Archived: Superior Care Folkestone

This inspection took place on 21 and 22 May 2015 and was announced. The provider was given 48 hours’ notice of the inspection, as this is our methodology for inspecting domiciliary care agencies, so that we can ensure someone will be available in the office to talk with us and enable us to access records.

Although this is an established service, this was their first inspection since the agency moved to its current location and registered the new location with us on 3 September 2014.

Superior Care Folkestone provides agency staff to other nursing or residential care services; in addition it operates a domiciliary care service providing personal care and support to adults and children in their own homes. The provider operates its services across three locations in Kent and provides personal care to people in Whitstable and surrounding areas, Maidstone and surrounding areas and Folkestone and surrounding areas. The service provides for older people, people with continuing care needs who have complex physical support needs, people with visual impairments, and people with acquired brain injury, and autism.

At the time of inspection the service was providing a personal care service to 19 people.

The service has 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of inspection the registered manager was unavailable. The managing director of the company was present and was able to respond to operational questions and also to queries we had in relation to individual packages of support.

The registered manager was not a visible presence at the office and spent most of their time based at another office some distance away. Some staff were unaware who the registered manager was and commented that it was difficult to keep up with so many changes to staff in the office. The registered provider visited the office often but there was a lack of management oversight. This showed in a number of areas for example, the absence of organised and recorded staff supervisions and competency checks, and the lack of a system for routine site visits to people’s homes to seek feedback from them about service quality. Care staff were able to visit the office to raise issues with office staff, but other staff avoided this and said they did not feel listened to, and felt there was a lack of formal opportunities for them to speak together with a manager or on an individual basis.

A number of staff provided support on a regular basis to people with complex needs and they knew the people they supported well. People’s levels of satisfaction around the service were highest when speaking about their regular care staff, for whom they had nothing but praise. However there were recurring communication issues between office staff and with people using the service. People and care staff told us that communication needed improvement. Some staff told us that they did not get their rotas until halfway through the week; some people did not receive a rota on a regular basis and had to ring the office to find out who was coming to support them.

Only eight staff had received specific Mental Capacity Act 2005 training, but all staff were given a basic understanding of the principles of the Mental Capacity Act 2005 at induction. Staff demonstrated an understanding of mental capacity issues and where people lacked capacity the service was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interest.

People who required weekend support told us that these were particularly difficult for them because of problems of staff cover. The commented on the difficulty of getting hold of people covering the out of hour’s emergency number for the agency. They said that sometimes they could not get through at all or if they left a message, someone responded some hours later and sometimes not at all. There were not many missed calls but due to the complex needs of some people when they did occur they compromised the person and their family’s plans for the rest of the day.

The agency had enough staff available to cover leave and sickness, but care staff with the right skills and knowledge to provide dedicated support were not always available. Staff undertaking some of the complex support packages were without back up from other dedicated care staff and so felt unable to take leave or sickness because they knew how much their support meant to people. A staff member said they had been unable to take planned leave for nearly seven months.

All the people we spoke with commented positively about their regular care staff who they described as “fantastic”. They felt they ensured their privacy and dignity was respected in the way they delivered support, and people had confidence in their knowledge and skills and trust in them. Some people told us that they did not always feel they could rely on the service. They told us that they were not always kept informed of new care staff that might visit them and had not been introduced to them previously; and often the new care staff had not shadowed the person’s usual allocated care staff to learn about how the person’s support was delivered. People said they were not always confident about the attitude and skills of some staff sent along by the agency, who had failed to build a rapport with them, which helped if they were undertaking personal care. Two people said they did not always feel comfortable or safe with care staff who were sent and who they had not met previously. One person said they sometimes felt intimidated and made to feel uncomfortable in their own home.

Spot checks of care staff, and visits to people’s homes to assess their satisfaction with the service were happening infrequently; only some of these visits were recorded. An overall system of assessment and monitoring of service quality was not in use. The provider could not assure themselves that all areas of the service were operating to a good standard, or was sufficiently effective to highlight the shortfalls found by this inspection; some of which have been recurrent.

Staff were provided with a classroom based interactive training programme to ensure they had all the essential skills they needed to support people’s everyday basic needs. Some staff had received additional training in respect of specialist support, for example tracheostomy care. This was either provided by a lead nurse employed by the agency or by other professionals in the community.

Staff had received safeguarding training in respect of adults and children and understood their responsibility to raise concerns if they found them. They were aware of being able to raise alerts with other organisations, for example Social Services if they felt action was not being taken by the agency.

Environmental risk assessments and some individual risk information in regards to moving and handling and medicines were completed but these were not always dated. Individual risk assessments in respect of the specialist needs some people had for example, pressure ulcers, were not in place to show how risks were reduced.

People’s needs were assessed prior to a service beginning. Everyone had a care plan and these were developed from this assessment and were individualised. Some people described how well their regular care staff understood the important details of their care whether small or big that added to their feeling of comfort and reassurance when staff left them, for example putting a lamp on, drawing the curtains, making sure things were within easy reach for them when there was no one else around. The importance of these small details cannot be over stressed in ensuring that people have a good experience of care, However, this was not reflected within the support plans that informed staff about what they needed to do; new staff would not have this knowledge to hand and this would impact on how people felt about the care they received.

People were informed about their right to make a complaint and those spoken with said they would feel confident about raising issues with staff at the office if needed. Most said they had not felt the need to formally complain but others who described numerous occasions when they had not been satisfied with the service, said they had discussed this with the office but it was unclear from records viewed whether staff recorded these issues as complaints.

There was a recruitment process that ensured that staff were interviewed and appropriate checks of their suitability to undertake their role were carried out, including criminal record and conduct in employment checks. Minor improvement was needed to ensure that full employment histories were recorded and gaps explored with applicants.

People told us they received their medicines as prescribed. Staff had received the necessary training to administer medicines and there was a clear medicine policy that detailed staff roles and responsibilities.

Staff showed an awareness of people’s health needs and whilst not responsible for this aspect of people’s wellbeing liaised appropriately with health professionals and relatives when appropriate to ensure interventions were arranged if people were seen to be unwell.

We found a number of 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 the report.