Archived: All Seasons Community Support LLP

There was a registered manager employed at the service. 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 registered manager was responsible for the day to day control of the service. They were supported by a head of care, quality assurance manager, area managers, co-ordinators, team leaders, human resources and an administration team.

At the last inspection in August 2016 three requirement notices were served. The provider sent the Care Quality Commission an action plan to address the shortfalls, with a timescale to become complaint with the regulations. At this inspection the breaches found at the last inspection had been met.

People were protected from the risks of abuse and discrimination. Staff were knowledgeable about the risks of abuse and understood the process for reporting any concerns. When concerns had been raised these were reported in line with guidance to the relevant authorities.

Risks to people were identified, assessed, monitored and reviewed. Risk assessments were in place to give staff the guidance on how to reduce risks to people. These were regularly reviewed and updated as required.

There was sufficient staff on duty to make sure people received consistent care. Staff had permanent rotas which were co-ordinated geographically, to reduce the travel time and help people receive their call at the requested time. People told us the staff usually arrived on time and stayed the duration of the call.

Staff were recruited safely with the necessary checks being carried out to make sure they were suitable to work at the service. New staff received an induction and shadowed experienced staff before they started to work on their own. Staff received support through one to one supervision meetings, staff meetings and competency spot checks. Staff received appropriate training to be able to perform their role and have the skills and competencies to meet people’s needs.

Some people took their medicines independently with no involvement from staff. Other people did need prompting or support and guidance from staff to take their medicines as prescribed by their doctor. Staff were trained to support people with their medicines and senior staff checked they were competent to do so.

People told us that the staff asked for their consent before providing their care. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. People were supported to make decisions and when required best interest meetings involving the person, relatives and health care professionals were held.

People’s dietary needs were assessed and staff supported people with their meals and left drinks and snacks for people to eat later when needed.

People told us the staff supported them with their health care needs. Records showed that when required, staff contacted the relevant health care professional such as doctors and community nurses.

People told us the staff knew them well and that they were kind and caring. Staff were able to tell us about people’s preferences and personal histories. Staff spoke about people in a kind and compassionate way. People were involved in the planning and reviewing of their care and support.

People told us that staff treated them with dignity and respect. Staff spoke with us about how they promoted and maintained people’s dignity when they supported them. People’s confidentiality was respected and records were stored securely in the office. People told us that the care staff were discreet and did not discuss other clients with them.

Care plans centred on the individual person and provided staff with important information and guidance to make sure they supported people in the way they preferred. People told us they received support from regular ‘core’ carers.

People and their relatives told us they knew how to complain. A copy of the provider’s complaints process was in each person’s home. When a complaint was received it was investigated and responded to appropriately. People, relatives, staff and health professionals were given the opportunity to provide feedback to the service.

The registered manager led by example. They had oversight of the day to day running of the service and used concerns and complaints as a learning exercise to make improvements. There was an open culture which was promoted by the staff.

There were systems in place to gather people’s views, including regular reviews and quality surveys. Staff told us they felt valued by the organisation. Regular quality audits were completed to assess, monitor and improve the quality of the service provided.

All Seasons Community Support LLP provides a domiciliary and support service and is part of a community interest (not for profit) company. The agency provides services in the Kent area. The service has a designated office in Margate and operates an on-call system outside office hours. All Seasons Community Support LLP provides care and support for periods of 30 minutes to 24 hours a day, 7 days a week. At the time of the inspection All Seasons Community Support LLP were providing care and support to over 550 people.

There was a registered manager employed at the service. 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 registered manager was responsible for the day to day control of the service. They were supported by the director, co-ordinators and team leaders.

Assessments identified specific risks to individuals. There was a lack of detail in risk assessments to guide staff on how to manage risks. The systems in place to ensure people received their medicines were not consistently safe.

Care plans were not consistently person-centred. They did not contain sufficient, consistent guidance and information for staff to follow to ensure people’s needs were met. Staff did not have sufficient information about people’s interests to enable them to discuss meaningful topics with people.

People told us they felt safe and trusted the staff that supported them. One person said “I trust them all. They always make me comfortable”. Staff knew how to protect people from the risk of abuse and the action they needed to take to keep people safe. Staff completed regular training about how to keep people safe. The provider had a whistle-blowing policy and staff knew they could take any concerns to other organisations if they had concerns. Staff said they felt confident to whistle blow.

The registered manager monitored and reviewed accidents / incidents and analysed them to identify any trends. When a pattern had been identified action was taken by the registered manager to refer people to other health professionals and minimise risks of further incidents and keep people safe.

There was sufficient staff employed to give people the care and support that they needed. Some people told us they received care from regular staff and their calls were usually covered in times of sickness and annual leave. Other people said they would like more regular carers to support them. People commented, “I haven’t had any missed calls. Sometimes they are a bit late but I understand they may get caught up in traffic or at another call”, “Most of the time I have regular carers” and “There used to be regular carers but not now”.

The provider’s policies were followed when new staff were appointed. Checks, including references and criminal records, were completed to make sure staff were safe to work with people. The registered manager followed the provider’s disciplinary process when required.

People’s medicines were stored safely in their homes. Most people took their medicines independently with no involvement from staff. Some people did need prompting or support and guidance from staff to take their medicines as prescribed by their doctor. Staff were trained to support people with their medicines and senior staff checked they were competent to do so.

People said the service was effective and generally reliable. The provider had a comprehensive training programme and staff completed refresher training to make sure they had the skills and knowledge to carry out their roles effectively. Staff attended regular one to one supervision meetings with their line manager and annual appraisals were completed.

People felt informed about, and involved in, their healthcare and were empowered to have as much choice and control as possible. Staff understood the key requirements of the Mental Capacity Act 2005 (MCA) and how it impacted on the people they supported.

People were supported to maintain a balanced diet. Staff supported people to maintain good health. Staff knew people’s routine health needs and kept them under review.

People spoke positively about staff and told us they were kind and caring. People said “I think the staff are kind and caring” and “They are always jolly. Sometimes they have a sing-song with [my loved one]. The carers know what you need”. People were happy with the care and support they received. Staff knew people well.

People were involved in writing their care plans. Staff were knowledgeable about people’s likes, dislikes and preferences.

People told us they did not have any complaints but would speak to staff in the office if they had any concerns. They said that staff listened to them and sorted out any issues. One person commented “I would speak to the office if I was worried. They would do something”. Each person had a copy of the complaints procedure in their care plans in their home, and appropriate systems were in place to address any complaints.

There were systems in place to monitor the safety and quality of the service. People were asked for their views and opinions through quality assurance visits, care plan review visits and an annual survey. We have made a recommendation for the provider to obtain formal feedback from staff and health professionals.

There was an open and transparent culture. Staff said the management were very supportive and listened to their suggestions and ideas. The provider valued their staff and there were systems in place to recognise loyal service and good performance. Staff were clear about what was expected of them and their roles and responsibilities. The management team looked for creative and innovative ways to empower people. The provider had established links with the local community to improve services for people living in the Thanet area.

Audits were completed on the quality of the service and actions taken when shortfalls were identified. However, the audits completed had not identified any of the shortfalls highlighted during the inspection regarding the inconsistencies with risk assessments and care plans.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager submitted notifications to CQC in line with CQC guidelines.

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