Scott Care's Medway Branch

About the service

Scott Care's Medway Branch is a domiciliary care agency providing personal care and support for people in their own homes. People receiving care and support were adults, older people and autistic people. At the time of our inspection, 78 people were using the service.

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

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

The service did not make reasonable adjustments for people so they could be fully in discussions about how they received support. People received surveys and provided feedback but the service failed to act on these to improve the service.

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.

Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Right Care:

People had not always received care that supported their needs and aspirations, was not focused on their quality of life, and did not follow best practice. Care calls were sometimes late or missed and people were not informed about these changes. This put people at risk of their care needs not being met.

People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. People benefitted from staff who understood and responded to their individual needs.

Right Culture:

Management failed to effectively evaluate the quality of support provided to people and to fully involve the person, their families and other professionals as appropriate.

People’s quality of life had not been enhanced due to the lack of the service’s culture of improvement and inclusivity.

Staff had not ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 requires improvement (published 26 October 2020). 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 the provider remained in breach of regulations 12 and 17.

Why we inspected

The inspection was prompted in part due to concerns received about poor care provided, care visits timing, missed calls, staffing, complaints, compliance with Mental Capacity Act, incidents and accidents and management. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Scott Care’s Medway Branch provides personal care to older people living in their own homes. At the time of the inspection 127 people were using the service.

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

People received safe care and the provider had made improvements since our last inspection. There were enough staff to ensure people’s needs were met. Where there had been incidents of missed visits the provider and registered manager had taken robust action to prevent these recurring. New risk assessments had been implemented to ensure all risk to people were managed safely.

Lessons had been learnt by the provider when things went wrong and used to make improvements. New systems had been implemented to ensure people received their medicines safely. The provider had managed well during the Coronavirus pandemic and had robust policies and procedures in place to prevent and control infection.

There were improvements to the management of the service since the last inspection. There was a better oversight of areas for improvement from incidents, accidents and complaints. There were clear action plans for how these would be addressed. There was still some improvement needed for more detail and clearer actions from quality audits. The provider and registered manager sought people’s views on their care provided and worked with other health and social care professionals to meet people’s needs.

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 18 April 2020) 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 in the safe and well-led domains.

Why we inspected

We received concerns in relation to people missing their care visits as planned. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. The provider has taken action to mitigate the risk of missed care visits. Please see the safe and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Scott Care’s Medway Branch 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.

Scott Care’s Medway Branch provides personal care to older people living in their own homes. At the time of the inspection 180 people were using the service.

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

There were not always enough staff to keep people safe and meet their needs. People had not received visits, not always received their full visit or at the time they needed to meet their needs. This meant people had not received essential care and medicines. People and relatives told us they were not always informed if their carer was running late. Medicines were not managed safely as records did not make it clear what medicines were prescribed.

Reporting of incidents and complaints was unreliable and inconsistent. Not all complaints had been investigated and used to make improvements to people’s care. Missed visits had been an on-going concern and an action and development plan with new systems to prevent future reoccurrence had been completed. However, systems for managing these risks were ineffective and people had been placed at risk as a result.

The provider had not achieved an open and person-centred culture and had not ensured the delivery of high quality and safe care. Staff gave mixed feedback on the support they received from the manager and communications needed improvement. The provider lacked oversight of staff training and supervision records. People and staff were not engaged with the service. People told us they found it difficult to contact the office and their calls were not returned.

Lessons were not always learnt when things went wrong. Quality assurance systems were not used effectively and had not identified all the concerns we found at inspection. Feedback from surveys and complaints had not always been analysed to identify trends. Learning from these was therefore missed and the provider had failed to make necessary improvements.

People’s care was not always person centred and planned to meet their needs. Care plans lacked detail of people’s likes and dislikes. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There was a lack of risk management around people’s individual needs. We have made a recommendation about this. Not all allegations of abuse had been reported to the manager and therefore not all had been investigated by the manager. We have made a recommendation about safeguarding policy and procedures. Safe recruitment systems were in place although some improvements were needed with obtaining professional references.

Feedback on whether staff were kind and caring was mixed. We have made a recommendation about reviewing people’s visit lengths and times to ensure people are treated with dignity and respect. People's communication needs were not always met. We have made a recommendation about the provision of accessible information.

Staff had not received training around all individual’s needs. We have made a recommendation about staff training. People had not always received consistent staff to meet their needs. Assessments lacked information about people’s choices. People did not always have choice and control over their care as they didn’t always receive their care at a time to meet their needs.

People’s end of life wishes were not always recorded. Therefore, staff did not have the guidance to support people in line with their wishes should an unexpected death occur. We have made a recommendation about the management of ‘Do Not Resuscitate’ orders.

Environmental risks to people were managed safely and people were protected from the risk of infection. Where staff prepared meals for people or assisted them to eat, they were aware of people's needs in relation to any associated risks. People were referred to appropriate health professionals and staff worked in partnership with other agencies to ensure people’s needs were met.

People’s needs around equality and diversity were identified. People confirmed staff respected their privacy when providing personal care. People were involved in their care on a day to day basis. New staff received training and an induction to the service.

The provider had regularly sought people’s and relative’s views on the quality of the care they received. People and relatives told us they could complain if they needed to. The manager clearly understood their role and responsibilities.

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 (published 15 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care and missed visits. These concerns included staff not staying for the duration of their visits, not visiting at the right times and therefore not providing the care needed. A decision was made to inspect the service and examine those risks.

We have found evidence that the provider needed to make improvements. Please see all the sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider and manager were responsive to our concerns and has completed an initial action plan following our Inspection feedback. At the time of writing we are unable to confirm whether any action taken has been effective.

Enforcement

We have identified breaches in relation to the following at this inspection: The provider had not ensured there were enough staff to meet people’s needs. The provider had not ensured people’s medicines were managed safely. The provider had not acted in line with the Mental Capacity Act and had not ensured care was person-centred. The provider had not investigated all complaints and acted in response to failure. The provider had failed to seek and act on feedback to improve the service. The provider had failed to maintain accurate and complete records. The provider had therefore not ensured effective systems to assess, monitor and improve the safety and quality of the service and ensure it was effectively managed.

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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Not everyone who used the service received personal care. 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.

People’s experience of using this service:

We continued to receive positive feedback about Scott Care’s Medway Branch. Comments from people included, “I do feel safe with staff because they are all the ones I know and my regular staff know exactly what I need. I'm quite satisfied.” “I’m ok with Scott Care and I would let them know if I felt concerned or had a problem.” “I do have regular carers morning and evening which suits me well. I’m absolutely happy with the carers and I’m lucky with the ones I have.” “Extremely pleased with service. The cares are wonderful, always on time and leave us safe and happy.”

People told us that staff met their needs with care and were friendly towards them.

Equality, diversity and human rights policies were in place and the care assessments included sections about people’s backgrounds and lifestyles. Staff worked in partnership with people, respecting people’s rights and always offering people choices about their care.

Risks assessments minimised the risk of people being exposed to harm.

People’s needs were fully assessed and people’s right to retain independence was respected. Staff understood how to safeguard people at risk and how to report any concerns they may have. The staff learnt from incidents and accidents to reduce the risk of them reoccurring.

Care plans had been developed to assist staff to meet people’s needs. The care plans were consistently reviewed and updated.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated.

Safe recruitment practices had been followed before staff started working at the service. Staff had supervision and personal development opportunities to learn skills in social care. Staff training was ongoing to ensure staff met people's needs. There were systems in place for ensuring the staffing levels and staff skills balance were maintained to meet people’s needs.

There were policies and procedures in place for the safe administration of medicines. Staff had been trained to administer medicines safely.

People were encouraged to eat healthily by staff when needed. People had access to GPs via their relatives. Staff understood they needed to share concerns they may have to make sure people has support to make referrals and have access to medical care if they became unwell.

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.

Staff followed good hygiene practice to minimise the risks from the spread of infection.

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. (published 26 January 2017).

Why we inspected

This was a comprehensive inspection scheduled based on the previous rating.

Follow up

We will continue to monitor the service.

Scott Care office is based in Sittingbourne and is easily accessible for staff, visitors, including people who may have mobility difficulties. At the time of the inspection the service was providing support to 120 people. Most people were funded by the local authority or through NHS continuing care services with a smaller proportion of people paying privately for their support.

We last inspected the service on the 1 July 2015, when we made three recommendations to assist the provider with improvements. The recommendations were in relation to the administration of medicines, people being provided with a copy of the complaints procedure and the formal system for monitoring quality and safety across the service. At this inspection we found that the registered manager had taken action and improvements had been made.

There was a registered manager for 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 and associated Regulations about how the service is run.

The feedback we received from people was positive. Those people who used the service expressed satisfaction and spoke highly of the staff. For example, one person said, “I am very happy with the service”.

The agency had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the whistleblowing policy. Staff were trained in how to respond in an emergency (such as not being able to gain access to a person’s premises or finding a person collapsed) to protect people from harm.

The service had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals. All staff received induction training and they worked alongside experienced staff and had their competency assessed before they were allowed to work on their own.

The provider carried out risk assessments when they visited people for the first time which included an environmental assessment.

Incidents and accidents were recorded and checked by the provider to see what steps could be taken to prevent these happening again. The registered manager ensured that they had planned for foreseeable emergencies, so that should they happen, people’s care needs would continue to be met.

The registered manager involved people in planning their care by assessing their needs on the first visit to the person, and then by asking people if they were happy with the care they received.

People were supported to choose a healthy and balanced diet. Where staff had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment.

Most people either managed their own medicines or members of their family helped them. Some people required staff assistance with medicines. Staff who administered medicines had received training and management checked that staff were safe to administer people’s medicines by carrying out regular competency assessments. The registered manager ensured that staff had a full understanding of people’s care needs and had the skills and knowledge to meet people’s needs. People received consistent support from staff who knew them well. People felt safe and secure when receiving care.

Staff presented a caring approach as did the staff working in the office who supported the delivery of care. People were happy with the staff and made many positive comments about the staff who supported them. The provider made sure people had information about the service before the commencement of care and support being provided.

The service had processes in place to monitor the delivery of the service. People were given information about how to make a complaint and the people we spoke to knew how to go about making a complaint if they needed to. People and their families thought the service was well run. People’s views were obtained through meetings with the person and meetings with families of people who used the service. The provider checked how well people felt the service was meeting their needs, by carrying out surveys.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the service provided by the agency was safe. People we spoke with said that they were happy with the service provided and they felt safe in the hands of the staff. We looked at how staff had been recruited and saw they were now undertaking all the required checks to ensure staff were suitable to work with vulnerable people.

Is the service caring?

People were supported by staff who were kind and attentive. All of the people we spoke with told us that the staff were polite and friendly. We saw there were cards and letters received by the service from people expressing their thanks for the care they had received. For example one person had written in to thank the service for 'All the care your staff gave my mother'.

Is the service effective?

We found that most people who used the service felt that it met their needs. People told us that the care was good and one person commented on the willingness of their staff as 'many of the carers stay a bit longer than they should to make everything is done'. Relatives we spoke with told us that care was provided in line with assessed care and support needs.

Is the service responsive?

People's needs had been assessed before they started using the service. When their needs changed, care plans were updated to reflect what support was required. We saw that systems were in place for reviewing care plans. Assessments were detailed and reflected a range of care needs such as personal care, preparing food and drinks and prompting medication.

Is the service well-led?

People told us they were able to raise concerns with the manager. We saw that suitable systems were in place to assess and monitor the quality of the service. This included spot checks, telephone surveys and questionnaires for people who used the service and their relatives.

People said that they were involved in their care and treatment. They said that staff respected their privacy and dignity. However, one person had woken up one morning to find a member of staff standing in front of them who they had never met before.

People had individual plans of care and most people told us that they had a regular team of staff to support them. However, one person told us that they no longer had a regular team this lack of consistency was impacting on their experience of the service.

Selection and recruitment procedures did not ensure that people who used the service were safeguarded.

People said that they felt safe when being supported by staff. Staff knew how to raise concerns with the agency and to external agencies.

Staff had regular training and support to help them carry out their roles, including how to administer medicines.

People were regularly contacted to provide feedback on the level of the service that they received.

People consented to the care and treatment they received and were able to make changes to their care packages when they needed to. Records were accurate and up to date and reflected peoples' care needs.

Staff were recruited fairly and the service undertook the necessary checks to ensure that staff were fit to work for the service. Staff received support and training that enabled them to deliver care safely and meet peoples' needs.

The provider responded appropriately to complaints and investigated them where necessary. People told us 'If I have any concerns or want to change anything I can just phone the office and they sort it all out for me'.