Kent Social Care Professionals Domiciliary Service

About the service

Kent Social Care Professionals Domiciliary Service is a care at home service providing personal care to 230 people within their own homes, at the time of the 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

Risks to people were not always recorded in their risk assessments or care plans and these records were not always personalised. This put people at potential risk of harm and at risk of receiving inconsistent care. We have made a recommendation in this area.

Feedback from people about staff deployment from the service was negative. People told us calls were often late and sometimes missed. People did not always receive information about this from the office which impacted on people emotionally and physically. A relative told us, “I would say there is a shortage of staff, there are delays in the morning visit. Today carers didn’t get [loved one] up till 11.30am. The target time is 9.00am... It impacts on [loved one’s] diet, like a late breakfast and [they] might not then eat lunch.”

Accidents and incidents were not consistently recorded. Despite this, where accidents or incidents were recorded, action was taken to make people safe and lessons were shared.

Staffing level challenges had had an impact on people receiving timely support and the management of the service. The provider was in the process of implementing new strategies at the time of our inspection to try and increase recruitment and continued to do so following the inspection.

Audits had not taken place regularly in the months prior to the inspection. Risk assessments and care plans were not up to date and did not reflect the care that people were currently receiving. Actions were not consistently taken from the audits that had previously been completed. We did not see evidence of trends analysis to further aid learning and drive improvements.

Feedback from people was negative about communication from the office. Although, staff said they received necessary updates from the office and a recent survey had been sent out to people at the time of our inspection.

Feedback from people about the care they received during visits, from regular carers, was positive. People told us they felt safe. One person said, “I have a trio of lovely [carers] who look after me and I trust them with my life.” Staff knew the signs and symptoms of abuse and how to report any concerns. Safeguarding concerns were reported to external agencies.

Risks from the spread of infections such as COVID-19 had been considered. Staff knew how to prevent the spread of infections for example by wearing personal protective equipment.

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 and systems in the service supported this practice.

There was no one receiving end of life care at the time of the inspection, however staff had received training regarding care at the end of people’s lives and preferences around this were included in care planning.

The service worked in partnership with healthcare professionals and other external agencies.

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 26 July 2018).

Why we inspected

We received concerns in relation to staffing levels, the quality of care provided and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led. We carried out a targeted inspection in the key question responsive to look at concerns in relation to end of life care.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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

The provider had been aware of the concerns the inspection identified prior to the site visit. They had a plan to increase recruitment which would allow for better service delivery. This was being implemented during our inspection and therefore we cannot comment on the effectiveness of these plans.

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 breaches in relation to ineffective staff deployment and ineffective quality assurance systems and processes 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.

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.

Governance systems had not been fully embedded into the service. The registered manager had an oversight of and reviewed the daily culture in the service, including the attitudes and behaviour of staff. The registered manager promoted transparency and fairness within the workforce. People, their families and staff were encouraged to be engaged and involved with the service.

People were protected from abuse. Staff received training in how to identify different types of abuse. Risks to people and the environment were assessed and where issues were identified action was taken to mitigate the risk of harm. There were enough staff to meet the needs of those being supported. When people needed support with their medicines, they were helped in a safe way by staff that were trained. People were protected by the prevention and control of infection. Staff understood their responsibilities to report safety incidents, and improvements were made when things went wrong.

People’s needs were assessed before staff began to support them. The assessments took into account peoples protected characteristics such as their ethnicity and sexuality. Staff were trained to have to skills and knowledge to deliver effective care and support. Where responsible, people were supported to eat and drink enough to maintain a balanced diet.

Staff made referrals to health professionals when required. Staff worked together to ensure that people received consistent and person-centred support when they moved between different services. When people lacked the capacity to consent to care, staff sought consent from people in line with legislation. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

Staff were encouraged to develop caring relationships with the people they supported. People’s dignity and independence was respected at all times. 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 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.

People and their families were encouraged and supported to raise any issues or concerns with the registered 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.

Kent Social Care Professionals domiciliary care agency provides care and support for people in their own homes. Care is provided for a range of people including older people and people with dementia. The agency operates in areas including Tonbridge, Tunbridge Wells, Paddock Wood, Sittingbourne, Medway, Dartford and Gravesham. At the time of our inspection they were supporting approximately 700 people.

There was 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 2008 and associated Regulations about how the service is run.

Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

People were treated with dignity and respect by staff who also maintained people’s privacy.

People experienced a service that was safe. They received support and assistance from enough staff to fulfil their expected care packages and meet their assessed needs. Staff and the management team had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and recorded with measures put into place to manage any hazards identified.

Where staff were involved in assisting to managing people’s medicines, they did so safely. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely.

Staff had received the training they required to meet people’s needs. Staff had a clear understanding of their roles and people’s needs. Staff were supported in their role from the management team.

People’s needs had been assessed to identify the care and support they required. Care and support was planned with people and reviewed to make sure people continued to have the support they needed. People were encouraged to be as independent as possible. Detailed guidance was provided to staff within people’s homes about how to provide all areas of the care and support people needed. People, if required were supported to eat and drink enough to maintain good health.

Systems were in place for monitoring the quality and safety of the service and assessing people’s experiences. These included telephone reviews, face to face reviews and spot checks.

The agency was currently providing care to 96 people, and we telephoned 20% of people using the service. We chose these at random from the information provided by the manager during the visit to the office.

We found that there were suitable procedures in place for people's care plans to be discussed and agreed with them prior to commencing the service.

We received a variety of comments from people about the services provided, but the majority said that the care was good and they were happy with the care staff provided. One person said "I am well satisfied. Some staff are good, and some are very good." Others were unhappy with unreliable timekeeping or a lack of continuity with care staff.

We found that there were processes in place for care staff to assist people with maintaining their food and fluid intake. However, two people said that 'A lot of the staff cannot cook.'

The agency enabled staff to prompt or assist people with their medication, and staff had received appropriate training for this.

We found that the agency had suitable training procedures in place for new staff inductions and mandatory training.

The agency provided people with the opportunity to feed back information about the service; and had monitoring processes in place.