Caremaid Services Limited

Not everyone using Abbey House (Caremaid Services Ltd) 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.

The registered manager was present during the inspection. 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.

People did not always receive a safe service from Abbey House (Caremaid Services Ltd). We had feedback from people that use the service and service commissioners about concerns with the timeliness and consistency of staff. The provider sent us information after the inspection about how they had addressed these concerns. Time was now needed for the provider to evidence the changes made had been so that people had their support at the agreed times, and with consistent staff wherever possible.

Hazards to people’s and staff’s health and safety had been assessed. Information on how to manage and minimise the risk of harm were in place and understood by staff. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

Staff recruitment procedures were safe. The provider had undertaken appropriate safety checks to ensure that only suitable staff were employed to support people in their own home. There were sufficient numbers of staff who were appropriately trained to meet the needs of the people who used the service. The provider was looking at ways to improve staff’s punctuality, as this was the main complaint people had about the service.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. Staff understood the need to protect people fomr the spread of infections.

Prior to people joining the service a detailed assessment of their needs was completed. Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). Staff understood that they had to gain people’s consent before they provided care, and that they could not make decisions for people.

Where required staff supported people to have enough to eat and drink. This varied from buying and preparing meals for people who needed help eating to checking that people had eaten something for those who were more independent.

People were supported to maintain good health. Staff responded quickly if people’s health deteriorated. They made sure they contacted the appropriate professionals to ensure people received effective treatment. Emergency plans were in place to deal with situations that may stop the service running, such as adverse weather. These had proved effective earlier in the year during a period of bad weather.

People told us that the staff were kind and caring and treated them with dignity and respect. The staff knew the people they cared for as individuals, and had a good rapport with relatives.

People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to reference so they knew what support was required. People were supported by staff to maintain as much independence as possible.

People knew how to make a complaint, and told us they would feel comfortable doing this. Staff knew how to respond to a complaint and welcomed them as an opportunity to improve the service.

The provider had effective systems in place to monitor the quality of care and support that people received. The provider had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained. The registered manager regularly visited people in their homes, or the office telephoned them to give people an opportunity to talk, and to ensure a good standard of care was being provided.

Records for checks on health and safety, and medicines audits were all up to date. Accident and incident records were kept, and were analysed and used to improve the care provided to people.

We have made one recommendation in the report for the provider to continue to monitor and address feedback about late calls.

We undertook an announced inspection of Caremaid Services Ltd on 27 September 2017. We told the provider 48 hours before our visit that we would be coming because the location provided a domiciliary care service for people in their own homes and the registered manager and staff might be not be available to assist with the inspection if they were out visiting people.

The service was last inspected on 30 and 31 August 2016, when we found breaches of Regulations in relation to safe care and treatment, person centred care, recruitment of staff and governance. The provider sent us an action plan on 19 October 2016 telling us they had made the necessary improvements. At this inspection we found the provider had made most of the necessary improvements, but had not fully met the regulation in regards to safe care and treatment.

Caremaid Services Ltd provides a range of services to people in their own home including personal care. Most people using the service were older people, some of whom were living with dementia. At the time of our inspection 72 people were receiving personal care in their home. Most people were funded by their local authority.

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.

Staff did not always follow the procedure for the management of people’s medicines and there was a risk that people were not receiving their medicines as prescribed.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines. You can see what actions we told the provider to take at the back of the full version of this report.

There were systems in place to monitor and assess the quality and effectiveness of the service, and the provider ensured that areas for improvement were identified and addressed. However, audits had not been effective in addressing shortfalls in the management of medicines.

People's needs were assessed prior to receiving a service and care plans were developed from the assessments. Care plans contained the necessary information for staff to know how to support people and meet their needs and were written in a person centred way.

The risks to people's wellbeing and safety had been assessed, and there was information on people’s records about how to mitigate these risks.

There were procedures for safeguarding adults and staff were aware of these. Staff knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

Feedback from people and their relatives was mostly positive. Most people said they had regular staff visiting which enabled them to build a rapport and get to know them.

Most people we spoke with and their relatives said that they were happy with the level of care people were receiving from the service.

The registered manager was aware of their responsibilities in line with the requirements of the Mental Capacity Act 2005 (MCA) and staff had received training on this. People had consented to their care and support and had their capacity assessed prior to receiving a service.

The service employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff’s absence. Recruitment checks were in place to obtain information about new staff before they supported people unsupervised.

People's health and nutritional needs had been assessed, recorded and were being monitored.

Care staff received an induction and shadowing period before delivering care and support to people. They received the training and support they needed to care for people appropriately.

There was a complaints procedure in place which the provider followed. People felt confident that if they raised a complaint, they would be listened to and their concerns addressed.

People, staff and relatives told us that the registered manager and senior team were approachable and supportive. There was a clear management structure, and the provider encouraged an open and transparent culture within the service. People and staff were supported to raise concerns and make suggestions about where improvements could be made.

Caremaid Services Limited is a domiciliary care agency which provides personal care for people in their own homes. At the time of our inspection, there were 69 people using the service, most of whom were funded by their local authority. People who received a service included those with physical frailty or memory loss due to the progression of age, terminal illness, eating disorders and dementia. The frequency of visits varied from one to four visits per day depending on people’s individual needs.

There was a registered manager in post at the time of our inspection. 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.

People using the service were at risk of unsafe or inappropriate care as the provider did not always carry out checks on new staff to make sure they were suitable to work in the service.

The risks to people’s wellbeing and safety had been assessed, however, risk assessments were generic and not person-centred and there were no detailed plans in place for some of the risks identified.

Care plans were written from the person’s perspective, however these were basic and lacked detail.

Feedback from people and their relatives was mostly positive, although some people said that care workers were often late and did not always inform them of this. Some people said they had different care workers visiting which made it difficult for them to build a rapport and get to know them. However, all of them said the care workers were reliable and caring and that they trusted them.

People’s needs were assessed by the local authority prior to receiving a service and support plans were developed from the assessment. Most people told us that they did not know the names of people in the office and were not sure who they would contact if they had a concern. Some people told us they had received a visit recently from someone from the office. Some people told us that they had been involved in the planning of their care. Everybody using the service whom we spoke with said that they were happy with the level of care they were receiving from the service.

There were procedures for safeguarding adults and the care workers were aware of these. Care workers knew how to respond to any medical emergencies or significant changes in a person’s condition.

The registered manager was aware of their responsibilities in line with the requirements of the Mental Capacity Act (MCA) 2005 but told us that none of the staff had received in depth training in this. Records showed that people had consented to their care and support and had their capacity assessed prior to receiving a service from Caremaid Services Ltd.

There were systems in place to ensure that people received their medicines safely and all staff had received training in the administration of medicines.

The service employed enough staff to meet people’s needs safely and had contingency plans in place in the event of staff absence.

People’s health and nutritional needs had been assessed, recorded and were being monitored. These informed carers about how to support the person safely and in a dignified way.

Care workers received induction training and shadowed experienced staff before delivering care and support to people. They received the training and support they needed to care for people effectively.

There was a complaints procedure in place which the provider followed, however, some people did not feel confident that if they raised a complaint, they would be listened to and have their concerns addressed.

There were systems in place to monitor and assess the quality and effectiveness of the service, but audits had failed to highlight that there were no detailed plans in place for some risks identified during people’s assessment.

We made a recommendation with regards to the management of accidents and incidents.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the safe care and treatment of people, recruitment and good governance. You can see what action we told the provider to take at the back of the full version of this report.