Archived: CARE4U - SURREY

Care4U - Surrey is a domiciliary care agency. At the time of our inspection, it was providing personal care to four people living in their own houses and flats. It provides a service to older adults, some of whom are living with dementia. Everyone using Care4U - Surrey receives a regulated activity; 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.

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

People and their relatives told us they felt safe, and staff were aware of their role in safeguarding people from abuse. Risks to people were appropriately recorded, but more information was required around people’s medical conditions and what support was required to manage these. Medicine recording and administration was safe, and accidents and incidents were recorded appropriately. There was a sufficient number of safely recruited staff to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did support this practice. Staff were up to date with mandatory training and received regular supervision and competency checks. Staff felt there was an effective communication system in place and referrals to healthcare professionals were made where required. People’s dietary preferences were recorded in their care plans which staff followed. At our previous inspection, there were shortfalls in national guidance and standards not being followed or adhered to. We found there had been significant improvement during this inspection, but further work was needed to fully embed this in to the service.

People and relatives told us staff were kind and caring and treated them with dignity and respect. We were told of occasions where staff had gone above and beyond people’s expectations when providing their care. People were encouraged to be independent and involved in decisions around their care where possible. Where people were unable to be involved in these decisions, their next of kin had been approached.

Care plans were personalised to reflect the individualised care that people received. Complaints were dealt with in a timely manner and in line with the provider’s policy. The service was not delivering end of life care to anyone at the time of the inspection, but this topic had been approached with people and their relatives and their preferences documented.

There had been significant improvements to the management oversight of the service since our last inspection. Further work was now needed to ensure new systems and practices were fully embedded and sustained over time. Robust internal quality audits had been completed by the registered manager, and feedback sought from people and staff. People and relatives felt the management team were approachable and staff felt valued. There were links to local organisations where best practice, knowledge and training resources could be shared to support further improvement to the service. 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)

At the last inspection the service was rated Inadequate (18 December 2018) and there were multiple breaches of regulation. Following the last inspection, we asked the provider to complete an action plan 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.

This service has been in Special Measures since 17 December 2018. 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 no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor intelligence 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 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 inspection took place on 7 November 2018 and was announced.

Risks to people were not identified and recorded. There was no monitoring or analysis of accidents and incidents that had taken place to identify trends and reduce further risk. Although staff felt they knew people’s needs, care plans were not person-centred and did not include any detail around people’s end of life wishes. People were not always referred to healthcare professionals when needed.

People and their possessions were not always treated with kindness, respect or dignity. We received varied feedback from people and relatives about staff. We were told a person and two relatives that staff had been verbally abusive towards them. The registered manager had not informed us and the local authority of this. We have now informed the local authority.

Appropriate checks were not in place to ensure that staff were suitable to work at the service. Following the inspection, we asked the registered manager for additional information so we could check that staff had satisfactory Disclosure Barring Service (DBS) checks completed. We have still not received this information.

Rotas were not available for staff to view and there was no call monitoring system in place. This left people at risk of missing care calls. Following the inspection, the registered manager sent us a rota for five days worth of calls that showed not all staff had travelling time in between calls. This meant that staff would be late arriving to care calls.

Staff members were not up to date with mandatory training. They had also not completed training around preventing pressure ulcers even though they cared for people with pressure wounds. Staff received regular supervision.

Communication between staff was not always effective. Staff members could not identify who had management oversight of the service due the registered manager’s absence. People told us that there was not always a care file in their home for the staff to be able to communicate with each other, and they were not always informed if staff were running late.

The service had not notified the Commission of all reportable incidents. This included people missing care calls and staff being verbally abusive towards people. Safeguarding procedures were not followed and appropriate referrals were not made to local authority.

Although people, some relatives and staff felt the registered manager was approachable, there was a lack of management oversight. The service did not have quality assurance systems in place. Only one audit had been completed since the service had started operating. The issues found in this audit had not been resolved.

There was a lack of evidence that pre-assessments had been completed. The registered manager told us they had thrown them out as he thought they were no longer needed. People gave varied feedback on whether they were involved in their care planning or not.

There were gaps in Medicine Administration Records (MARs) and additional handwritten entries on to MARs had not been double signed by staff to ensure their accuracy. There was no evidence to show that staff had undertaken medicines competency checks.

People and relatives felt able to complain. However, the registered manager did not keep a record of complaints as mentioned in the service’s complaints policy. People’s concerns were not being investigated and therefore leaving people at risk of abuse.

People’s rights were not protected. The service did not follow the Mental Capacity Act principles and correct legal authorisation had not been sought to deprive people of their liberty.

Staff encouraged people to stay hydrated. However, people’s choices around their meals was not always respected and listened to.

There were some plans for improvement within the service were in place. They were in the process of implementing a new online system which would allow staff to view rotas and complete electronic MARs at people’s houses during care calls.

People were being cared for by staff who carried out safe infection control processes. Aprons and gloves were provided to staff and people confirmed they wore these.

The registered manager was planning to send out a survey to people to gather their feedback on the service and how they could improve. They had also recently joined the UK Home Care Association to learn best practice from others.

During this inspection we identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. This was the service’s first inspection since they registered with the Commission in November 2017.

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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

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.