Wilnash Care Limited

Wilnash Care Limited is a domiciliary care agency providing personal care to people living in their own homes and flats. At the time of our inspection the service was providing care and support to 27 people.

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 and what we found

People told us that they felt safe and were supported by consistent, reliable staff. Staff understood their responsibilities with regards to safeguarding people and they had received training. There were systems in place to safeguard people from the risk of possible harm. The service had robust recruitment procedures in place.

People’s needs had been assessed and they had been involved in planning their care and deciding how their care was provided. Each person had a detailed care plan which was reflective of their needs and had been reviewed regularly. Staff were knowledgeable about the people they were supporting and provided personalised care.

Medicines were being managed well and staff followed good infection control practices.

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.

There was a positive culture throughout the service. Staff told us, they enjoyed working there and they were well supported by the management team. Staff felt valued and were committed to the people they were supporting.

There was positive leadership at the service and people and staff spoke highly of the registered manager. Senior staff were committed to ensuring people received quality care and there were quality assurance systems in place to monitor all aspects of the service.

People told us they felt listened to. No formal complaints had been raised at the service; however, there was a procedure in place should any concerns be raised.

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 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

When we last inspected the service on 5 August 2016 we found breaches of regulations 9, 10, 12, 16, 17 & 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to manage people’s medicines safely, there was insufficient care planning in place to ensure people’s individual needs were being met, people’s dignity was not always respected or maintained, the staff team were not provided with support or supervision to ensure they were able to meet people’s specific health needs. The provider’s governance and monitoring systems had failed to identify and address concerns about the lack of training for staff to meet people’s specific health conditions. We took action using our regulatory powers and urgently imposed a restriction to ensure Wilnash Care Limited took no further admissions, and sought urgent assurances to ensure people were kept safe. We also placed the service in Special Measures and kept the service under review along with referring our findings to the local authorities safeguarding and commissioning teams.

Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made the necessary improvements and therefore improved the quality of the service provided at Wilnash Care Limited.

At this inspection we found that the service had significantly improved. People told us they received care and support that met their individual needs. People were involved in the development, planning and review of their care.

Staff knew people well and treated them with dignity and respect. Care plans were personalised and contained detailed information about people’s support needs and risk assessments were detailed and specific providing staff with all relevant information to ensure risks were both identified and mitigated where possible. Staff knew how to recognise and respond to any allegations of abuse. Medicines were managed safely.

People were supported by sufficient numbers of staff and these were recruited through a robust process which helped ensure staff were suited for the roles they performed. Staff were inducted and received on-going training and support. Staff had individual supervisions, team meetings and regular contact with office staff to share good practice and discuss any concerns.

People were supported to make their own decisions, and to retain where possible everyday living skills and abilities and their choices were respected. Their views were obtained through a variety of communication feedback methods and people’s views were taken into account.

The service demonstrated they had systems and processes in place to monitor and improve the service to achieve a consistently good standard of care and support for everyone who used the service. There was a call monitoring system in place and spot checks were carried which ensured visits to people were provided at the agreed times.

Wilnash Care Ltd is a domiciliary care service providing care and support to 36 people in their own homes. At the time of our inspection there were 32 people using the service.

The service had not had a registered manager in post for two years prior to our inspection. 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 were left at risk of receiving care and support that was unsafe and did not meet their needs. There were not enough staff deployed by the service to meet people’s needs. Calls requiring two care workers were routinely attended by a single member of staff, which left people at risk of not being moved correctly. There was insufficient monitoring of call times to identify patterns or trends that may have impacted on the quality of care that people received. People’s medicines were not managed or accounted for correctly and changes to medicines were not identified and included in people’s care plans. Risk assessments were not detailed enough to adequately capture risks to people or control measures to minimise these.

Some staff did not have valid employment references on their files. Existing staff did not receive regular supervision nor appraisal of their performance, training or development needs. While staff had received an induction and some training, this was not regularly refreshed or updated, and there was no system in place to monitor this or plan a schedule to train staff in the future. Not all staff understood the correct way to safeguard people or what constituted a safeguarding incident. There was no training provided to help staff to understand the Mental Capacity Act (2005) and people’s care plans did not include any information in relation to their capacity to make and understand decisions about their care and support. While there was some evidence of consent in place, relatives had sometimes consented on people’s behalf without an assessment of the person’s capacity to make their own decisions or a decision made in the person’s best interest that the relative should give consent.

The service did not adequately identify people’s needs in relation to nutrition and hydration. There was limited information available in people’s care plans to help staff understand the foods and drinks that were appropriate for them. There was some evidence that support was being sought from external healthcare professionals as necessary.

People told us that staff were kind and caring, and staff had developed positive relationships with people. However there was not always enough information in people’s care plans to provide staff with adequate knowledge of the person. Some people felt treated with dignity and respect, but others told us this was not always observed. People’s care plans did not fully reflect the extent of people’s needs, and were not always reviewed if the person’s needs changed. There was limited evidence of involvement from people or relatives in reviews of people’s needs.

The provider’s complaints policy was out of date and included incorrect information about how to make a complaint. The service did not record or monitor all complaints and the response to complaints was inadequate.

There was no registered manager in post and no application to register a manager had been made since the previous one had left two years previously. While people, relatives and staff were positive about the support provided by the manager of the service, there was inadequate governance and oversight overall which meant that systems were ineffective. There were no audits carried out to identify improvements that needed to be made. Some quality monitoring took place but there was no action taken to make improvements in response to people’s feedback.

During the inspection we identified serious concerns and several breaches of regulations which put people at risk of harm. As a result we have taken enforcement action against the provider to ensure that improvements are made.

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.

At our review of compliance undertaken in July 2014 we found that the agency's statement of purpose was not up to date and did not include information about how to make a complaint.

Subsequent to our inspection the provider updated the organisation's statement of purpose and submitted it to the commission.

The updated statement of purpose provided people with the information necessary about the services provided and how to raise concerns with external stakeholders should the need arise.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw evidence that risk assessments had been undertaken to help minimise the risk to people living in their own homes. The agency had a complaints policy and procedure in place, which was user friendly. A copy of the complaints procedure was available to people who used the service.

Is the service effective?

We found that people had an assessment of their needs carried out and staff had ensured that the identified needs had been met. Each person had a care package agreed by the individual, their relatives, the service and social services where appropriate. We saw evidence in people’s daily records how people had been cared for and supported during the home visits.

We looked at a sample of the agency’s call monitoring system and we were able to see that the majority of home visits were made within the agreed time.

Is the service caring?

We spoke with some people who used the service on 26 June 2014, 27 June 2014 and 1 July 2014. People we spoke with confirmed that staff were caring and very supportive. One person we spoke with said when speaking of staff “They are splendid.” Another person said “The carers are brilliant.”

Is the service responsive?

We found that the care plans had been reviewed regularly and any changes in people’s care needs had been reflected so that up to date information was available to staff. This ensured that people’s needs were met appropriately.

We noted that although staff had regularly supervision, the agency did not held regular staff meetings to ensure that information regarding changes which affected the agency and the people who used the service were cascaded to all staff.

Is the service well-led?

People expressed their satisfaction with the service they received.

The agency has a registered manager but we were told on the day of our inspection that the registered manager was inactive. The deputy manager had assumed the responsibilities which were held by the registered manager. The staff members we spoke with told us that they felt supported by the management team and that they were able to discuss any concerns they may have.

We looked at the agency’s financial accounts and we found that the agency was financially viable and had additional funds in place to deal with unexpected emergencies.

We looked at the agency’s statement of purpose and we found that it had not been updated with their current address. We also found that the statement of purpose did not provide clear information on how and where people who use the service can escalate a complaint.

We have asked the provider to tell us how they will become compliant with the regulation which relates to the statement of purpose.

We looked at quality monitoring data and the system for managing and recording complaints. We reviewed the providers safeguarding policy and arrangements for processing any safeguarding concerns or alerts.

We reviewed staff support systems and spoke to staff about their roles and responsibilities within the organisation.

We talked to office based staff about how the provider had implemented systems and processes to ensure sustained compliance with the regulations, we also made observations during our visit about how staff interacted with each other and how they went about their business in a clearly defined role.

Staff also told us that things were working much better and everybody was clear now about their roles and responsibilities and there was a robust structure from which they could rebuild the business. The managers told us they spent more time 'managing the service in a proactive way' as opposed to the way the service had previously been managed by reacting to and dealing with incidents as they occurred. We found evidence to show that the service was structured to deliver good quality care and support in a planned way. The service was meeting all the standards we reviewed during our visit.

Although a safeguarding policy was in place to protect vulnerable people it was clear from the lack of safeguarding records available that the policy to deal with safeguarding concerns was not being followed.

A number of concerns were found in the recruitment process. We were told by the manager that staff who worked for this service had received some training, but this could not be checked as the information and records were not readily available for inspection when requested. Team meetings and supervision records were limited and did not provide meaningful information that could be assessed. Although some surveys had been sent to people who used the service, these had not been evaluated and any action identified from these surveys had not been put in place as a result of feedback received. Some complaints had been recorded. However, it was difficult to assess if the policy was being followed, because of anomalies in the way complaints were investigated and reported.

We also found some concerns about the way in which visits had been allocated to the care staff.

The rotas indicated that multiple visits had often been allocated to a care worker within the same short time interval: for example, records showed that one care worker had been scheduled to attend three people between 12.30pm and 1pm. This meant that people’s visit times had had to be moved, and they had not always been notified of the changes.

On several occasions, people who use the service had cancelled visits because they could not be provided at the times stated in the care plan. This meant that people had not always received the care that they had been assessed as needing.

Other people who use this service said that the staff were very nice and helped as much as they could. One person said that the staff went out of their way to assist them.