Professional Carers

Professional Carers is a domiciliary care service providing care and support to people living in their own homes. At the time of our inspection the service was providing personal care to 277 people. The service supported 25 people who lived in their own home in a specialist Extra Care Housing called St Oswald's Court in Birkenhead.

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

Professional Carers had an open and transparent culture resulting in an effectively organised, supportive and well-run service. The registered manager and nominated individual were clear about how the service should be provided and they led by example.

People's needs were comprehensively assessed before they started using the service, people and their relatives were fully involved in the assessment and care planning processes. Staff had established supportive relationships with people and knew them extremely well. Staff provided people with person centred care. Staff supported people to access healthcare professionals when required and supported people to manage their medicines safely.

The provider was driven in supporting their staff and provided access to resources to benefit the health and wellbeing of employees. Care workers spoke very highly about working for the service. People told us their care workers were caring and kind. Care workers had a good understanding of how to support people in a way that promoted their privacy, dignity and independence.

The provider had systems in place to protect people from the risk of abuse and people told us they felt safe. Risk assessments were completed to help identify and minimise risks people faced. Infection control measures were safe. Steps were taken to learn lessons when things went wrong.

The provider had addressed issues identified from the last inspection and internal quality assurance audits relating to medicine and care records were well embedded and used to drive improvements identified at the last inspection.

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

The last rating for the service was Requires improvement (published on 29 January 2021).

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

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Professional Carers on our website at www.cqc.org.uk

Follow up

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

Professional Carers is a domiciliary care service that provides support and personal care to older people in their own homes. 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.

At the time of our inspection 227 people received support from the service. Most of the people using the service lived in the community. The service however did support 22 people who lived in their own home in a specialist Extra Care Housing called St Oswald’s Court in Birkenhead.

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

This was a focused inspection looking at the domains of safe and well-led only. At the last inspection, the provider was rated good and outstanding respectively in these domains. At this inspection, these domains had deteriorated to requires improvement.

Medication management was not safe. Adequate systems were not in place to check that people’s medicines were administered as prescribed. Medication administration records were not always clear or accurate. One of the people whose care records we looked at, had one of their medicines secondary dispensed without appropriate risks assessments in place to support this safely. This meant it was taken out of its packaging and left for the person to take later on, or for example, for a relative to support them to take this medicine at a later time. This was not good practice.

Some people’s care was not always adequately planned or delivered. For example, some people’s care plans lacked sufficient detail and guidance for staff on their needs and risks. Where people had specific requirements or wishes in relation to their care, these were not always respected. Some people’s visits were completed by a range of different carers which impacted on people's continuity of care.

Staff recruitment required improvement to ensure that people’s previous employment history and conduct was properly verified as suitable prior to appointment.

The management team told us that they had experienced no major staffing issues during the Covid 19 pandemic. Despite this, the deployment of staff during the pandemic did not always adhere to best practice. For example, by minimising the number of different staff members' conducting people's visits. We spoke with the provider about this.

Staff had access to sufficient supplies of Personal Protective Equipment (PPE) and received regular updates from the provider on the management of risks related to Covid 19. There were organisational Covid 19 policies and guidance in place for staff to follow which followed best practice. However, staff lacked specific guidance on how to care for individual people living with Covid 19.

There were systems in place to monitor the quality and safety of the service however these were not always effective. The audits had not identified the concerns we identified during the inspection. This aspect of governance required improvement.

During the inspection, the management team were open and approachable. They were passionate about the service and were aware of their legal responsibilities as a health and social care provider.

Staff morale was good and staff told us they felt supported by the management team to provide good care. People we spoke with spoke positively about care staff and said they supported them with the things they needed help with. For the most part, people’s visits were completed on time or within an acceptable time frame.

Rating at last inspection and update

The last rating for this service was outstanding (published 29 October 2019). At the last inspection the domains of safe and well led were rated good and outstanding. At this inspection, these domains had deteriorated to requires improvement. A breach of regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to medication management was identified.

Why we inspected

We received concerns in relation to the quality and safety of the service. We also reviewed and took into account other intelligence including notifications sent to us by the provider in relation to Covid 19. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from outstanding to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Professional Carers on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We identified a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to risk and medication management.

We will continue to monitor the service.

Follow up:

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Professional Carers is a domiciliary care service that provides support and personal care to older people in their own homes. 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. At the time of our inspection 184 people were receiving support with personal care.

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

Everyone involved in the running of the service, from the managers and provider to the care staff, exuded passion for delivering care that was person centred and gave people a meaningful life. All 'Professional Carers' staff went above and beyond to provide people with positive outcomes and experiences; people were consistently placed at the heart of the service.

People and family members described the service as ‘exceptional’ and told us staff were "excellent" and "outstanding". Strong, positive relationships had been developed between staff and people and it was evident that staff went out of their way to ensure people lived a happier life. People had been supported and encouraged to access various community groups to develop friendships, maintain independence and improve life skills; one person told us staff had "changed their life for the better".

It was clear that staff knew people extremely well; people and family members were consistently positive about the caring, compassionate and respectful attitudes of all staff. People were supported through difficult times and staff were constantly looking at ways to help them experience happiness and deal with situations such as relationship breakdowns and loss of people close to them.

It was evident the passion within the care staff had been cascaded down from the management team and provider. Professional Carers is a family run service with a management team who shared the constant desire and drive to improve people’s lives and promote an extremely person-centred culture. Their excellent working relationship and shared vision and values had resulted in many positive outcomes for people.

The service was constantly looking at ways to grow and improve the quality of care and had been recognised by external professionals for their willingness to ‘step up’ and support with new initiatives and pilot schemes. The collaborative work involved had resulted in people receiving more streamlined assessments that were based on their individual needs, preferences and best practice guidance. Due to the excellent working relationships between staff and health and social care professionals, people received a package of care that was right for them.

The service placed great emphasis on ‘community ethos’. They regularly organised charity and social events and attended community groups that encouraged people, family and members of the public to engage with the service. These events and community groups had helped to reduce social isolation and raise awareness of important health issues.

People told us they felt safe with staff who supported them and family members were confident their loved ones were safe. Staff knew how to recognise abuse and were confident reporting safeguarding concerns. Sufficient numbers of suitably qualified and skilled staff were deployed to meet people’s needs and people told us staff were always on time.

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.

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 31 January 2017).

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

Follow up: We will continue to monitor information 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.

The agency was last inspected on 04 & 08 September 2014 and met the standards required by legislation at that time.

The agency 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.

Accurate records were in place to monitor people’s assessed risks, support and ongoing care needs.

Arrangements were in place to manage people’s medicines safely which included staff training.

Excellent staff recruitment was in place and thoroughly explored people’s suitability to work for the agency.

People’s care plans guided staff on how a person liked and wished to be supported.

The agency had superb links with a range of healthcare and professional agencies so that people were supported with all aspects of their health and wellbeing.

Care records documented that without exception people and/or their relatives had been involved in the care planning process.

Staff received training and support which met and matched people’s individual needs.

Staff performance was monitored and reviewed during supervisions, appraisals and spot checks to make sure staff were competent and confident providing effective care and support.

Staff took the time to get to know people well and to understand their needs.

Staff valued the experiences of those they supported.

Care records were reviewed and kept up to date to meet the person’s current needs.

Staff knew their responsibility to report poor care practice or suspicion of harm.

There were effective joined up quality monitoring systems in place to assess the quality of the service provided and ensure best possible practice.

People using the agency and their relatives felt listened to.

People using the service and the carers told us that they felt valued.

Staff working at Professional Carers felt supported and enabled by the management to fulfil their role and enrich people’s lives.

We last inspected this service in September 2013 and found that action was needed to address issues around respect and involvement, consent to care and treatment and to the assessing and monitoring the quality of service provision. During this visit, we saw evidence that the provider had addressed these issues and that the service was now compliant.

Below is a summary of what we found. The summary is based on our observations during the inspection and speaking with five people who used the service and two of their relatives and five staff supporting them. We reviewed twelve care plan files and eight staff files, along with other records.

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

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported.

People told us that they felt their rights and dignity were respected.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helps the service to continually improve.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action. Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. People said that their care plans were up to date and reflected their current needs. One relative told us, 'They take the strain off me'.

Is the service caring?

We asked people and their relatives for their opinions about the staff who supported them. Feedback from people was positive, for example, one person told us, 'They are lovely and polite'. We read in an annual questionnaire that a person had written, 'They are not just my carers, they have become my friends. I look forward to their visits'.

When speaking with staff it was clear that they genuinely cared for the people they supported.

People using the service and their relative completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that the provider responded to people's needs and queries. People knew how to make a complaint if they were unhappy. People were assured that complaints were investigated and action taken as necessary. The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

The service was managed by a registered manager. It had a quality assurance system. We were shown records which demonstrated that identified problems and opportunities to change things for the better, were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service. This helped to ensure that people received a good quality service at all times.

We reviewed how the provider assessed and planned people's care. We found some people had not been given the opportunity to express their views and be involved in decisions about their care.

We reviewed four care records. In two files we looked at, the person need's had not been assessed by the provider prior to care being given. We also saw that people's assessment and care planning records were inconsistently completed. This meant that there was a risk that people's health, welfare and safety needs would not be met.

We noted staff received regular training in safeguarding and demonstrated a general awareness of abuse. People said they had no concerns and felt safe with staff.

There were suitable arrangements in place to ensure staff received appropriate induction appraisal, supervision and training in respect of their job roles.

An annual satisfaction questionnaire was sent out to people and/or their relatives to seek their views about the standard of care but there were no systems in place to regularly assess and monitor the performance of the service or the quality of the care provided.

We looked at a sample of six care files and found there were clear guidelines for carers as to what level of care and support was required for each individual. People we spoke with confirmed they were involved in the care planning process.

We found that Professional Carers had complaints and safeguarding vulnerable adults procedures in place. We found that the agency carried out appropriate recruitment checks before employing staff and provided support and training to enable them to look after the people in their care.