06 Care Limited

06 Care is a domiciliary care agency. It provides personal care to people living in their own homes the community. It provides a service to adults, older adults, people living with dementia and people with learning disabilities. CQC only inspects the service being received by people provided with 'personal care.' At the time of the inspection the service was providing 41 people with personal care, none of whom had a learning disability.

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

At the last inspection the service was rated as requires improvement. No breaches of regulation were identified, however, we needed to see the many improvements which had been made would be sustained over time. On this inspection not only had the previous improvements been sustained, they had been further developed. The leadership was exceptional and distinctive. The manager and the culture they created promoted high-quality, person-centred care. This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service. The service has now improved to outstanding in caring and good in every other area.

People received support from staff who were exceptionally kind and caring and who frequently went above and beyond what was expected of them. People were involved in making decisions about their care and were treated with the utmost dignity and respect. People were encouraged to be independent and their equality and diversity needs were respected.

The leadership of the service was excellent. The provider invested in technology and the staff team to ensure people got a high-quality service. The provider had excellent governance and auditing systems in place to ensure people received safe care and treatment. This meant the provider was identifying and rectifying any short falls in the service. People were extremely positive about the manager who was highly motivated and dedicated to providing people with the best possible service. People told us they would recommend the service to others and as an organisation to work for.

Staff understood how to keep people in their care safe from harm. Where risks to individuals had been identified very effective measures had been put in place to reduce or eliminate those risks. Safe systems were in place to ensure people got their medicines at the right times. Staff had been recruited safely and there were enough staff to provide people with consistent, timely care and support.

Staff received good quality training and support and had the skills to meet people’s care needs. Staff provided people with support to meet their nutrition, hydration and health care needs. 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.

People’s care needs were assessed before a service was offered, to make sure staff would be able to meet their needs. Personalised care plans were developed to make sure staff knew what they needed to do to meet people’s needs. The systems in place made sure people received a very responsive service. This meant people received person centred care. A complaints procedure was in place and people said they would speak to staff if they had any concerns.

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

Why we inspected

This was a planned inspection based on the previous rating.

Rating at last inspection: The last rating for this service was requires improvement (published 29 August 2018) and there were no breaches of regulation. At this inspection we found the service has improved to good.

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.

Our last inspection took place on 9 and 16 October 2017 and at that time we found the service was not meeting five of the regulations we looked at. These related to safe care and treatment, need for consent, staffing and good governance. The service was rated ‘Inadequate’ and was placed 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. This inspection was therefore carried out to see if improvements had been made since the last inspection and whether or not the service should be taken out of ‘Special measures.’

During this inspection the provider demonstrated significant improvements had been made and the service is no longer rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of ‘Special Measures.’ However, while we concluded improvements had been made they needed to be fully embedded and sustained to make sure people consistently received safe, effective and responsive care and support. This is reflected in the overall rating for the service which is now ‘Requires Improvement.'

There was 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.

On the first day of inspection the registered manager was on annual leave and therefore information was provided by two directors of the company. However, the registered manager was present on the second day of inspection.

People told us they felt safe having their care and support provided by 06 Care Limited. We found staff had received training in safeguarding vulnerable people and were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy and told us they were certain any concerns they raised would be taken seriously by the registered manager.

We found support plans were person centred and contained detailed information that guided staff on the level of support people needed to meet their health and social care needs. Care records were reviewed regularly to ensure they reflected people’s changing needs and detailed risk assessments were in place. People told us they had been consulted about their care records and felt involved in how their care was provided.

People’s nutritional needs were met and people were encouraged to eat a varied and balanced diet if this formed part of their care package. People told us staff treated them with kindness and respect and promoted their independence and right to privacy.

There were enough staff employed for operational purposes and the staff recruitment process ensured only people suitable to work in the caring profession were employed. Staff received the training, support and supervision they needed to carry out their roles effectively.

The service had an infection control policy which gave staff guidance on preventing, detecting and controlling the spread of infection. Staff had received training on infection prevention and control.

The registered manager demonstrated a good understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and staff demonstrated good knowledge of the people they supported and their capacity to make decisions. The registered manager and staff were aware of the process to follow should a person lack the capacity to consent to their care.

We found that the registered manager and all the staff we spoke with could tell us about the people who used the service. They knew their likes and dislikes and things that were important to them.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. People told us they felt able to raise any concerns with the registered manager and felt these would be listened to and responded to effectively and in a timely manner.

Policies and procedures we reviewed included protecting people’s confidential information and showed the service placed importance on ensuring people’s rights, privacy and dignity were respected.

There was a quality assurance monitoring system in place which was designed to continually monitor and identify shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required. However, it was too early for the provider to be able to demonstrate that the new processes were fully embedded and that these improvements could be sustained over time.

During our inspection we spoke with three directors of the company, one of whom was the registered manager and found them to be enthusiastic, caring and committed to providing a quality person centred service. We found they worked closely together and demonstrated they had a shared vision of the service they wished to provide.

06 Care Limited provides personal care support to 61 people, adults and children, living in their own homes in Bradford and its environs. This support includes day calls and night check visits (for eight people), and the agency also provides a night-sitting service for three people with complex health needs.

There was 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.

Most people told us they felt safe but one person raised concerns about the different staff visiting. We found 06 Care provided staffing through ‘runs’ which meant staff were told a start time and were given a list of people to visit. This information was not consistently shared with people using the service and staff had unrealistic schedules to follow. Call times were frequently cut short and people were subject to a wide variance in call times.

Medication was not properly managed or safely administered as the provider did not demonstrate an awareness of the NICE Guidelines for domiciliary care agencies which provide clear direction. 06’s source of information for most topics was the local authority but this meant they were not always following the relevant legislation.

Staff were trained but this was not always followed up with timely competency checks and more experienced staff had not received regular supervision or appraisal. Staff were also not supported through regular meetings.

Risks in regards to moving and handling, or more complex care packages were managed in a person-centred manner with detailed guidance provided for staff. Staff demonstrated a sound awareness of infection control procedures.

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. We spoke to the registered manager about ensuring the person signed their own record unless physically unable to do so.

People were supported with their nutritional needs and had access to external health and social care support as required.

Staff were spoken of highly by people who told us they were caring, kind and compassionate. We saw some compliments which endorsed this view. People felt they participated in planning their care.

Care records contained sufficient detail so staff knew what support to offer people. Daily notes tended to be task-focused.

The service had not logged any specific complaints as they dealt with issues when they arose. We saw these ‘occurrences’ were dealt with promptly and investigated well.

The service had detailed quality assurance processes which considered certain aspects of care delivery. However, the more general service delivery was not audited sufficiently well as can be seen by the issues we found with staffing and medication.

This inspection found breaches of the Health and Social Care Act 2008 associated regulations relating to the need for consent, safe care and treatment, good governance and staffing.

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.

During our last inspection which took place between 25 August and 1 September 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to safe care and treatment, person centred care and good governance. We issued warning notices in relation to the breach of safe care and treatment which had a compliance date of 13 November 2015. The issues identified were around how medicines and potential risks to people’s health and safety were being managed. We also issued requirement notices for the breaches relating to person centred care and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

06 Care Ltd provides support to people living in their own homes in Bradford, Keighley, North Yorkshire and the surrounding areas. Referrals are made from continuing health care, direct payments and private customers. 06 Care Ltd support people with personal care and support to enable them to live in their own homes. At the time of this visit there were approximately 61 people using the service.

The service had 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.

Improvements had been made to how medicines were managed. For example, more robust arrangements were in place for recording the administration of medicines. However, further improvements were required to the documentation and audit processes to ensure people were fully protected from the risks associated with medicines.

Care records needed to be improved to ensure they were accurate, complete and up to date so that care staff had the information they needed to provide effective and consistent care. Care records did not always contain person centred information particularly in areas such as people’s preferred visit times, dietary needs and social histories.

We saw evidence staff provided appropriate support to ensure people consumed an appropriate diet and maintained good health. We also saw some good practices in relation to how risks had been assessed. However, further improvements were required to ensure risk assessments were person centred and that staff consistency recorded how they mitigated potential risks to people’s health and wellbeing.

People told us they felt safe when staff visited them and we saw staff took effective action to help protect people from the risk of abuse. However full details of the decision making and actions taken to reduce risk were not always recorded.

Where people provided feedback about the service they told us they felt listened to and staff were responsive in addressing any issues or concerns. People provided positive feedback about care staff and told us staff treated them with dignity and respect.

People told us staff asked their consent before providing support and the staff we spoke with demonstrated they had a good knowledge of the people they supported and their capacity to make decisions.

Staff were recruited in a safe way and there were sufficient numbers of staff to ensure people received the support they needed. Staff had the required skills, knowledge and experience to deliver effective care.

The provider had introduced a system to ensure daily notes were returned to the main office to be checked each month. This enabled the office staff to identify any concerns or issues and ensure people had received the support they needed. However, staff needed to improve the quality of information they recorded within daily notes to ensure they fully evidenced that appropriate care had been provided. We also found the audits of daily notes needed to be more robust to ensure all issues were identified and addressed.

People were usually supported by the same staff each week which helped encourage a consistent approach to care delivery and enabled staff to develop meaningful relationships with the people they supported. People told us they had noticed an improvement in the consistency of care they received but said the timing of their visits could still be unpredictable. Improvements to the rota planning system were required to ensure people received visits at the times they needed and preferred their support to be delivered.

We concluded that the provider and management team were committed to the continuous improvement of the service. They had implemented processes designed to monitor and assess the quality of the service. As part of a robust quality assurance system the registered manager and provider should actively identify improvements on a regular basis and put plans in place to achieve these and not wait for the Commission to identify shortfalls. We concluded that further development of the quality assurance systems was required to ensure areas for improvement were identified and addressed by the provider. There were also areas where robust audits needed to be implemented such as checks of care records.

We identified two breaches of legal requirements. You can see what action we told the provider to take at the back of the full version of the report

We spoke with three people or their relatives who used this agency. They all spoke highly of the care they or their relatives received and told us they would recommend it.

One person commented, "they are very polite and do a good job, they always respect my dignity and know my needs," another person said "they tick all the boxes," and another person said "very pleased with them, they go over and above what you expect every person deserves the care that 06 give."

The care records we reviewed showed people who used the service were involved in making care decisions and consented to their care. The care records also showed care plans were up to date and people had their health and welfare needs met.

We spoke with four care staff who were very complimentary about the agency and the support they received. One care worker told us, "the managers are very professional they have a good attitude towards me and the clients.They always ask me how I am, I enjoy going to work." Another member of the care staff said "06 is run with consistency and continuity," and another said "the managers are very good, no complaints at all I love it here."

06 Care Ltd was a local winner of the Local Business Accelerators competition and they will go forward to the national final later this year which is to be held in London.

We spoke with three people who were using the service. They all gave very positive feedback about the care they received from 06 Care. One person told us "The care has been really good so far and the staff are fantastic" they also told us the service had accommodated changes to the plan at short notice and this had been extremely helpful. Other comments included;

"The staff always have happy faces no matter what time of the day they come and they are never rushed, they take time to include all the family."

"The staff are wonderful, I am very happy with the care I receive."

"They are always kind and gentle when they help me."

"They come in and get an with the job, we look forward to them coming as they are always so nice."

All three of the people we spoke with told us they felt safe being supported by 06 Care.