Clovecare Limited

At our last comprehensive inspection on 13 July 2017 we found the provider was breaching regulations relating to assessing risks to people and good governance. We also found the provider was not caring for people in line with the Mental Capacity Act 2005 (MCA) and rated the effective question as requires improvement. We issued the provider with a warning notice in relation to the repeated breach of good governance. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well led to at least good. At our next focussed inspection on 24 November 2017 we found the provider had met the requirements of the warning notice and was no longer in breach of the regulations. However, we did not improve the rating for these questions from requires improvement because to do so requires consistent good practice over time.

At this inspection we found the provider had sustained the necessary improvements and judged the overall rating to be Good.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, some of whom may be living with dementia. There were 29 people using the service at the time of this inspection.

Not everyone using Clovecare Limited receives 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.

Since our last inspection, the manager had become registered. 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 felt safe with the care provided and with the staff who supported them. Risk assessments were undertaken to help people to live safely. The provider had improved these to ensure they matched the person's assessed needs and considered risks in people's homes.

The process for staff recruitment was robust and well managed. Appropriate checks were carried out to help ensure only suitable staff were employed to work at the service. There were enough staff to meet people’s needs and the provider made sure they had the resources and capacity to deliver the support people required.

People were supported by regular carers who were appropriately trained and supervised in their roles. Management monitored and observed staff practice to ensure people received their agreed care and support.

Staff were caring and attentive, and knew the people they cared for. People felt that care staff respected their privacy and dignity and helped them to remain as independent as they could.

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.

The support provided was person-centred and flexible, taking into account peoples’ preferences and individual circumstances. People’s care needs were assessed and they were fully involved in making decisions about their care and support before they started using the service.

Assessments considered whether people had any needs in relation to their disability, sexuality, religion or culture. Staff understood and respected these needs.

People's healthcare and dietary needs were assessed and met. Other health and social care professionals were involved where further support was needed for people. Where people required assistance to take their medicines, this was managed safely.

There was effective leadership and people, relatives and staff told us the agency was well run. People and their relatives were given regular opportunities to share their views about the quality of care and any concerns or complaints were acted on.

People benefitted from safe quality care and support as the provider had systems in place to monitor the quality of the service and make improvements and changes where necessary.

This was a relatively new agency and the registered provider and manager knew what was required to develop the service.

At our last announced comprehensive inspection of this service on 13 July 2017. We rated the service as 'requires improvement' overall and in the key questions ‘Is the service Safe’, ‘Effective’ and ‘Well-led’? The provider did not always assess risks relating to people’s care well and did not always ensure management plans were in place to guide staff on the best ways to care for people. The provider had not always followed the Mental Capacity Act (2005) where people may have lacked capacity in relation to the care they received. In addition the provider had not always put care plans in place to inform staff about some people’s individual needs. Although the provider had some audits in place to monitor and assess the quality of service, these had not identified the issues we identified during our inspection because the provider did not have good governance arrangements in place. In addition, audits of medicines management required improving to keep people safe from risks relating to poor oversight of medicines by the provider.

We undertook this focused inspection to check that the provider had followed their plan in relation to the key question ‘Is the service Well-led?’ and to confirm that they now met legal requirements in relation to the warning notice we served. This report only covers our findings in relation to those requirements and we will inspect in relation to the other issues we identified previously at our next comprehensive inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clovecare on our website at www.cqc.org.uk.

This inspection took place on 24 November 2017 and was announced. We gave the provider 48 hours to make sure someone was available in the office to meet with us.

The service did not have 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. The provider told us they had recruited a manager who had begun the process to register with CQC.

At this inspection we found the provider had improved and now met the requirements of the warning notice. The provider had made some improvements to audits of medicines management and planned further improvements which we will check at our next inspection. In addition the provider had a programme in place to review risk assessments and care plans for all people using the service to make documentation more reliable for staff to follow. The provider was also reviewing whether people had capacity to consent to their care, in accordance with the MCA, as part of this programme. The provider told us this programme was going according to plan and would be complete in April 2018.

The provider continued to monitor the training, support and supervision staff received and to communicate openly with people using the service and staff.

We did not improve the rating for ‘is the service well-led’ from requires improvement as there was no registered manager in post and also because we need to see consistency in the improvements over time.

At our last announced comprehensive inspection of this service on 25 May 2016 and we found three breaches of regulations. We rated the service as 'requires improvement'. This was because the provider was not carrying out appropriate checks on staff prior to their employment. They were also not adequately supporting staff through training and one to one meetings to equip them to undertake their roles. Additionally the provider did not monitor key aspects of the service. They did not have systems in place to check the quality of the service, this included checking with people themselves about their views of the service they were receiving. We undertook a focused inspection on the 5 January 2017 to check the provider had improved the service and we confirmed they were meeting legal requirements. However, we did not improve the rating from requires improvement as to do so we needed to see consistency in the improvements over time.

Clovecare is a domiciliary care agency that provides personal care and support to people living in their own homes, many of whom were older people, some of whom were living with dementia. There were 38 people receiving services from Clovecare at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider did not always assess risks to people in line with guidance from the Health and Safety Executive (HSE). This included risks relating to people’s medical and health needs. In addition the provider did not always have care plans in place to inform staff about some people’s individual needs and the best ways to care for people in relation to these. Although the provider had audits in place to monitor and assess the quality of service, these had not identified the issues we identified relating to the risk assessments and care plans which meant people were at risk because the provider had poor governance arrangements in place.

The provider recruited staff following robust procedures to check they were suitable to work with people. In addition there were enough staff deployed to meet people’s needs. People felt safe and staff understood how to respond if they suspected anyone was being abused to keep them safe as they received training in relation to this from the provider. Medicines management was safe. The provider audited medicines management. However, they did not record these audits which meant there was no audit trail to evidence issues which the provider had identified with information about how they had dealt with these. This meant improvements may not be made because of a lack of audits and because records were not always well maintained.

Staff generally understood their responsibilities to provide care to people in line with the Mental Capacity Act 2005. However, the provider had not always carried out mental capacity assessments regarding decisions such as those relating to medicines administration, in line with their policy. The provider told us they would carry out mental capacity assessments and then arrange best interests meetings with relevant people to decide the best ways to care for people where necessary.

The provider continued to support staff with a programme of training and group supervision. The provider told us they would provide additional courses to the training programme specific to people’s needs, such as catheter care. People were positive with the support they received around eating and drinking and the provider supported people to access the healthcare services they needed where this was part of their care package.

Staff treated people with kindness, dignity and respect. Staff understood the needs of the people they were caring for as well as their backgrounds, interests and preferences. Staff supported people to maintain their independence. Staff provided people with information at the times they needed it.

Care was provided based on how people themselves wanted to receive care. The provider was responsive to people’s changing needs. The provider encouraged feedback from people and their relatives and a suitable complaints policy was in place.

The registered manager had open and inclusive ways of communicating with people, their relatives and staff. People, relative and staff were confident in the leadership and management of the service.

We found breaches of the regulations relating to safe care and treatment and good governance. We are taking further action in relation to the breach of good governance and we will report on this when our action is complete. You can see what action we have asked the provider to take to address the breach relating to safe care and treatment at the back of this report.

Additionally the provider did not monitor key aspects of the service. They did not have systems in place to check the quality of the service, this included checking with people themselves about their views of the service they were receiving.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of regulations described above.

We undertook a focused inspection on the 5 January 2017 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 these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clovecare Limited on our website at www.cqc.org.uk

Clovecare Limited is registered to provide personal care to people in their own homes. At the time of this inspection they provided a service to approximately 30 people living in Merton and Sutton.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our focused inspection we found the provider had followed their action plan. They were undertaking pre-employment checks to ensure as far as possible, only suitable staff were employed. Once in post, staff received training and support to undertake their roles and responsibilities.

The provider had established mechanisms to gather the views of people who used the service. They had also put in place quality assurance measures to drive improvements within the service. A policy for whistle-blowing had been introduced.

Whilst the provider had taken sufficient action to meet the legal requirements that were being breached at the last inspection, we have not improved our rating for the service. We need to see consistent improvements over time before we are able to change the rating of this service from ‘requires improvement’.

Clovecare provides personal care to people living in their own homes. They currently provide a service to approximately 20 people who mainly live in the London Boroughs of Merton and Sutton.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. At the time of the inspection the provider had recruited a manager who had submitted their application to CQC to become the registered manager.

We found the provider had not always followed their own recruitment processes which may have resulted in care workers being employed who were not suitable to care for people. In addition, there were risks people’s needs may not have always been met because staff were not always suitably trained or supported to carry out their roles.

Furthermore, the provider had not established good governance systems to regularly assess, monitor, and where required, improve the quality and safety of the service people received. This included having no formal processes in place to regularly seek and act on the feedback from people.

We identified three breaches of the Health and Social Care (Regulated Activities) Regulations during our inspection. You can see what action we told the provider to take at the back of the full version of this report.

Notwithstanding these issues, people who received care from Clovecare were happy with the care they received. They told us care workers provided care that was specific to their needs and wishes. They also said care workers asked for consent prior to providing care.

Staff at Clovecare were able to tell us how they kept people safe and if any issues arose what action they would take to protect people. They also made sure people received the medicines prescribed to them. Care workers routinely monitored people’s health, which included ensuring people were getting enough to eat and drink.

The service had identified risks to people and how these risks could be minimised. Accidents and incidents were recorded and analysed in order to reduce re-occurrences. There were systems in place for care workers to contact senior staff out of hours if there was an emergency.

The manager was aware of their responsibilities and knew when they had to contact CQC to inform us of significant issues that had arisen within the service. Care workers told us they felt they could raise issues with the manager and they would be listened to.

Care workers respected people’s rights to privacy and dignity. This included making sure people’s confidentiality was maintained when required. People were encouraged wherever possible to do as much as they could for themselves. In this way people’s independent skills were maintained.