Cera - Norwich

Inspection site activity commenced on 17 January 2019. At the time of inspecting 221 people were receiving a regulated activity. Not everyone using Mears Care (Norwich) receives a regulated activity; CQC only inspects the service being provided by people with 'personal care; help with tasks related to personal hygiene and eating.

The service had a registered manager in place. They were present throughout the inspection. 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 our last inspection we rated the service ‘Requires Improvement’. At that inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We were concerned that the systems in place around monitoring the administration of medicines were not fully effective, and we could not be assured they were always managed safely. We were also concerned at our last inspection that there were no systems in place to check that the content of people’s care plans was relevant with enough individualised guidance for staff to follow. We also had found that people's visit times were not always carried out at the agreed times and for the agreed length of time. People's preferences were also not always being met and care records did not always contain sufficient guidance for staff with regards to people's individual risks around specific health conditions or behaviours. People's mental capacity was not assessed for specific decisions, and there were no records of best interest’s decisions for those people who did not have full capacity. People knew how to complain; however, some people did not feel comfortable to do so.

At this inspection we found that improvements had been made and that the service was no longer in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager and staff team had taken on board the feedback we had provided and had worked hard to make the necessary changes. Between our inspection on 17 June 2017 and the current inspection commenced on 17 January 2019 the registered manager and substantially reduced the number of people they were providing a personal care service to in order to work on improvements and embed new practices. At this inspection we have rated the service ‘Good’ overall.

People felt safe with the service they received and were confident with the knowledge and skills of the care staff that supported them. Staff were well trained and had observations of their practice carried out at frequent intervals. Staff knew what abuse and harm was and they were also aware of how to report any concerns if they had them. People were positive that they consistently received their care calls however these were on occasion late resulting in two people telling us they had been unable to have their meal at their planned time. People couldn’t always have their care at their choice of time.

Staff managed people’s medicines in a safe way and were trained in the safe administration of medicines. Staff understood the need to protect people from the spread of infections. People were supported to maintain good health. Staff responded appropriately if people's health deteriorated or they felt unwell and staff made sure they contacted the appropriate professionals to ensure people received effective treatment.

People felt that staff treated them with kindness and were caring in their approach to supporting people. People had their privacy and dignity respected by staff. Feedback from people and relatives indicated that positive relationships had developed between people and care support staff.

There were effective systems in place to monitor the quality of care and support that people received. The provider had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained. Plans were in place and been commenced to update the care planning system to a new electronic format.

Systems were in place to obtain feedback from people about the quality of the service they received through satisfaction surveys and frequent review meetings. Audits had been carried out in relation to care documentation, staff files and medicines. The aim of this audit was to look at the overall running of the service. Feedback from people and their relatives was welcomed. People and their relatives knew who to contact if they needed to raise a concern or a complaint. There were opportunities for people to provide their feedback about the service they received.

At the time of our inspection visit 580 people were using the service.

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. There was a registered manager in post who was present for both days of the inspection.

At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report

The systems in place around monitoring the administration of medicines were not fully effective, and we could not be assured they were always managed safely. There was a lack of oversight with regards to some medicines, and the provider was not able to assure themselves that they were being administered and managed safely. There were no systems in place to check that the content of care plans was relevant with enough individualised guidance for staff about people.

People’s visit times were not always carried out at the agreed times for the agreed length of time, and there was no system in place leading to action to improve this. People’s preferences were not always reasonably met. Care records did not always contain sufficient guidance for staff with regards to people’s individual risks around specific health conditions or behaviours.

People’s mental capacity was not assessed for specific decisions, and there were no records of best interests decisions for those people who did not have full capacity.

People knew how to complain, however some people did not feel comfortable to do so. The organisation obtained feedback from people during visits and through surveys.

Staff supported people with their mealtimes when they needed and supported them to access healthcare services. Staff had knowledge of safeguarding and how to report any concerns they had about people. Risk assessments were in place for people’s home environments with guidance for staff on mitigating these risks.

The organisation had a comprehensive training programme in place for staff which included subjects relevant to their role, as well as an induction for new staff. Staff were also supported to complete qualifications in health and social care. Staff were well-supported by their management team.

There were enough staff to cover visits to people, however they were not always at the agreed times. The staff had a good morale and teamwork, communicating well with each other. Some people had consistent staff members visit them and had built up a strong relationship. People were supported by staff who were compassionate.

The inspection took place on 30 June and 1 July 2016 and we contacted the service before we visited to announce the inspection. This was because the service provides a domiciliary care service to people in their own homes and we wanted to ensure that the manager was available to speak with us.

Mears of Norwich provide domiciliary care to around 700 people who lived in their own homes in the Norwich and Hingham area. The Norwich and Hingham branch’s had recently merged to form one single registered location. Mears of Norwich was a ‘block provider’ to the local authority. Mears supported people who were living with long term conditions.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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.

We could not determine whether medicines were being administered in a consistently safe manner. There were gaps on the medicines administration record (MAR) where staff had not signed to confirm that people had been given their medicines. This meant the service couldn’t be confident people had received their medicines as the prescriber had intended. The service had not effectively audited the MAR charts.

People were supported by staff who were knowledgeable in their roles and demonstrated the skills required. Staff had been safely recruited. There was a robust training system in place delivered by a trainer who was based at the Norwich office. Staff had a thorough induction to the service and their role. Staff had been selected for their willingness to care for people. Staff told us they felt supported in their roles. Staff were motivated and committed to provide a good service to people.

Staff demonstrated they understood how to prevent and protect people from the risk of abuse. Staff were mindful of this issue. The service had procedures in place to report any safeguarding concerns to the local authority. People and staff were protected from the potential risk of harm as the service had identified and assessed the risks people faced. People had assessments which were individual to the person and their environment.

Staff received training and opportunities to further improve their skills and knowledge. Staff were given opportunities to discuss their performance with the management team. The competencies of staff were assessed and recorded to ensure an appropriate standard of care was delivered. Although this was not as regular as the service wanted, there was a plan in place to address this issue.

People benefited from staff who felt valued by the service. Staff told us they were motivated to make a positive contribution to people’s lives. They had confidence in the management team and the service they were providing.

People told us they were treated in a respectful, compassionate and caring manner. People said they generally saw the same care staff at regular times, and did not have missed visits.

Staff demonstrated that they understood the importance of promoting people’s dignity, privacy and independence. They gave many examples of a caring and empathetic approach to the people they supported.

Staff had received training in the Mental Capacity Act 2005 (MCA) and demonstrated they understood the importance of gaining people’s consent before assisting them.

Care and support was delivered in a person centred way. The service had completed assessments of people’s needs. People received individualised care as their care plans had been developed in collaboration with them.

Staff assisted people, where necessary, to access healthcare services. Staff had a good understanding of people’s healthcare needs. Staff demonstrated they had the knowledge to manage emergency situations, should they arise.

Staff supported people to avoid social isolation.

People felt comfortable making a complaint. There was a complaints process in place for people to follow if they wanted to make a complaint. Staff also felt comfortable in raising any concerns they had.

The manager demonstrated an inclusive approach to the management of the service and people had confidence in the manager. They were supportive, accessible and they encouraged people to comment on the service they provided. The manager had a good knowledge of the people the service supported and their needs, despite it being a large service.

Medication procedures were in place and staff had received suitable training in the administration of medication. Due to some changes in medication dispensing, individual boxes for each medication were now being used by the pharmacist instead of a blister pack/dossett system. Some staff told us that they did not always feel confident when administering a number of different medications. One person using the service told us how they used to have a blister pack and ".......felt it was much better then." However, although the process was slower they said they received their tablets when required.

During this visit of May 2013 we found that records of staff training and the checks carried out on competencies were being managed correctly. Staff we spoke with told us that they were supported well.

There was a complaints procedure in place. People knew how to complain, records were seen of how a complaint was managed and the correct outcome was achieved.

People told us they had been involved in drawing up their plans of care and this was confirmed by signatures in the records we saw. Plans of care were also kept up to date. However, information we received indicated that staff did not always refer to the care plan to see what they needed to do.

Although staff felt well supported and that they could go to someone more senior for advice if they needed it, we noted that supervision and appraisal did not always happen as expected and stated in policy guidance. Some training was also overdue for renewal.

Everyone said that they knew how to contact the agency if they needed to complain. One person said that their complaint had been properly dealt with and this was confirmed by what we saw in records.