Kumari Care

Kumari Care is a domiciliary care agency in Bath providing personal care to people living in their own homes. The service provides care to people over and under 65 years, people with a learning disability, physical disability, sensory impairment, mental health condition and people living with dementia. There were 62 people receiving personal care at the time of the inspection.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

People’s needs were recorded in their care plans, so staff knew how to support them safely. Risks to people’s safety were assessed and plans put in place which were regularly reviewed. People’s medicines were managed safely, staff had guidance on what medicines support to provide and had been trained.

Right Care:

Recruiting staff had been a challenge for the provider. Some people and relatives told us this challenge had been noticed as their visits could be late. The provider was aware of this issue and taking steps to make improvements such as obtaining a sponsorship licence from the government. This would mean the provider could recruit from overseas.

People were supported by staff who understood person-centred values of privacy, dignity and promoting independence. Staff told us they visited the same people so had time to build relationships and get to know people well. We found guidance was recorded in people’s records on how to promote independence. It focused on what people could do for themselves and the areas where people might need more support.

Right Culture:

There was not a registered manager in post and the provider told us they were struggling to recruit into this position. The service was managed day to day by the owner of the service who was very experienced. There was a management structure in place which the staff were clear about. Any concern could be reported, and action taken in response. Staff worked in partnership with professionals who told us there was good lines of communication.

Quality monitoring systems were in place and improvements identified. The provider had invested in an electronic care planning system which gave them better oversight of people’s records. The next stage of the service improvement plan was to add audits to the electronic system. This would help the service be more paper free and give the provider oversight of the service in one place.

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 7 November 2019).

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 remains good.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kumari Care 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.

Kumari Care provides domiciliary care to people in their own homes in the Bath, Bristol and South Gloucestershire areas. Kumari Care was providing personal care to 105 people at the time of the inspection.

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

Improvements in the service had been made to ensure systems were operated effectively and actions taken when needed. Care plans had been reviewed to ensure they detailed people’s preferences and gave clear guidance to staff.

People told us they received care and support as outlined and agreed in their care plan. Staff arrived on time and stayed for the correct amount of time. People were supported with their medicines administration and nutritional needs.

Staff were kind, caring and respectful. People felt safe with the service they received. Risk assessments supported people with identified risks in a way that maximised their independence.

People were asked for feedback around the service and care they experienced. This was used to make changes and improve the service.

Recruitment processes had been improved to ensure they were robust and fully completed. Staff were supported through regular supervision, training and an induction.

People 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.

We have made a recommendation about developing end of life care plans.

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 this service was Requires Improvement (published 24 October 2018).

At the last inspection breaches were identified in Regulation 12; Safe care and treatment, Regulation 19: Fit and proper persons employed and Regulation 17; Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A recommendation was given in relation to assessing people’s capacity to consent in line with legislation and guidance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The provider sent us monthly reports under Regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to update us on the progress of their actions.

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 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.

At our last comprehensive inspection of Kumari Care in December 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, person centred care and good governance. The service was rated requires improvement.

Following this inspection, the provider sent us a fortnightly action plan around the changes being made in the management of medicines within Regulation 12, safe care and treatment. We undertook a focused inspection in the domains of safe and well-led in April 2018 to check the provider’s progress. At this inspection we found some actions had been taken but not all those as detailed in the provider’s action plan. This meant the provider was still not meeting the regulations.

At this inspection we reviewed the action the service had taken to meet previous breaches in regulations. You can read the report from our last comprehensive by selecting the, 'All reports' link for ‘Kumari Care’ on our website at www.cqc.org.uk

Kumari Care provides domiciliary care to people in their own homes in the Bath, Bristol and South Gloucestershire areas. Kumari Care provides a service to 107 people.

There was a registered manager in post. 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 this inspection the service was not consistently safe as improvements to recruitment checks were still needed. We identified shortfalls in the timing and duration of calls during the night that could put people at risk if care was not given as planned.

Improvements had been made to governance systems. This had identified some outstanding actions and areas for further improvement. However, further improvements were needed due to the findings of this inspection.

Care plans guided staff in supporting people with their decision making. People told us consent to care was sought. However, legislation and guidance in relation to the Mental Capacity Act 2005 had not always been followed in relation to capacity assessments.

The provider had made improvements in the safe management and administration of medicines. Care plans gave guidance about people’s medicines. Environmental risk assessments were now in place to guide staff and keep people safe.

The service had made improvements that had been noted by people, relatives, staff and health and social care professionals. People spoke positively about the changes they had noticed around staffing consistency and that missed visits were rarely occurring.

Staff were supported by an effective induction, supervision and regular training. Care plans that had been updated gave guidance about people’s food and fluid requirements. People told us staff supported them with their healthcare needs.

People were supported by staff that were kind, caring and respectful. People had developed good relationships with staff members. People’s privacy and dignity was maintained. Improvements had been made to ensure people’s care plans gave guidance around how people’s independence should be promoted and supported.

A systematic review of care plans was being undertaken. Care plans that had been updated and reviewed now contained person centred information. This included details about people’s background, histories and communication preferences. People’s preferences were now being met around choices of carers. People knew how to raise a complaint and felt comfortable doing so.

Positive feedback was received about the changes and improvements made. The provider had been open and transparent and worked with other agencies to make improvements. Staff culture had developed and communication was more effective.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made a recommendation about assessing people’s capacity to consent to care and support in line with The Mental Capacity Act 2005. You can see what action we told the provider to take at the back of this report.

We undertook a focused inspection on 9 April 2018 to check the provider had completed the areas set out in their action plan. You can read the report from our last comprehensive by selecting the, 'All reports' link for ‘Kumari Care’ on our website at www.cqc.org.uk

Kumari Care provides domiciliary care to people in their own homes in the Bath, Bristol and South Gloucestershire areas. Kumari Care provides a service to approximately 200 people.

There was a registered manager in post. 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 this inspection, we found the provider had taken action to progress towards meeting the warning notice. However, further elements of the regulation needed to be met.

We found two 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 this report.

At our last comprehensive inspection of Kumari Care in April 2017 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations and the service was rated inadequate. Following this inspection, we served two Warning Notices for a breach of regulation 17 and 18 of the Health and Social Care Act 2008. This was because we found that staff had not been provided with suitable induction, supervision or training to enable them to be effective within their roles. There were also ineffective systems in place to monitor and review the quality of the service.

We undertook a focused inspection in August 2017 to check the provider was meeting the legal requirements in regards to one of the regulations they had breached and had complied with the Warning Notice. The focused inspection looked at the breach of regulation 18. The induction, supervision and training which staff received. At this inspection, we found the provider had taken action to progress towards meeting the warning notice. However, further elements of the regulation needed to be met.

At this inspection we reviewed the action the service had taken to meet previous breaches in regulation and to ensure the provider was meeting the areas set out in the warning notice in regards to Regulation 17.

You can read the report from our last comprehensive by selecting the, 'All reports' link for ‘Kumari Care’ on our website at www.cqc.org.uk

Kumari Care provides domiciliary care to people in their own homes in the Bath, Bristol and South Gloucestershire areas. Kumari Care provides a service to approximately 130 people.

There was a registered manager in post. 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 service was not safe as medicines were not managed safely. There were widespread shortfalls found relating to the recording and administration of people’s medicines. Risk assessments had been reviewed and changed since the last inspection and people’s risk were identified. Further guidance to staff was needed. There were no environmental risk assessments in place to keep people and staff safe. Recruitment procedures had been improved although some shortfalls were identified in document verification.

Staff received an induction, training and supervision to support them in their role. Staff were aware how the Mental Capacity Act (MCA) 2005 applied to their role. However, capacity assessments had not been consistently completed.

Positive feedback was received about the care and support received from staff. Staff were caring and respectful. People’s privacy and dignity were upheld.

Care plans were not always person centred as people’s background and histories were not consistently completed. Care plans did not always give sufficient detail and guidance into people’s support needs around communication, health and food and fluids. People’s preferences were not always able to be met around choices of carers.

Improvements had been made into how complaints were recorded, investigated and responded to. Staff knew how to identify and report any safeguarding concerns. Concerns were investigated and responded to appropriately.

Systems to monitor and review the quality of the service had been introduced. However, further improvements were required to ensure identified shortfalls were progressed. Regular meetings had been introduced to staff to promote better communication and information sharing. A monthly newsletter kept people up to date with changes and gave key information. People’s opinions were sought through a survey and actions taken to make improvements as a result.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

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 this report.

We undertook a focused inspection on 15 August 2017 to check the provider was meeting the legal requirements in regards to one of the regulations they had breached and had complied with the Warning Notice. This focused inspection looked at the breach of regulation 18. The induction, supervision and training which staff received. This report only covers our findings in relation to this area. The second warning notice will be followed up in due course. You can read the report from our last comprehensive by selecting the, 'All reports' link for ‘Kumari Care’ on our website at www.cqc.org.uk

Kumari Care provides domiciliary care to people in their own homes in the Bath, Bristol and South Gloucestershire areas. Kumari Care provides a service to approximately 200 people.

There was a registered manager in post. 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 this inspection, we found the provider had taken action to progress towards meeting the warning notice. However, further elements of the regulation needed to be met. New systems had been introduced to mitigate against the risk of the regulation being breached again. However, these systems have not yet been embedded or fully completed.

Progress had been made towards staff completing mandatory training such as medicines administration, manual handling, first aid and safeguarding. However, not all staff were fully up to date. Staff had not yet completed training in the Mental Capacity Act 2005, The Deprivation of Liberty Safeguards or areas specific to the needs of individuals. For example, particular health conditions. Systems were being developed to plan for all appropriate training.

Since the last inspection staff had received a minimum of one supervision with their line manager. An appraisal system had been introduced. Spot checks had been recommenced. However, these were not yet occurring regularly.

New staff now received an induction aligned with the Care Certificate. Previous staff who had not completed the Care Certificate had been registered although had not yet completed it. All staff were undertaking the new induction process.

The provider had communicated with staff about the changes and expectations around induction, supervision and training. Peer support meetings had been introduced so staff could raise any concerns.

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 service provides domiciliary care to approximately 200 people in the Bath, Bristol and South Gloucestershire areas.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a registered manager in post. 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.

We found shortfalls in relation to the safety of the service. Information about medicines was unclear in people’s support plans. We also found some poor practice in the recording of medicine administration. This meant there was a risk that people would not receive their medicines in line with their prescribed needs. We also found that risk assessments were not sufficient to ensure that staff had clear guidance about how to manage risks associated with people’s care.

Recruitment procedures were not sufficiently robust to ensure that new staff were safe and suitable for their roles. Disclosure and Barring Service checks were not always completed for office based staff; references and gaps in employment history were not always investigated fully.

People were supported by staff who did not receive adequate supervision and training. This was found to be a breach of regulation at our last inspection and the concerns had not been addressed since that time. People were at risk because staff did not have the specialist training required to ensure they were confident and able to meet people’s complex needs. Staff performance and development needs were not regularly assessed through supervision. Staff confirmed with us that there were gaps in their training and support.

People’s support plans were not sufficient to guide staff in meeting people’s needs. Where people had complex health needs, there was no clear information in care plans to guide staff in meeting those needs.

There was an inconsistent approach to managing and addressing people’s complaints and concerns. We saw examples of complaints that had been investigated and responded to appropriately; however we found others that had not been addressed.

Quality monitoring systems were insufficient to ensure that concerns and issues with the service would be identified and acted upon before they presented a risk to people. There was a breach of regulation at our last inspection in relation to the systems for monitoring the service; the service continued to be in breach of this regulation. The provider was reactive to shortfalls identified by external inspections, rather than proactive in identifying concerns within their own service.

Feedback from people who used the service was varied. Some people made positive comments about the care staff that supported them but others raised concerns about the approach of care staff and their ability to build a positive relationship with them. Missed and late visits were a concern identified by people in their discussions with us.

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

Kumari Care provides personal care to people in Bath and surrounding areas. They offer a range of services to individuals who live in their own homes and need support or care. .At the time of this inspection there were 200 people receiving service from Kumari Care. People who used the service had a variety of care needs. Some had 24 hour live in care staff, some very complex needs with several care calls a day and others required one call a day.

At the last inspection of the service in 20 October 2014 we found the service was meeting the regulations.

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

There were mixed comments from people about staff timeliness. The majority of people told us care staff arrived on time. However some people told us care staff didn't always arrive on time and people were not told if there was to be a change in care staff. They told us they were not always informed if care staff would be arriving late.

People’s care needs and risk assessments were not regularly reviewed. However care staff knew the people they cared for well. There were gaps in training for staff and this also included important training updates. Staff had not received regular support to help them understand how to deliver good care in line with the provider’s policy. Staff completed an induction when they started work.

There were policies and procedures in place in relation to the Mental Capacity Act 2005.People’s consent was always sort when offering care and support. However staff showed a lack of understanding of how to ensure their practice was in line with the Act.

Most of the people we spoke with told us they were very happy with the care and support they received from the service.

We saw the provider had a quality assurance monitoring system; however the system was not always effective because it had not identified the shortfalls that were found at the inspection

There was a risk that people may not have their medicines as prescribed due to lack of detail when recording administration. People who used the service told us they felt safe with the staff and the care and support they were provided with. We found there were systems in place to protect people from risk of harm There was a reporting process in place to record accidents, incidents and near misses for people who used the service.

Complaints were welcomed and were investigated and responded to appropriately.

Some people who used the service said their visit times suited their wishes and staff in the main always stayed the agreed length of time. However, some people told us their care worker timekeeping was not good, and they could be late.

Recruitment procedures were effective with checks made on people’s employment histories and with the Disclosure and Barring Service (DBS).There was enough staff to meet the needs of people who used the service.

People’s care plans contained sufficient information to provide consistent, care and support. People received good support which ensured their health care needs were met. Staff knew how to respect people’s privacy and dignity.

We identified that the provider was not meeting all regulatory requirements and was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We have made a recommendation about the management of medicines.