Storm Homecare Limited

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

Storm Homecare Limited is a domiciliary care agency providing personal care to people living in their own homes. The service provides support to older adults, younger disabled adults, people with a long-term mental health condition, and people with a learning disability or autistic people. At the time of our inspection there were 19 people 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

Right Support: Medicines were not always managed safely, and risks to people were not always adequately assessed and mitigated. Safeguarding training was not always effective and there were not always enough staff to meet the needs of the people using the service. Staff completed training, however, not all training was adequate due to the concerns identified above. Staff received regular supervisions.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: People felt the service was good, and staff were caring. People spoke positively about the care they received, the staff and the registered manager. People knew how to make a complaint, should the need arise. People's individual communication needs were met.

Right Culture: Systems and processes were not always effective at identifying the concerns we found during the inspection. Some records contained conflicting information, or had gaps. Staff felt supported and treated fairly, and spoke positively about the registered manager.

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 15 January 2018)

Why we inspected

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

The provider took effective action during the inspection to mitigate the risks identified.

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

Enforcement

We have identified breaches in relation to safe care and treatment, the identifying and reporting of allegations of abuse, staffing and recruitment, the need for consent, and good governance and oversight.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 in September 2016, this service was rated overall as requires improvement. At this inspection, we found that improvements had been made and sustained and the service was rated overall good.

A registered manager was in post. 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.

People told us they felt safe with the staff team who provided their care and support. Relatives we spoke with agreed that their relatives were safe with the staff team who supported them.

Training on the safeguarding of adults had been completed and the staff team were aware of their responsibilities for keeping people safe from avoidable harm. The registered manager and management team understood their responsibilities for keeping people safe and knew to refer any concerns on to the local authority and Care Quality Commission (CQC).

People's support needs had been identified and risks associated with people's care had been assessed and monitored. There were arrangements in place to make sure action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Adequate staffing levels were in place.

Staff induction training and on-going training was provided to ensure that staff had the skills, knowledge and support they needed to perform their roles. Staff were well supported by the senior management team and had regular one to one supervisions.

People were protected by the prevention and control of infection. The staff team had received training in infection control and understood their responsibilities around this.

People received their medicines as prescribed and staff supported people to access support from healthcare professionals when required. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing support.

People were involved in planning how their support would be provided and staff took time to understand people’s needs and preferences. Care documentation provided staff with appropriate guidance regarding the care and support people needed to maintain their independence. Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes.

People, relatives and staff were encouraged to provide feedback about the service and it was used to drive continuous improvement. The provider had systems in place to monitor the quality of the service and had a process in place, which ensured people could raise any complaints or concerns.

People knew what to do if they had a concern, complaints were investigated, and lessons learnt to reduce future concerns.

The service notified the Care Quality Commission of certain events and incidents, as required.

Storm Homecare Ltd is a domiciliary care service providing personal care and support to people living in their own homes in Leicester and Leicestershire. The office is based in Leicester city centre. At the time of our inspection there were 22 people using the service.

The service had two registered managers although at the time of our inspection one had left. 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.

The provider’s quality assurance system of audits and checks had failed to identify shortfalls in the service. This meant that the provider had not taken action when records were out of date and not fit for purpose, or when policies and procedures had not been followed. Consequently we could not be assured the service was well-led.

People using the service had had mixed views about the quality of the care and support provided. Some people said they felt safe using the service, but others did not due to concerns they had about the suitability of some of the staff. The provider’s recruitment policy had not always been followed meaning a staff member had been employed without their police check being completed.

All staff had an induction and ongoing training. However some people felt that new and relief staff were not trained to the standard of regular staff. People’s healthcare needs were met and some staff had had extra training to meet these needs. All staff had been trained in safeguarding.

People had written risk assessments in place with regard to their personal care and support routines. These did not always give staff clear instructions about how to manage risks. People were satisfied with how staff supported them with their medicines. People and relatives told us staff encouraged people to make choices and maintain their independence.

All the people we spoke with said the staff were caring and kind. They told us the staff were thoughtful and willing to do extra to improve the quality of their lives. Relatives, whose family members had communication needs, told us staff were good at communicating with them and spoke clearly and slowly.

Some people told us they usually had the same staff and this gave them the opportunity to build positive, caring relationships with the staff who supported them. However other people expressed concerns about the provider sending staff they did not know and who had not been introduced to them.

Most people told us they had care plans and that staff read these and recorded the care that had been provided at each call. Some people said they were dissatisfied with how their care was recorded. Some care plans lacked detail which meant staff did not have the information they needed to provide responsive care.

Some people told us they were satisfied with the timeliness and reliability of their calls but other people said they had experienced staff being early, late or not turning up at all. Some people said they thought the problem was organisational as staff were at times double-booked.

The service had a complaints procedure and people who had raised concerns said improvements had been made as a result.

We found one breach 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 this report.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People told us they felt safe. The relatives we spoke with also said they thought their relatives were safe with staff. People said that they felt their rights and dignity were respected by staff.

Staff had been aware about care plans and support plans had been written for people with particular needs. Some plans did not contain sufficient detail to promote people's welfare. This did not entirely protect people from unnecessary risk of harm or promote their welfare.

Is the service effective?

People's health and care needs had been assessed and care plans had been in place. There was evidence of people being involved in assessments of their needs and planning their care.

All care plans had been reviewed regularly. Relatives told us that they had been involved in reviews of the care of their relatives. Specialist dietary needs were assessed and included in care plans though more detail was needed in some plans to ensure people got the right food, received proper dementia care and had the right equipment to prevent pressure sores. This did not entirely confirm that people's needs were being met.

Is the service caring?

Five people told us that staff had supported them properly. One person said 'the staff member I have is marvellous. She would do anything for me'.

People and their relatives said they had been sent a satisfaction survey. This meant there was an opportunity for people to comment on the service provided.

We saw no evidence of an action plan produced from surveys. This would have helped to ensure people were not at risk of not receiving good quality care.

Is the service responsive?

No one said they had needed to make a complaint. People told us when they told the office about anything that had concerned them, this had been put right.

Is the service well-led?

Staff told us that if they witnessed or heard of poor practice they would report their concerns to their management.

The service had some aspects of a quality assurance system. We saw that staff had been spot checked to ensure care was meeting the needs of people. Staff received supervision to check their competence and provide them with support. However, there were no specific audits in place to check that specific issues were working well such as care plans, medication and staff turning up on time to provide care. There was no evidence of shortfalls identified and addressed.

There were suggestions made to us during the inspection; to make sure that staff had the proper training to deal with behaviour that challenged the service and to always have the same staff providing care.

People were involved in deciding what care and support they needed and we found that appropriate assessments had taken place. This showed us that the service assured itself that the individual needs of each person could be met, prior to their care package commencing.

People's consent had been obtained prior to their care and support commencing and records showed that where a person had declined their agreed support; this decision had been respected by the workers who were supporting them.

People told us that they were provided with regular support workers and training records showed that they [support workers] were appropriately trained. This enabled them to carry out their role within the service safely and competently.

We found a number of monitoring systems in place which enabled the management team to assess the quality of service being provided.

People told us that they were satisfied with the care and support that they received. They told us that they felt safe with the workers who supported them and that they were treated with dignity and respect. One person told us: 'They are very good, first class.' Another explained: 'We are very satisfied, we get regular carers and that keeps mum happy.'

We were told that the service involved people in deciding what care and support they needed and we found that initial assessments had taken place. This showed us that the service ensured itself that the individual needs of each person could be met, prior to their care package commencing. One person explained,'They came and visited, we were fully involved.'

People told us that they were satisfied with the care and support provided and that the support workers treated them with dignity and respect. One person told us, 'We have been very satisfied, we have not had one problem since we've been with them.'

Support workers were well trained. The service used an external training company to ensure that support workers received the training required in order for them to carry out their roles appropriately. Training provided included health and safety, moving and handling and infection control.

We were told that people felt safe with the support workers who visited them and we saw that the support workers had been provided with training in the safeguarding of adults, This assured the service that support workers knew how to keep people safe from harm.