Care Sante Kent

121 Care and Mobility is domiciliary care provider that was providing personal care to people in their own homes. People receiving support had a range of needs including, the elderly, people that were living with dementia. At the time of our inspection there were 280 people receiving personal care.

People’s experience of using this service:

• The provider had made changes to improve the service for people. Care plans had all been reviewed to make sure that they reflected the care that people needed and people told us that they had been involved with this.

• Care was person centred, achieved good outcomes and people were offered choice and involved wherever possible.

• People's care plans reflected their needs and preferences and staff could explain specific care that people required.

• People received care from staff who were well supported with induction, training and ongoing supervision.

• People knew how to complain and that any concerns would be listened and responded to by the provider. Actions were taken as a response to complaints.

• Feedback was sought and used to make improvements. Feedback from people, relatives, health care professionals and staff were all positive.

• Quality monitoring systems included audits, checks on staff practice and checks on people's satisfaction with the service they received, using questionnaires.

• The provider has systems in place to ensure they kept up to date with developments in the sector and changes in the law.

• Lessons were learnt and used to make improvements.

• The service was led by an experienced, competent manager who understood their role and responsibilities, as did staff. The service had a clear management structure and people had confidence in the manager and provider.

Rating at last inspection: At the last inspection the service was rated Inadequate (report published on 09 October 2018). This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this inspection on 3 April 2019 we found that sufficient progress had been achieved to meet all the breaches of regulations.

Why we inspected: This was a comprehensive planned inspection based on the previous rating.

Follow up: We will continue to monitor this domicillary care agency and plan to inspect in line with our re-inspection schedule for those services rated Good

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

121 Care and Mobility Limited is a domiciliary care agency, it provides personal care to people living in their own homes. The service provides support visits to people in Whitstable, Herne Bay, Faversham and surrounding areas who are mainly older people, and some younger adults. At the time of the inspection they were supporting 292 people. Not everyone using 121 Care and Mobility 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.

At the time of the inspections in June and July 2018, the registered manager’s registration was being processed by CQC. The registration is now completed and there is a registered manager at 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.

At our previous inspection on 21 and 22 February 2017, we rated the service as Requires Improvement having found breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk because the service was not assessing health related risks and ensuring measures to keep people safe were in place. Audit systems were not utilised effectively to identify and respond to shortfalls identified by people and staff. We asked the provider to take action to meet the regulations. We received an action plan on 11 May 2017 which stated that the provider would be meeting the regulations by 01 July 2017.

At this inspection, we found that the previous breaches had not been met and that there were further breaches of Regulations relating to: not ensuring that people were kept safe, failing to ensure care plans were reviewed regularly to reflect people’s needs; not consistently protecting people’s dignity; not meeting the requirements of the Mental Capacity Act; not protecting people from risks; not ensuring that systems and processes for safeguarding people had been put in place; and not responding to safeguarding risk in a timely manner, not meeting nutritional and hydration needs effectively; not ensuring governance systems monitor and improve the quality of the service; not ensuring sufficient competent staff were delivering the care and not ensuring an accurate CQC rating was displayed at all times.

People had not been kept safe from risk of harm. Risks had not been adequately managed and risk assessments had not been updated in a timely manner to ensure that risks had been correctly identified and actions put in place to lessen the risks.

Environmental risks had not been correctly assessed so that necessary infection control measures could be introduced to provide a safe working environment in people’s homes, for example during food preparation.

The provider had not carried out adequate individual risk assessments for people joining the service and there was insufficient detail to individualised care-related risk assessments to support people’s specific health and care needs, their mental health needs, medicines management, and equipment requirements.

Medicines had not been managed safely and people had not always received their prescribed dosage on time. Medicine administration was not correctly recorded and medication errors had occurred.

People’s changing needs had not been correctly recorded. We found gaps in care plans and essential risk assessments for example, to mitigate the risk of choking or falling, had not been completed with key follow up actions and learning by the provider, so that people could be kept safe from dangerous situations that might cause significant harm to them.

The provider did not have adequate processes in place to monitor the delivery of the service and staff communication systems were not effective in ensuring that all of the staff team were consistently updated to any changes.

People’s needs and choices had not been assessed effectively. Care plans were in place but there was a lack of essential details which left room for error and confusion and some staff were unaware of changes that had been introduced to plans. We have made a recommendation about this in our report.

The provider followed effective recruitment procedures to check that potential staff employed by the service were of good character and had the skills and experience required. All staff received core induction training at start of their employment covering key subjects to enable them to carry out their duties with refresher training provided at intervals. Sufficient numbers of staff were employed to meet people’s needs and provide a flexible service.

People were not consistently supported with meal planning and preparation, and eating and drinking as required. Choking risks had not been adequately assessed and staff had not sufficiently ensured that people had been supported to maintain healthy eating where guidelines had been put in place for health purposes.

People were supported to attend routine and follow up appointments if required. However, we reviewed care plans that showed a lack of detail around people’s health needs, especially where clear professional guidelines from trained professionals would ensure that people could be supported to reduce and manage their health risks more effectively.

Consent had not consistently been sought and the principles of the Mental Capacity Act 2005 (MCA) had not been complied with.

People told us they felt supported by the staff team. People liked staff and told us they were ‘really kind and thoughtful’. People told us they felt their choices and homes were respected by the staff team. People’s independence was supported by staff at home and staff protected people’s dignity by explaining what they were doing during personal care.

Information was kept safe in locked cabinets at the provider’s offices with copies in people’s homes. Staff understood the need for confidentiality; but on occasion, information sharing had lacked dignity and respect.

Peoples care plans had not been sufficiently developed with their input. There was a lack of evidence of personalisation so that people’s choices and wishes could truly reflect their needs holistically.

People said that they knew they could contact the provider at any time, and they felt confident about raising any concerns or other issues. Complaints had been logged and we found evidence of follow up by the registered manager. However, complaints information was not available in assessable format for people with communication difficulties. We have made a recommendation about this in our report.

People’s care plans contained no evidence of end of life care planning even though a significant number of people were older with complex health needs. We have a made a recommendation about this in our report.

The organisations vision and culture had not been reflected through a clear and credible delivery strategy for delivering high quality care and support. Staff did not appear to work collaboratively and this was having a negative impact on the quality of the service offered to people.

Quality monitoring and audit systems were ineffective and there was a lack of urgency about addressing some of the high and complex risks. The service has not demonstrated a commitment to driving improvement and breaches from the last inspection had not been addressed.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service is run by an experienced 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.

Risks associated with people’s care and support had been identified, but there was not always sufficient guidance in place for staff, to aid risk management and help ensure people were safe.

Comprehensive audits and systems in place to monitor that the service ran efficiently had not been utilised effectively and had not picked up that although most people found the office staff kind and courteous, they did not always tell people about changes to their calls or ring back when messages were left. Care staff also felt communication from the office could be improved upon, and supervisions had not picked up or addressed staff feelings of being unsupported. Audits of care records had not identified where there were gaps in risk information. People had opportunities to provide feedback about the service provided, but they did not in turn receive feedback about how their comments were used to help service development.

People told us they received their medicines when they should and felt their medicines were handled safely. They said that they felt safe using the service and when staff were in their homes.

The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People had their needs met by sufficient numbers of staff. Most people told us staff generally arrived on time and that on the whole they received support from a team of regular staff. New staff underwent an induction programme, which included relevant training and shadowing of experienced staff, until they were competent to work on their own.

People told us staff always asked for their consent before carrying out activities at each visit. People were supported to make their own decisions and choices although some were supported by relatives. The Mental Capacity Act (MCA) provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process and was working to the principles of the MCA.

People were supported to maintain good health and they told us staff were observant in spotting any concerns with their health and taking appropriate action.

People were involved in the initial assessment and the planning of their care and support and some had chosen to involve their relatives as well. Care plans reflected the care and support people received. People told us their independence was encouraged wherever possible.

People felt the majority of staff were kind and caring. People said they were comfortable with staff in their home and undertaking their personal care they said staff listened and acted on what they said. People were treated with respect and their dignity and privacy protected. People said they felt able to raise concerns if they had them.

The providers had invested in the expansion of the service and were proactive in participating in pilot projects with other stakeholders regarding the most effective delivery of domiciliary care currently and in the future. The office was well equipped to enable the smooth running of the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.