in a format people could easily understand.

Where people lived with medical conditions that may have impacted on their ability to understand and consent, it was difficult to see if any consideration had been given to the Mental Capacity Act when planning or reviewing their care. We have recommended that the provider reviews the implementation of the Mental Capacity Act to ensure the service compiles in full with this legislation.

The systems and governance arrangements in place to monitor the quality and safety of the service were ineffective. They failed to identify the areas for improvement we found at this inspection and failed to mitigate risks to people’s health, safety and welfare. We also found that although the management team were clear about their roles and responsibilities they lacked sufficient insight into the delivery of people’s care and the issues we identified at this inspection. This meant that the service was not well led.

People’s feedback on the service was positive. They told us that staff were kind, caring and patient and knew them well. Most people said they received support from the same staff team most of the time. This was good practice and enabled people to get to know and build positive relationships with the staff supporting them.

People told us their privacy and dignity were always respected and their independence promoted as much as possible. They told us they knew how to make a complaint but no--one we spoke had any complaints and were happy with the service they received.

Staff were recruited safely and received regular supervision and training. People told us they felt the staff were well trained and had the skills and knowledge to provide the support they needed. Spot checks on the competency of staff however were not always undertaken in accordance with the provider’s policy.

Throughout the inspection, the management team were open and transparent. It was obvious they were passionate about the service and committed to making any necessary improvements.

As we had serious concerns about the management of medication, we asked the manager to provide CQC with an action plan specifying the immediate action they intended to take to improve the safety of medication administration. The action plan submitted was detailed and reassured us that suitable action would be taken. At our next inspection, we will check that this action plan has been effective.

Rating at last inspection : At the last inspection the rating of the service was good (Report published 07 December 2016). At this inspection, the service has been rated 'Requires Improvement'.

Why we inspected: This was a scheduled inspection based on the previous rating.

Enforcement: Please see the 'action we have told the provider to take' section at the end of the full report.

Follow up: The overall rating for this service is 'Requires improvement'. However, as the rating for ‘Safe’ is inadequate we will re-inspect within 6 months of the report’s publication date to check that significant improvements have been made. We will continue to monitor intelligence we receive about the service until we return to visit.

If we receive any concerning information we may inspect sooner.

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

There was a registered manager in post who participated in the inspection visit. 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’.

We looked at the care files belonging to eight people who used the service. We found they covered people’s needs and risks and provided adequate guidance to staff in the provision of safe and appropriate care. Care plans were personalised to people’s individual needs and it was evident that people had participated in their development. People we spoke with confirmed this.

None of the people whose care files we looked at had mental health issues that impacted on their ability to consent to decisions about their care. Where people had mental health issues that made them forgetful, there was information in the person’s care file about their level of understanding and concentration so staff could be aware of this during a visit. The provider had a policy in place for advising staff what to do should they suspect a person’s capacity for a specific decision may be in question. The manager told us that where concerns about a person’s capacity to make a particular decision had been raised previously they had liaised with the Local Authority to support the person with this.

We saw from people’s daily logs that people received the care they needed. Records showed that most of the time people received support from a small team of regular staff. This enabled people and staff to get to know each other and build positive relationships. The majority of people we spoke with were more than happy with the staff that supported them. They felt safe and well looked after. Relatives we spoke with confirmed this. Everyone we spoke with said that staff treated them with dignity and respect and everyone felt their regular staff were well trained, understood their needs and knew what to do.

We saw that telephone calls were made to people every six months by a care co-ordinator. These calls were to check on people’s welfare, to ensure people were receiving the support they needed and that they were happy with the service provided. Annual reviews of people’s also care took place and where changes were required, we could see that care plans had been updated and the delivery of care adapted to ensure the service continued to meet people’s needs.

From people’s daily logs and other information we were provided with during our visit, we saw evidence to indicate that visits were well planned. It was clear that the majority of staff had sufficient time to complete the tasks they were required to do during a visit within the allocated amount of time. Late and missed visits were monitored via a ‘live’ system that electronically monitored the start and end time of each visit to ensure visits were conducted as planned. The manager and care co-ordinators received an email alert if a visit had not started at the planned time. This enabled a welfare call to be made to the person with another member of staff sent to complete the visit if necessary. An ‘out of hours’ call system was also in place to enable people to contact a care co-ordinator ‘out of office’ hours if they needed to do so. This ensured continuity of care and kept people safe.

Staff were recruited safely with all appropriate pre-employment checks undertaken. Staff training records showed that staff received sufficient training and adequate support and supervision to do their job effectively. These systems ensured that staff skills were regularly evaluated and reviewed to ensure staff were competent and sufficiently skilled in the provision of safe and appropriate care.

We saw that the provider had a satisfactory complaints policy in place. We looked at a sample of the complaints and found they had been properly responded to and addressed by the manager. Everyone we spoke with told us they knew how to make a complaint and felt confident they would be listened and responded to by the manager and the staff team. Two people said they had previously complained and that satisfactory action had been taken.

People’s views about the quality of the service had been formally sought by the manager through the use of satisfaction questionnaires. We checked a sample of the questionnaires returned and saw that feedback was positive. People were happy with the service provided.

There were a range of effective monitoring systems in place to assess and monitor the quality and safety of the service. Information on planned and actual visits, visit times, the length of people’s visits and the continuity of people’s care were all recorded and monitored to ensure people receive the support they needed.

People’s care plans were checked through a process of quality assurance before they were agreed as an accurate record of people’s needs and care. Safeguarding issues and complaints were all logged and checked to ensure that appropriate action had been taken. Safeguarding issues had been reported appropriately to the Local Authority and the Care Quality Commission.

Overall we found the service to be well-managed. People were provided with person centred, flexible support in accordance with their needs. Staff spoken with were positive about the people they cared for and their employer and the management team demonstrated a positive commitment to continuous improvement.

We looked at five support plans and other care records for people who used the agency and they all had an assessment of their health and social needs completed. The documentation was up to date and reviewed on a regular basis. People confirmed they were involved in the development of their support plans and that these were reviewed with them.

We looked at the management of medication and saw that the service had appropriate policies and procedures in place. Staff received training in medication and people who used the agency confirmed that staff supported them with administration of medication when necessary.

We were supported by an expert by experience who spoke on the phone with sixteen people who used the agency and their relatives. This is a person who has personal experience of using or caring for someone who uses this type of care service. We also spoke with five staff members during the inspection. People we spoke with confirmed they were satisfied with the service.

People who used the service said: 'They are very good indeed, and I am very pleased with them', 'The care my mother has is very good', 'The care is good, although I do have different carers and would like to have familiar faces' and 'The carers know my wife's whims, and threat her with dignity and respect.' All the people who used the agency and their relatives agreed that on the whole the carers turn up on time and stay for the allocated length of time.

Staff commented: 'Where possible we have the maximum team of three carers for each call', 'The training here is excellent', 'I think the care plans are detailed and person centred', 'I like getting to know the people I support and seeing them get stronger' and 'We have regular meetings.' All the staff said they got good support from the management team and that they had no concerns about the welfare of the people they supported.

We looked at staff recruitment and saw that appropriate processes were in place and that people who used Community Caring Limited were protected by robust recruitment processes and practice.

We looked at the complaint process and procedure. We saw that where complaints had been made to the agency appropriate records had been kept and we saw these during the inspection. People we spoke with stated they didn't have any complaints.

The manager had sent surveys to the people who used the service to find out their views about how the service was operating. Forty-nine responses were returned. We looked at twenty five of these and found that the majority of people were happy with the care and support they received. Twenty four people rated the service as excellent or good. One person said the service was satisfactory.

The people we spoke to said that they knew how to make their views known if they were not happy with the service. Records showed that any issues raised about the service where looked into and action taken to address any shortfalls.

The service promoted the involvement of the people who used the service in their care. Records showed the care and support people needed and how any risks to their welfare were to be managed.

Staff had received the training they needed to appropriately support the people who used the service.

We found there were effective systems in place to monitor the quality of the service and to ensure people received safe and effective support.