Retons Care and Training Services Ltd

Retons Care and Training Services Ltd is a domiciliary agency providing care and support to people in their own homes. 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. At the time of the inspection they were providing personal care to 23 people.

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

People spoke highly of the care and support they received from staff. Comments included, “I am very happy with the service provided” and, “They’re doing a marvellous job.”

Staff followed detailed guidance to reduce potential risks posed to people to keep them safe. Staff were recruited safely, and systems were in place to inform people if staff were running late. People told us care staff had never missed a care call.

People told us they had built a relationship with their care staff who knew how to meet their needs. Staff knew how to protect people from the potential risk of harm and abuse. Staff had been trained and understood the action to take if they had suspicions.

Medicines were managed safely, and people received their medicines as prescribed. Medicine records were audited monthly by a member of the management team. Care plans were individualised and contained detailed guidance infirming staff how the person wanted their needs met.

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 supported this practice. Checks were made to ensure people had the legal authority to sign on other people’s behalf.

Staff had been trained to meet people’s needs and felt supported in their role. Staff attended regular team meetings giving them the opportunity to raise any concerns or to make suggestions.

Systems were in place to monitor the quality of the service people received. People were asked for their views and changes were implemented promptly to improve the service.

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 29 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 18 and 23 July 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Regulation 12 (Safe Care and Treatment), Regulation 11 (Need for Consent) and Regulation 17 (Good Governance).

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Retons Care and Training Service Ltd on our website at www.cqc.org.uk.

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.

Retons Care and Training Services Ltd is a domiciliary care service that provides care and support to people living in their own houses or flats in the community.

Not everyone using the service receives a regulated activity. CQC only inspects where people received personal care. This is 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 this inspection, there were 16 people receiving a regulated activity.

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

Risk assessments were in place to prevent or reduce the risk of people being harmed. However, appropriate management plans were not in place specifically with risk related to pressure ulcers

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, information in people’ care plans was not clear in relation to people’s capacity to make decisions for themselves.

There were systems in place to assess and monitor the quality of the service provided. However, these were not effective and did not identify the concerns found during this inspection.

People’s care plans were not person centred and were task focused.

We have made a recommendation about person centred care planning.

People spoke positively about the service. They told us they felt safe and their needs were being met. Assessments were carried out to ensure people's needs could be met.

Medicines were managed safely. Staff followed appropriate infection control practices. Appropriate numbers of suitably skilled staff were available to meet people's needs. Accident and incidents were recorded and acted upon. Any lessons learnt were used as opportunities to improve the quality of service

Staff had the knowledge and experience to support people's needs. They were supported through induction, training and supervision to ensure they performed their roles effectively. People were supported to maintain good health and access healthcare services when needed. People were supported with their nutritional and hydrational needs. People's privacy, dignity and independence was promoted. People told us care workers were kind and caring. There were procedures in place to respond to complaints. The provider had investigated and responded promptly to any concerns received.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 20 July 2018). The provider took action after the inspection to make improvements. At this inspection, enough improvement had not been sustained and the provider was in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, person centred care and good governance 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Retons Care and Training Services Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to 19 older adults in the London Borough of Bromley. 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 this inspection we found improvement was required because risk assessments for falls and medicines were not carried out. Where risks to people were identified, risk management plans did not always have detailed guidance in place for staff on how to manage these risks safely.

People did not have protocols in place for their 'as required' medicines (PRN). The provider did not have effective processes in place to monitor the quality of the service as they had not identified the issues we found at this inspection. Following the inspection the provider submitted documentation to show us that they had taken action to address our concerns.

The service had 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.

There were appropriate safeguarding and whistleblowing procedures in place and staff understood how to safeguard people and how to raise any concerns. There was a system to log accidents and incidents. People were protected from the risk of infection as staff had been trained in infection control. Appropriate recruitment checks took place before staff started work. There were enough staff deployed to meet people's care and support needs.

Staff completed an induction when they started work and they had completed a mandatory programme of training that was relevant to peoples’ needs. Staff were supported through regular supervisions and appraisals. Staff obtained people’s consent before assisting them with their care needs. People's needs were assessed to ensure the service could meet these needs. 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. People were also supported to have a balanced diet and had access to a range of healthcare professionals when required to maintain good health.

People told us staff were caring. Staff respected people’s privacy and dignity, and encouraged people to be as independent as possible. People were involved in making decisions about their daily care and support requirements and were provided with information about the service in the form of a service user guide. Staff had received training on equality and diversity. The registered manager said that the service would support people according to their diverse needs where required.

People were involved in planning their care and support needs. People were aware of the provider’s complaints procedure and knew how to make a complaint. Complaints were managed and dealt with in a timely manner. When appropriate, people’s end of life care wishes would be recorded in care plans.

The provider carried out regular spot and competency checks to make sure people were being supported in line with their care plans. Regular staff meetings were held and feedback was sought from people about the service through telephone checks and annual surveys. Staff were complimentary about the registered manager. The provider worked in partnership with the local authority to ensure people’s needs were planned and met.

This was the provider’s first inspection since their registration in October 2015. Retons care and training services Ltd is a domiciliary care service providing personal care to people living in their homes. At the time of the inspection only one person was using the service. Therefore we were not able to rate the service against the characteristics of inadequate, requires improvement, good and outstanding. We did not have enough information about the experiences of a sufficient number of people using the service to give a rating to each of the five questions and therefore could not provide an overall rating for the service.

The service had 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.

There were systems in place that ensured people received their care on time, people were kept safe and their needs were met. Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Risks to people using the service were assessed and risk assessments provided clear information and guidance for staff. There were systems in place to ensure the safe management, storage and administration of medicines, however at the time of our inspection no one required support with their medicines. There were enough staff deployed to meet people’s needs and the provider conducted appropriate recruitment checks before staff started work. The service had an on call system to make sure staff had support outside the office working hours..

Staff told us that they had completed an induction into the service and had completed mandatory training to help them carry out their role. Records confirmed staff training was up to date. Staff were supported by receiving regular supervisions.

People’s consent was sought before care was provided. The registered manager was aware of the requirements of the Mental Capacity Act 2005 (MCA). At the time of inspection the registered manager told us the person they were supporting had the capacity to make decisions for themselves.

People were supported to prepare meals and staff were available to support people to access health care appointments if needed.

Staff told us that they delivered care and support with kindness and consideration. People were provided with information about the service when they joined. People were involved in their care planning and people's needs were reviewed on a regular basis. Care plans provided clear information for staff on how to support people using the service with their needs. People were provided with the service's complaints procedure.

Regular staff meetings took place and people were provided with opportunities to provide feedback about the service. Staff and people told us they thought the service was well run and that the registered manager was supportive.

There were effective processes in place to monitor the quality and safety of the service and the registered manager recognised the importance of regularly monitoring the quality of the service provided.