Wealden community Care Limited

Wealden Community Care Limited is a domiciliary care service providing care and support to people living in their own homes. People supported were older adults some of whom lived with dementia and others with specific health needs associated with living with, for example, diabetes, Parkinson’s disease and reduced mobility. 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 the inspection the service was supporting 116 people, 114 of whom received personal care.

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

People were protected from harm and people told us they felt safe when being supported by the service. Risks to people had been identified and documented with clear guidelines for staff to follow in the event of an incident. Staff had been recruited safely and there were enough staff available to support people. Some people needed support with their medicines. Medicines were stored safely in people’s homes and were administered and recorded by trained staff. Medicine competency checks were regularly carried out by managers. Infection prevention and control measures were in place and staff continued to follow government guidelines following the recent pandemic. Accidents and incidents were recorded and analysed by the registered manager with any learning shared with all staff.

Most new referrals to the service were for people leaving hospital and a thorough pre-assessment process was carried out to ensure the service could meeting people’s needs. Following induction staff were supported with regular supervision and appraisals and refresher training in all areas. Some people were supported with their nutrition and hydration needs. 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 this practice.

People were treated with respect and dignity and people’s privacy was respected. People’s cultural and faith differences and needs were considered. People’s independence was encouraged safely, in all aspects of the care and support provided.

Care was person-centred and care calls were developed to suit people and their needs, likes and dislikes. The registered manager was aware of accessible information standards and each care plan had a section relating to people’s communication needs. People and their loved ones told us they were knew how to and were confident in raising issues or complaints. Staff had received end of life training and were able to tell us about the important aspects of care provision at this important time in people’s lives.

People, relatives and staff all spoke well of the registered manager and the wider management team. There were clear roles for staff dependent on geographic areas covered and the registered manager oversaw a robust auditing process. Everyone was given opportunities to feedback about the service and feedback was recorded and where necessary action taken to improve the service. The registered manager had a clear vision of continuous improvement and had established positive working relationships with other health and social care professionals.

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 4 March 2021) and there were breaches of regulation. 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 carried out to follow up on action we told the provider to take at the last inspection.

We found no evidence during this inspection that people were at risk of harm. Please see the safe, effective, responsive and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wealden Community Care Limited 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.

Wealden Community Care provides personal care to people living in their own houses and flats. It provides a service to older adults, some of whom are living with dementia. At the time of the inspection there were approximately 100 people using this 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

Most people described care calls as sometimes being late, some people had experienced missed calls and people told us there was not a robust system for being kept informed. Some people told us they were updated by care staff, other people said they did not receive any contact to explain late calls.

People told us they felt safe receiving care, however one person told us of an incident when a fall was not responded to safely or by following the correct procedure. This had not been recorded as an incident. Staff had not all received annual refresher training in knowledge and skills such as moving and handling, or safeguarding adults.

Some people we spoke with did not know if they had a care plan or what was in it. One person told us they had accurate care plans, another told us they had some care plans which were not relevant. We found care plan information to be lacking detail about how risks and needs, such as the application of prescription cream, should be supported.

People told us they were not asked for specific feedback about the quality of their care or if they were happy, some people had received a survey which they did not find meaningful. People who use the service knew how to contact the office if they had a question or concern. Some people had raised concerns with the manager and felt these had been dealt with appropriately.

People described care staff as being caring, respectful, polite and helpful. Some people told us they had regular care staff who understood their needs and respected their independence. One person told us, “Oh absolutely, they are caring! If I feel down, they’ll listen to me. We do have our little chats, which I like.”

People described care staff as responsive and respectful. People said they were asked how they wanted to be supported during care calls and their preferences were followed. One person told us the changes they requested to their care provision had been made.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 6 August 2019) and there were multiple breaches of regulation. 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 regulations.

The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wealden Community Care Ltd 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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.

Wealden Community Care provides personal care to people living in their own houses and flats. It provides a service to older adults, some of whom are living with dementia. Not everyone using Wealden Community Care receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection there were approximately 110 people using this service.

People’s experience of using this service:

People didn’t always receive their calls on time and staff didn’t always stay for the full duration of their visit. Some people were happy with this flexibility but the majority of people did not like it. There was no audit or quality assurance check in place to monitor times and durations although the service did have a call monitoring system in place. There was a mixture of feedback from people receiving care from this service. Some people described staff as caring and kind but other people did not. When some people had complained to the office there had been no written response or record of an outcome. People told us office staff had sometimes been uncaring in their response.

Although some audits and checks were being completed, they had failed to adequately address the re-occurring medicine errors. Some care plans did not contain much person-centred information. Risk assessments were not always detailed or fully completed in relation to known risks. Recruitment processes were not always followed correctly to ensure staff were safe and competent.

The management team did not always actively engage staff in staff meetings. People were engaged via questionnaires and phone surveys.

People were involved in decisions around their care and encouraged to be independent where possible. People’s rights were protected in line with the principles of the Mental Capacity Act 2005. Staff were up to date with mandatory training and received regular supervision. There was an effective communication system in place and referrals to healthcare professionals were made where required. The service completed pre-assessments to ensure they could meet people’s needs and followed national guidance and best practice. The registered manager had links to local organisations where best practice, knowledge and training resources were available.

Rating at last inspection:

Good (25 June 2018)

Why we inspected:

The inspection was prompted in part due to concerns received about unsafe medicines management, staff turning up late at visits, staff being uncaring, unsafe care and treatment. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Caring, Responsive and Well Led sections of this full report.

Enforcement:

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

Follow up:

We will continue to monitor the service closely and will return to inspect the service again in line with our policies.

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

The service 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.

At the last comprehensive inspection on 2 December 2016 the overall rating of the service was, ‘Requires Improvement’. We found that there were six breaches of the regulations. This was because the registered provider had not ensured people were kept safe from risks or avoidable harm. We also found they had not ensured that safe recruitment procedures were followed. Furthermore, they had not ensured medicines were being managed safely. In addition, we found that the service had not kept complete and up to date records of each person. The registered provider had not ensured that consent was sought in line with the Mental Capacity Act 2005 (MCA). Also, we found care was not always delivered in a person centred way. Lastly, we concluded that the registered provider had not ensured that quality monitoring was effective in highlighting shortfalls in the service. We told the registered persons to take action to make improvements to address each of our concerns and they subsequently told us that this had been done.

At this inspection we found the action taken was sufficient to meet the breaches identified above. Our other findings at the present inspection were as follows. People were protected from abuse. Staff were able to identify different types of abuse and were confident in reporting concerns when required. There were a sufficient number of staff on duty to meet the needs of the people using the service. Staffing levels were planned around the needs of people and rotas showed these were consistent. People were protected by the prevention and control of infection where possible. Accidents and incidents were reported by staff in line with the provider’s policy, and the registered manager took steps to ensure that lessons were learned when things went wrong. The registered manager kept a log of incidents concerning the safety of staff, and took appropriate action. However, the registered manager had not submitted one notification to us relating to a safeguarding incident.

People’s needs were assessed and their care was delivered in line with current legislation. When the service was responsible, people were supported to eat and drink enough to maintain a balanced diet. Appropriate referrals were made to dietician and Speech and Language teams. Staff received training which ensured they had the skills and knowledge to deliver effective care. Staff we spoke with had a good level of knowledge about the roles and responsibilities when supporting people. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff worked together to ensure that people received consistent and person-centred support when they moved between different services.

Staff were encouraged to develop positive, caring relationships with the people they supported. Staff supported people to express their views and be actively involved in making decisions about their care. People were involved in reviewing their care. People’s dignity and independence was respected at all times.

People and their families were encouraged and supported to raise any issues or concerns with the service manager. There was a formal complaints procedure in place, and details of how to complain were held with the person’s care records at their home. People were supported at the end of their life to have a comfortable, dignified and pain-free death. Records showed that staff worked closely with health professionals such as nurses from the local hospice, dieticians and GPs to ensure people had coordinated care at the end of their life.

The registered manager had failed to notify CQC of a notifiable event in a timely manner. The registered manager had oversight of and reviewed the daily culture in the service, including the attitudes, values and behaviour of staff. The registered manager promoted transparency and fairness within the workforce. Staff retention was good, and staff told us they felt proud to work for the organisation. People, their families and staff were encouraged to be engaged and involved with the service.

We found two breaches of the Health and Social Care Act 2008 (Registration) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

At the time of our inspection there was a registered manager at the service but they were no longer in day to day control. 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. However, the registered manager confirmed they would de-register and there was an acting manager who was in the process of registering with CQC.

People were protected from the risk of abuse but were susceptible to the risk from avoidable harm. For example key safe number s had been emailed to unsecure email addresses. Risks were not assessed comprehensively and where hazards had been identified these had not been mitigated fully. Medicines were not effectively being managed as the recording sheets used did not contain information about each medicines and prescribing instructions. In addition this information was not contained on any other part of the care plan.

Recruitment procedures were not consistently being followed and staff had not always had the correct pre-employment checks prior to working with people.

People had access to healthcare professionals but they were at risk of not having their health needs met as information was not consistently updated. For example one person had important changes to how staff should support them to eat and drink but these had not been included in the care plan three months after the changes had been made.

Consent had not consistently been sought and the principles of the Mental Capacity Act 2005 (MCA) had not consistently been complied with. Two people were being supported with the use of bed rails but the registered provider had not considered whether the use of bed rails was restrictive. Care plans did not always have consent forms signed by people or their representatives.

Care plans were not consistently person centred and did not always contain the person’s ‘voice’ or their input. One person’s care plan had failed to mention a diagnosis of mental health problems and how best to support the person in this area.

Quality monitoring systems were not effective in identifying shortfalls in the service and the current system had not been reviewed on a monthly basis as per the system requirements.

The staff were kind and caring and treated people with dignity and respect. Caring relationships were seen throughout the day of our inspection. Staff knew the people they cared for well. People spoke positively about the care and support they received from staff members.

People receive adequate food and drink and where necessary the registered provider uses food and fluid charts to monitor how much people are consuming. However, some records were not always complete and some plans lacked detail about people’s food preferences. We have made a recommendation about this in our report.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed. Staff met together regularly and felt supported by the manager. Staff were able to meet their line manager on a one to one basis regularly. Staff were supervised and had annual appraisals. However, these did not contain targets or much detail about performance. We have made a recommendation about this in our report.

Complaints were logged and responded to in line with the registered provider’s policy. However, not all complaints were handled in a person centred way or used as a tool for improving service delivery. We have made a recommendation about this in our report.

Care plans ensured people received the support they needed in the way they wanted. However, people’s preferences and views about their care were not always recorded. We have made a recommendation about this in our report.

The culture of the service was supportive to staff members. The management team provided leadership to the staff team and was an active presence in the service.

During our inspection we found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.