Shores Homecare Limited

Shores Home Care Limited is a domiciliary care service registered to provide personal care to people living in their own homes. The service supports adults, older people and people who may be living with dementia. There were 21 people being supported by the service at the time of our inspection.

Not everyone who used the service received personal care. The Care Quality Commission (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

The provider had day to day oversight of the service but lacked robust governance systems which would provide them with assurances that people's care needs were being delivered safely and effectively.

Care plans and risk assessments were not regularly updated to reflect people’s current needs. Care plans and risk assessments for specific health conditions were not in place and records of people’s end of life wishes were not completed. Accidents and incidents were not monitored to identify themes or trends. We have made a recommendation about this.

Medicines management was monitored by the registered manager. Documentation to support the use of topical medicines was not in place. We have made a recommendation about this.

Staff understood their role in safeguarding people. People felt the service was safe and spoke positively about the staff and management team. Recruitment was safe and staff felt supported within their role.

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.

People were supported by a consistent group of staff. Relatives were highly complementary of the service and the care and support their loved ones received. Relatives told us the provider was approachable and were confident if they raised any concerns, they would be dealt with appropriately.

The provider and registered manager were open and honest throughout the inspection and accepting of the feedback given following the inspection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 January 2020) and there was a breach of regulation 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulation 17.

Why we inspected

We carried out an announced comprehensive inspection of this service on 16 and 17 December 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, responsive and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Shores Homecare Limited 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 will continue to monitor the service.

We have identified a continued breach in relation to management oversight at this inspection.

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 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.

Shores Home Care Limited is a domiciliary care service registered to provide personal care to people living in their own homes. The service supports adults, older people and people who may be living with dementia.

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 inspection 19 people were receiving a regulated activity.

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

Checks in place to monitor the quality of care provided were not always effective. They had not identified the shortfalls identified at inspection. The provider’s policies did not always contain up to date information and staff recruitment was not consistently robust. We made a recommendation regarding recruitment.

Measures were not in place to safeguard people’s finances. The nominated individual started implementing a system during the inspection. Accidents and incidents records were not always fully completed and there was no monitoring to identify trends. People received their medication as prescribed. However, there was a lack of information in people’s care plans regarding the support they needed with medication administration.

People’s end of life wishes had not always been explored. People’s care plans did not contain person centred information. Care plans had not been reviewed to ensure they contained accurate, up to date information. The nominated individual told us they would carry out a full review of all care plans. We made a recommendation regarding person centred care planning.

People were happy with the care they received. People and staff gave positive feedback about the registered manager. There were sufficient staff employed to meet people’s needs. People told us there was a consistent staff team who treated them with respect. We received positive feedback about the staff and their caring nature. People’s privacy and dignity was maintained. Staff felt well supported. They received induction, training and ongoing supervision.

People told us they felt safe. Infection control procedures were in place to reduce the risk of spread of infection.

People's needs were assessed prior to them receiving a service. They were supported to access health care services. 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 20 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in the governance of the service. 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 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.

Shores Homecare provides help and support to adults with a variety of needs. Services provided include assistance with personal care, help with domestic tasks and carer support to people living in their own homes in areas of the East Riding of Yorkshire. The service had a registered manager at the time of our inspection. A registered manager is a person who has registered with 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 had previously inspected the service on 17 and 18 November, and 14 December 2016; it was rated as Requires Improvement overall and we issued a requirement notice for a breach in regulation for ineffective record keeping at the service. We also issued a warning notice for a continued breach in regulation for staff training. The registered provider sent us an action plan in response to the breach we identified stating what measures they were going to take in order to address the issues. This inspection visit included checks of the action taken in respect of the maintenance and management of records and staff training. At this inspection we found the registered provider had taken action to address these issues.

We found improvements had been made to staff training. Staff had undertaken training in a range of subjects relevant to the care needs of the people they supported. The training was used to maintain and develop their existing skills and staff demonstrated a good understanding of their roles and responsibilities. Staff worked together in a co-ordinated way and were provided with regular support including direct observations of their care practice by senior staff. The nominated individual confirmed a commitment to on-going staff training, which would include updates of relevant training.

At the last inspection we made a recommendation for the registered provider to ensure quality assurance systems were expanded to include audits on other areas of the service and to ensure people using the service and other stakeholders received feedback about the quality assurance and monitoring systems, so they could see any action taken as a result of this. We found improvements had been made to ensure the effectiveness of the quality assurance systems at the service. The registered manager had quality monitoring systems in place which included audits and surveys. These were used by the registered manager to organise and manage the service. The training records corresponded with information we received from care workers and induction records were up to date. We saw in-house forms had been introduced to capture any incidents that had occurred with people using the service. The reviewing of the service policies and procedures was on-going and we asked the registered provider to set out a clear and achievable timescale for the completion of these. This was provided to us immediately after this inspection.

People's needs were assessed and any potential risks to people and staff, including environmental risks were identified before any new services were started. This helped ensure risks were minimised. Staff understood how to report concerns about potential abuse and when it had been needed, the registered manager and staff took action to keep people safe from harm.

There was a satisfactory recruitment procedure to help ensure the staff recruited, were suitable to work with the people using the service and staffing levels were sufficient to provide the level of care required.

People who needed staff assistance to take their medicines were supported to do this and staff assisted people to eat and drink enough to keep them healthy, whenever this type of support was required.

CQC is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and to report on what we find. The registered manager had received training in this area and they told us if people lacked capacity to make their own decisions the principles of the MCA and codes of practice would be followed in order to protect people's rights.

Care plans were in place which helped inform staff about people's individual care needs. Staff were caring and they worked in ways which helped people to remain as independent as possible.

We found that there was an effective complaints procedure in place and people were able to have any complaints investigated. There had been no complaints made about the service since the last inspection.

At this inspection in 2016 we found the overall rating for this service continued to be 'Requires Improvement', as although there had been some improvements in the quality of the service since the last inspection there was a continued breach of regulation 18 with regards to training. Although the registered provider was monitoring training needs and had provided updated safeguarding adult's training for some support workers, other training was still not up-to-date. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We also identified a new breach of regulation 17 with regards to record keeping and effective management of the service. The registered manager had a reactive rather than proactive management style and did not complete managerial tasks in a timely manner particularly with regards to the maintenance of accurate formal records for the running of the regulated activity. Training records did not correspond with other information we received from support workers, policies and procedures were not reviewed, induction records were missing and incident records were not up-to-date. This was a breach of regulation for which we have made a requirement.

You can see what action we told the provider to take at the back of the full version of the report.

The service provides support to people in their own homes, who may be living with dementia, have mental health needs or have a physical disability. At the time of our inspection there were 34 people using the service. The support provided to people can be with personal care, food provision, personal safety and/or financial needs.

The registered provider was required to have a registered manager in post. On the day of the inspection there was a manager who had been the registered manager for the last three and a half years. A registered manager is a person who has registered with the Care Quality Commission (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.

The registered manager explained to us that the agency (service) was owned by a not-for-profit organisation and was set up to run so as to provide a service in an area where domiciliary care was scarce.

People were protected from the risk of harm because the registered provider had systems in place to manage safeguarding incidents. Some support workers were trained in safeguarding adults from abuse, but others were not. Workers understood their responsibilities in respect of managing safeguarding concerns. Risks were managed and reduced on an individual basis so that people avoided injury or harm.

Staffing numbers were sufficient to meet people’s needs and we saw that rosters accurately cross referenced with the support workers on duty. Recruitment policies, procedures and practices were followed to ensure staff were suitable to care for and support vulnerable people. We found that the management of people’s medicines was safely carried out.

People were cared for and supported by some qualified and competent support workers, although records did not always evidence this. Workers were supervised and took part in an appraisal scheme regarding their personal performance, but additional supervision in the form of 'spot checks' had lapsed.

Communication was satisfactory and people that used the service and support workers felt information was appropriately shared in good time. People’s mental capacity was appropriately assessed and their rights were protected with regard to ensuring their liberty. Support workers had some knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they encouraged people to make decisions for themselves. People were supported with nutrition and hydration where necessary.

We found that people received appropriate care from kind support workers who knew about people’s needs and preferences. People were involved in aspects of their care and were asked for their consent before support workers undertook care and support tasks. People’s wellbeing, privacy, dignity and independence were monitored and respected and support workers worked hard to maintain these wherever possible. People were supported according to their support plans, which were regularly reviewed and amended according to need and/or requests.

There was an effective complaints procedure in place and people felt confident their complaints would be addressed. People that used the service, relatives and their friends were encouraged to maintain healthy relationships.

There was a system in place for checking the quality of the service using audits, satisfaction surveys and occasional meetings. However, the audit system was limited in its range of areas checked. Information from the quality monitoring and assurance system had been used to take action and make changes to the service for people but there was no evidence to show this had been fed back to anyone who used the service or other stakeholders. We acknowledged that the registered manager and nominated individual were transparent in their verbal communications with the local authority, with regard to changes and improvements made in the service. However, we made a recommendation with regard to the shortfall of not feeding back information to people that used the service and other stakeholders.

People were assured that storage systems used in the service protected their privacy and confidentiality as records were held securely in the company offices.

People who used the service told us that they were involved in making decisions about the care or support they needed during the assessment process. They said that their care needs were reviewed regularly and that the service they received was flexible to accommodate their changing needs. People told us that they received the support they needed and that this was from a regular group of staff.

Some people received assistance with the administration of medication and they were satisfied with the support they received. They told us that they had received the right medication at the right time.

Staff had been recruited following safe employment practices and had received appropriate induction training. We found that there were sufficient numbers of staff to ensure that people received the support they needed, wherever they lived within the area covered by the agency.

There were quality monitoring systems in place that gave the people who used the service and staff the opportunity to comment on the service provided by the agency. This included the monitoring of medication records and care plan records.

The people who we had contacted during the last inspection had expressed satisfaction with the service they received. At this inspection we saw that the agency had sent a survey to a random selection of people to ask how satisfied they had been with the service they had received.

We found that improvements had been made in respect of staff training. There was an up to date staff matrix in place and, although this identified gaps in training, a training plan had been produced to record when training courses had been booked. Staff supervision systems had been developed and training had been arranged for supervisory staff to ensure that they were competent in this role.

Record keeping by agency staff had improved. We checked care plans, staff recruitment records, training records and quality assurance documentation and found that information was organised and easy to access. Care plans contained the information needed to enable staff to provide the support each person required and had been kept up to date.

Staff told us that they were well supported by the manager and that they liked working for the agency. However, we found that some staff had not received mandatory training.

We found that staff recorded good information on daily records and on accident/incident forms but that recording at the agency office was inadequate.