Walnut Care at Home

Updated 8 April 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by two inspectors, an assistant inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes and specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented and is the occupant's own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people's personal care and support service.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 72 hours’ notice of the inspection. This was because it is a large geographically dispersed service and due to the COVID-19 pandemic we wanted to reduce the amount of time spent at the office location. Therefore, the registered manager and provider needed time to prepare documentation before the inspection visit.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

During the inspection

We spoke with 12 people who used the service and eight relatives about their experience of the care provided. We spoke with 14 members of staff including the nominated individual, registered manager, supervising managers, key workers, team leaders, care workers and office staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included fourteen people's care records and multiple medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 8 April 2021

About the service

Walnut Care at Home is a domiciliary care service providing personal care to people living in their own homes. At the time of inspection there were 445 people using the service. 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

Staff were provided with information about how to reduce risks associated with people's care. The providers own risk assessments were often generic and could have included more person-centred information. We discussed this with the provider who was aware of this and had plans to develop this in the future. Staff were aware of the risks associated with people's care.

People told us there were enough staff to meet their needs. Some people told us staff absence could result in last minute changes and late calls. Some people told us that sometimes staff rushed to deliver their care. We considered the impact the COVID-19 pandemic had on staffing. Staff were recruited safely and in line with requirements.

People were administered medicines by staff who were trained and competent. Records of medicines administration were checked by the provider and errors were addressed.

People confirmed staff wore the correct PPE when providing care to them in their own homes. Records showed staff were provided with infection control training. The provider had reacted and responded to the COVID -19 pandemic in a proactive and dynamic way. Staff were provided with the PPE they needed.

Since the last inspection the provider has developed improved systems to monitor and review care to ensure incidents are escalated and responded to. Staff told us they reported concerns to a senior member of staff during daily handover.

Staff received training to ensure they could recognise and report abuse. Staff described how they would report their concerns to someone more senior.

People's needs were assessed when they commenced using the service. A system was in place to check the information in local authority needs assessments prior to agreeing to provide care. People had care plans which reflected their basic needs.

Systems to support staff learning and development had improved since our last inspection. Training records showed staff received the training they required to carry out their roles.

Records showed staff escalated concerns about people's health and wellbeing. Systems had been improved since the last inspection to ensure information about people was more accessible and could be shared with health and social care partner agencies.

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 told us staff treated them with courtesy and respect and were kind to them. People told us they felt involved and consulted about their care. People told us staff respected their privacy and dignity.

The quality of information in care plans and person-centred care guides varied. Some contained a detailed description of people's preferences and wishes, and others were less person centred and required further development.

Records showed peoples care was reviewed and people were consulted about their care and encouraged to contribute ideas and views.

A complaints procedure was in place and records showed complaints were investigated and responded to.

Staff were provided with training and support to recognise frailty and support people who were at the end of their life. The provider had a system to ensure people who were at the end of their life had a palliative care plan in place.

Since our last inspection the provider had developed a clear governance process and had improved systems to ensure they had clearer oversight of the service and risk.

The provider had developed an improvement plan which incorporated actions from service checks, feedback from service users and complaints. The provider and senior management team had worked hard to drive improvements during the COVID-19 pandemic.

Some people told us they found it difficult to contact the office on occasion, others confirmed service checks were carried out and they were asked for feedback about their care.

Staff consistently told us they felt supported in their roles and they felt confident to raise concerns.

The provider has worked extensively with partner agencies and local groups throughout the pandemic and have shared information to support the local care network in the area.

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

Rating at last inspection and update

The last rating for this service was requires improvement (Published 24 November 2020) and there were multiple breaches of regulation. A Warning Notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 was issued. Due to the COVID-19 pandemic we were unable to return within the specified timescale to check the Warning Notice had been met, therefore this was checked at this inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.