Crestar Healthcare

Crestar Health Care is a domiciliary care agency that provides personal care and support to people in their own homes. At the time of our inspection there were 24 people receiving personal care.

People’s experience of using this service:

Systems to monitor the quality and safety of the service had not been effective at monitoring and improving the quality of the service. Robust recruitment practice was not in place to ensure only staff that were suitable were employed. Care records and risk assessments did not detail how risks would be managed effectively. Staff did not receive all the support they needed to carry out their role effectively. Supervision of staff and observations of their practice to monitor their competencies were infrequent.

People received their medicines safely and as prescribed. Staff sought people’s consent before providing care and support. 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’s rights to privacy and their dignity was maintained and respected by the staff who supported them. People were supported to express their views about their care.

People told us that the management of the service had improved in recent months. people were confident about approaching the registered manager if they needed to. The views of people on the quality of the service was gathered and used to support service development.

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 (report published January 2017).

Why we inspected:

This was a planned comprehensive inspection.

Enforcement

We have identified breaches in relation to safe recruitment practice and good governance at this inspection.

The service had previously been inspected on 16 December 2015 where it was found to require improvement in the following areas; Safe, where there were concerns around staff numbers, incidents and accidents not being recorded and unsafe administration of medicines. Responsive where complaints were not always acted upon effectively and Well Led, due to concerns around the management of the service, lack of quality assurance audits being carried out and the service were not notifying us of any incidents involving people using the service. The lack of notifications received led to a breach of Regulation 18 CQC (Registration) Regulations 2009, Notification of Other Incidents. We asked the provider to take action in response to this and we found that this action had been completed.

Crestar are registered to deliver personal care. They provide support to adults living in their own homes. Some care provided is on a, “live-in basis”, which is where the carer remains living in the person’s home to care for them. At the time of our inspection 10 people were accessing this care through the provider.

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.

Staff supported people in a way that made them feel safe. Staff understood the procedures they should follow if they witnessed or suspected that a person was being abused or harmed. Criminal records checks were undertaken before staff were able to begin their role. People were supported to take their medication at the appropriate times. People received the support they needed and were satisfied with the timings of calls. Staff had knowledge of the risks posed to people supported them safely.

Staff had the skills and knowledge required to support people effectively. Staff received an induction prior to them working for the service and they felt prepared to do their job. Staff could access on-going comprehensive training and regular supervision to assist them in their role. Staff knew how to support people in line with the Mental Capacity Act and gained their consent before assisting or supporting them. Staff assisted people to access food and drink and encouraged people to eat healthily.

People were involved in making their own decisions about their care and their own specific needs. People felt listened to, had the information they needed and were consulted about their care. Staff provided dignity and respect to people. People were encouraged to retain a high level of independence with staff there ready to support them if they needed help.

People’s preferences for how they wished to receive support were known and always considered by the care staff. Staff understood people’s needs and provided specific care that met their preferences. Staff considered how people’s diverse needs should be met. People knew how to raise complaints or concerns and felt that they would be listened to and the appropriate action would be taken. The provider requested feedback from people using the service.

People were happy with the service they received and felt the service was led in an appropriate way. Staff were well supported in their roles with a clear management structure. Staff felt that their views or opinions were listened to. Some quality assurance audits were carried out and we could see clear developments in how audits were being used to assess the quality of care being provided.

The manager was registered with us as is required by law. 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 medicine appropriately and the recording of medicines could lead to confusion.

People, their relatives and staff spoke about the approachable nature of the registered manager, however concerns were raised about his management style.

Quality assurance audits had not been carried out recently and feedback was not used appropriately. Incidents and accidents were not recorded and we had not received notifications.

The complaints procedure had been given to people in a clear and understandable way, but this was not always followed appropriately. People and their relatives told us that they were able to raise any concerns they had and felt that the registered manager would listen.

There were concerns around the level of staff during weekends and also the lack of risk assessments for staff who had disclosures on their Disclosure and Barring Service (DBS) check.

Staff had a basic understanding of safeguarding, but did not have a clear understanding of whistle-blowing.

Staff had a basic knowledge of the Mental Capacity Act 2005. They obtained consent where possible and explained their actions to people.

People were supported to take food and drinks in sufficient quantities to prevent malnutrition and dehydration. People were supported to ensure their health needs were met.

Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People and their relatives were involved in the planning of care and staff delivered care in line with what was considered to be people’s preferences and wishes.

Structures for supervision allowing staff to understand their roles and responsibilities were in place.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were in place.