Background to this inspection
Updated
30 June 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 31 May and 1 June 2018 and was announced.
The provider was given 48 hours’ notice prior to the inspection visit. Prior notice is provided because the location provides a domiciliary care service and we needed to be sure that staff would be available on the day.
The inspection team consisted of one adult social care inspector.
Before the inspection visit we reviewed the information which was held on Surecare Cheshire East. This included notifications we had received from the registered provider such as incidents which had occurred in relation to the people who were being supported. A notification is information about important events which the service is required to send to us by law.
A Provider Information Return (PIR) was received prior to the inspection. This is the form that asks the provider to give some key information in relation to the service, what the service does well and what improvements need to be made. We also contacted commissioners and the local authority prior to the inspection. We used all of this information to plan how the inspection should be conducted.
During the inspection we spoke with the registered provider, training manager, administrator, five members of staff, five people who was being supported and three relatives. We also spent time reviewing specific records and documents, including six care records of people who were receiving support, four staff personnel files, staff training records, six medication administration records and audits, complaints, accidents and incidents, health and safety records, action plans, policies and procedures and other documentation relating to the overall management of the service.
Updated
30 June 2018
This inspection took place on 31 May and 1 June, 2018 and was announced.
Surecare Cheshire East is a large domiciliary care agency. It provides care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection the registered provider was providing support to 117 people.
Not everyone being supported by Surecare Cheshire East received personal care. The Care Quality Commission (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.
There was a registered manager in post at the time of the inspection. A ‘registered manager’ is a person who has registered with CQC 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.
At the last inspection which took place in January, 2017 we identified a breach of Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 Care Quality Commission (Registration) Regulation 2009. The registered provider was awarded an overall rating of ‘Requires Improvement’. Following the inspection we asked the registered provider to complete an action plan to tell us what changes they would make and by when. An action plan was submitted and during this inspection, we looked to see if the registered provider had made the necessary improvements.
At the last inspection we found that local governance systems were ineffective. The systems which were in place did not effectively monitor and assess the quality and standard of care people received. During this inspection we looked at the governance systems, audits and checks which were in place and found that improvements had been made. The registered provider was no longer in breach of regulation in relation to ‘Good Governance’ although further developments could be made to the area of quality assurance.
We have recommended that the registered provider reviews some of the quality assurance systems to further to improve the quality and standard of care being provided.
At the last inspection we found that the registered provider had not notified CQC of incidents that had happened in accordance with their regulatory responsibilities. During this inspection, the registered provider demonstrated their knowledge and understanding of the notification process and the different notifications they should be submitting. The registered provider was no longer in breach of this regulation regarding ‘notification of other incidents’.
People and relatives told us that the standard and quality of care provided was safe. Risk assessments contained the most relevant and up to date information and staff were knowledgeable in the area of safeguarding and whistleblowing procedures; they knew how to report any concerns and who to report their concerns to.
We found that there was sufficient numbers of staff on duty to meet the needs of people who were receiving personal care. We received positive feedback from people, relatives and staff about the staffing levels, how staffing levels were managed and how people generally received care from consistent and regular carers.
The registered provider’s recruitment processes were reviewed. Staff records were organised and contained the necessary information required. The records we looked at had suitable references, previous employment history and disclosure and barring system checks (DBS) in place. DBS checks ensure that staff who are employed are suitable to work within a health and social care setting. This enables the registered manager to make informed decisions about the suitability of applicants with regards to working with vulnerable adults.
Medication management procedures were reviewed. We found that the registered provider had improved the medicines processes following the last inspection. New medicine administration paperwork had been introduced, staff expressed that they had been fully trained and had their competency assessed on a regular basis.
Accidents and incidents were recorded and monitored. There was an up to date ‘Accident Reporting’ policy in place. Staff explained how they reported accidents/incidents and the processes they had to follow.
Health and safety policies and procedures were reviewed. Staff were provided with personal protective equipment (PPE) and were aware of the different infection prevention control measures that needed to be followed.
During the inspection we checked to see if the registered provider was complying with the principles of the Mental Capacity Act, (MCA) 2005. It was identified on the last inspection that staff did not understand the principles of the MCA and the importance of assessing people’s capacity. People’s ability to make decisions about the care they received was considered in line with principles of the MCA.
We reviewed how staff were supported with delivering the provision of care which was expected. Staff received regular supervisions, annual appraisals and there was an effective training package in place. Training, learning and development was encouraged by the registered provider and staff expressed that they felt supported.
The day to day support needs of people was well managed. We saw evidence of support being provided by external healthcare professionals such as GP, district nurses, occupational therapists and dieticians.
People’s nutrition and hydration support needs were safely and effectively managed. People were regularly assessed, measures were in place to mitigate risk and appropriate referrals were made to external healthcare professionals. The guidance provided by external healthcare professionals was incorporated within care plans and staff were familiar with guidance which needed to be followed.
People expressed that they were treated with respect and received kind, compassionate and dignified care from all staff who supported them. Relatives also expressed that the care provided was of a high standard.
A person centred approach to care was evident. Care records were detailed, provided a thorough account of the person’s preferences, likes/dislikes and enabled staff to develop a clear understanding of the needs and desires of each person they were supporting.
A complaints policy and procedure was in place. We reviewed how complaints were responded to and processed. People and relatives knew how to raise any concerns if they ever needed to and were provided with the complaints process from the outset.
Systems were in place to gather feedback regarding the provision of care provided. People and relatives were encouraged to share their views, opinions and thoughts through annual surveys and regular observations and ‘spot checks’ were conducted.
The registered provider had a number of different policies and procedures in place. Policies contained up to date and relevant information and were accessible to all staff. Some of the policies we reviewed included medication administration, equality and diversity, safeguarding, infection prevention control and care planning.