Archived: Care at Home Services (South East) Ltd - Eastbourne

The agency provided approximately 100 people with a domiciliary service. Most were older people or people who lived with long-term medical conditions. People received a range of different support in their own homes. Some people received infrequent visits, for example weekly support to enable them to have a bath. Other people needed more frequent visits, including daily visits, and visits several times a day, to support them with their personal care. This could include use of aids to support their mobility. Some people needed support with medicines and meal preparation. Some people needed visits from two care workers to support them with their personal care.

Care at Home – Eastbourne, supplies a service to people in the town of Eastbourne, and rural areas around the town. The provider is Care at Home Services (South East) Limited who provide domiciliary care services to people from different offices in the South East of England.

Care at Home – Eastbourne has a registered manager in post. They had been appointed since the last 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.

The last inspection took place between 4 and 25 January 2016. At that inspection, we found the provider did not have effective systems to ensure they assessed, monitored and improved the quality of services and they did not mitigate risk to people. They also did not ensure accurate records were maintained. Additionally the provider did not have appropriate systems to ensure confidentiality of people’s information. The provider was also not seeking and acting on feedback from people, particularly in relation to visit times and number of different care workers visiting them. We issued a Warning Notice under Regulation 17 following the inspection and required the provider meet this Notice by 30 June 2016. The new registered manager had taken a wide range of actions to address this Notice and only a few areas remained to be addressed.

The areas which had not been addressed since the last inspection included audits by the provider, which had not identified that where people were not able to give consent, the agency were not working within the Regulations of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The provider had not ensured where they needed to provide care which might restrict people that relevant assessments were in place. They also did not have evidence that such care provision had only been provided in people's best interests. The provider had also not used information which they had available to them to audit such areas as timings of visits, trends where issues of concern had been raised and the consistency and accuracy of records.

The new registered manager had developed their own audits. They were aware that some areas relating to accurate record-keeping still needed to be addressed. They had ensured the number of late visits to people had reduced and continuity of care for people had improved. They had ensured where staff raised issues at supervision and other meetings, action was taken to address matters. The provider had developed improved systems to ensure the confidentiality of people’s personal information.

At the last inspection, the provider did not have effective systems to ensure they were assessing the risks to the health and safety of people and doing all they could to mitigate such risks. The provider was not ensuring the proper and safe management of medicines. We issued a Warning Notice under Regulation 12 following the inspection and required the provider meet this Notice by 30 June 2016. The new registered manager had taken full action to address this Notice. This included ensuring all people had full assessments and care plans in relation to risk. The new registered manager had also ensured there were safe systems for supporting people with their medicines and ensuring risk of infection to them was reduced.

At the last inspection, the provider was not ensuring that there were sufficient numbers of suitably qualified, competent, skilled and experienced care workers employed to provide care to people. They also did not ensure that care workers received appropriate support and training to enable them to carry out their duties. We issued a Warning Notice under Regulation 18 following the inspection and required the provider meet this Notice by 30 June 2016. The new registered manager had taken full action to address this Notice. The new registered manager had ensured staff were inducted into their new roles and trained appropriately, so they could support people in the way they needed. Where staff needed support to improve their performance, the new manager had ensured this had taken place, including by supervising staff in their roles.

At the last inspection, the provider was not ensuring people were provided with appropriate person-centred care which met their needs and reflected their preferences. This was a breach of Regulation 9 and we required the provider take action to address this. The new registered manager had taken full action to address this area. The new registered manager had reviewed and revised people’s care plans. People said they had been involved in these reviews and their care plans reflected what they wanted.

At the last inspection the provider was not ensuring they had effective and assessable systems for receiving and responding to complaints. This was a breach of Regulation 16 and we required the provider take action to address this. The new registered manager had taken action to address this area. The new registered manager had recorded all complaints received and there were clear records relating to outcomes for people, and actions taken in response to complaints.

People said staff respected them and supported them with their needs in a caring and friendly way. Staff knew people as individuals and supported them with their independence. People’s care plans were individual in tone. People said staff supported them with their meals and drinks in the way they wanted.

Staff knew how to support people who became unwell. Staff were also aware of how to safeguard people from risk of abuse. The agency had clear procedures, which were followed in relation to safeguarding people from risk of abuse. The systems for recruitment ensured staff were safe to provide care to people.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. One of the breaches was an area where the provider had not identified they were not taking appropriate action to meet Regulation 11. The other breach, in relation to Regulation 17 showed considerable improvement, however a few areas remained to be addressed.

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.

You can see what action we told the provider to take at the back of the full version of the report.

We saw that care plans were in place and these were personalised and reflected people's assessed needs and identified risks.

People we spoke with told us told us that they were happy with the care they received. They told us, 'I receive first class care.' Another person said, 'The carers are excellent, I couldn't ask for more.' However, people told us they were unhappy with the support provided by the office staff. One person said, 'The carer's are brilliant, it's the inconsistency of the office staff that is the problem.' People told us that this related to lack of regular care staff, rotas that were not up to date and office staff not responding to concerns that were raised.

Twelve people expressed concerns that they did not have regular staff, seven people told us they did not receive a rota and five people said they did not have a full week's rota. We were told, 'I don't know who's coming in at weekends and I don't get a rota.' ' It's better when we know the carers but we don't always and the rotas only cover 3 days of the week so you don't always know who's coming.' We also spoke with people's representatives, one person told us 'X needs a list so she knows who's coming as she gets anxious and needs consistency.'

We looked at people's care files and saw that people's consent was gained when they commenced using the service. One person said, 'They will ask you what you want doing and how you'd like it to be.'

We found that documentation in people's care files did not always detail their care needs. Gaps and inconsistencies were seen. This meant that people were at risk of receiving inappropriate care and treatment.

Staff were aware of their responsibilities in relation to safeguarding people. We saw that staff received training and updates that enabled them to care for people appropriately.

We saw that people who used the service were asked for their views about their care and treatment.

We looked at five care plans and saw that people were involved in planning their own care and treatment. Care plans were personalised and reflected the assessed need of the individual. One person told us, 'I like to see my carers, especially in the morning.'

People that we spoke with told us that staff reminded and supported them to take their medication. One person said, 'they always make sure I've taken my pills.' We saw that people received help with medication that was appropriate and safe.

We saw that a complaints procedure was in place and was available to people who used the service. One person told us they were aware how to raise a complaint then added, 'I haven't had occasion to do it so far.'