Care 4 U - 466 Melton Road

Care 4 U – 466 Melton Road is a domiciliary care service. The service provides care and support to people living in their own homes in the community.

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.

At the time of our inspection 73 people were receiving personal care.

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

Communication systems had improved to some extent since the last inspection but remained a cause of frustration for some people using the service. For example, people told us they were not always informed when staff were running late and when contacting the office with any queries they were not always responded to appropriately. One person commented the communication with the office staff was ‘hit and miss’, saying it depended on who they spoke with, whether anything gets done.

Since the last inspection the provider had introduced an electronic care monitoring system, which recorded the care people received in live time. However, relatives told us they did not have access to records regarding their relative’s care as paper records were no longer held in their homes. Also, some people were not familiar with using technology. The provider said they would consult with individuals and relatives to ensure they had access to the care records, either electronically or by having paper copies held within their homes.

People and their relatives knew how to raise a complaint and said they would feel confident to do so if needed. We found records of complaints needed to be recorded in more detail to clearly evidence when they were brought to the providers attention, the dates of investigation and conclusion.

People felt reassured and safe as staff followed government guidance on COVID-19. Staff followed infection prevention control (IPC) best practice, in relation to reducing the risks of infection spread, wearing personal protective equipment (PPE) and following good hand hygiene. Staff had access to enough supplies of PPE equipment.

People were supported by a core group of staff who they had developed positive and supportive relationships with. People spoke of the kind and caring approach of staff. Staff were recruited following safe recruitment practices. Upon appointment they underwent a period of induction and a programme of training and shadowing experienced staff.

People’s safety was promoted by staff who followed training and guidance on how to reduce potential risk. People were supported with their medicine’s safely by staff who had had their competency assessed.

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 28 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention controls. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-Led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating of Good has not changed based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care 4 U – 466 Melton Road on our website at www.cqc.org.uk.

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.

Care 4 U – 466 Melton Road is a domiciliary care service. The service provides personal care to people living in their own homes. At the time of the inspection there were 70 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

Systems to monitor the quality of the service were in place, and used to develop the service and drive improvement. However, the provider had not identified communication was an area which required improvement. People and their family members said communication with office-based staff was not effective. People told us queries were not consistently responded to, and messages not always passed on, especially messages relating to people not being informed that care staff would be late. Systems recording how information was shared could be improved, such as minutes of meetings and action points to address identified shortfalls.

People were confident to raise concerns should they arise, some people told us issues they had raised had been quickly addressed. People’s views as to the timeliness of visits by care staff were mixed, however many had noted improvements. Systems were in place to monitor the timeliness of visits.

People’s safety was promoted by staff who followed guidance on how to reduce potential risk. This included the use of equipment to support people moving around their home. People were supported by sufficient numbers of staff who had undergone a robust recruitment process. People were supported with their medicines. Staff training in key safety areas promoted people’s safety, which included staff knowledge and understanding of reporting potential safeguarding concerns, the management of medicines, and the importance of following infection control procedures.

People were supported to have maximum choice and control of their life 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 needs and expectations of care were assessed, which included assessing people’s needs based on their cultural diversity and communication needs. People were supported by staff who had the necessary skills and knowledge, which included staff’s ability to communicate with people in their preferred language. Staff were supported through ongoing training and supervision to enable them to provide good quality care. Staff promoted people’s health by liaising with health care professionals when required.

Most people spoke positively about the care they received and the approach of staff towards them. People’s experiences about their care was often influenced by whether they received care from staff who they were familiar with, who were able to communicate effectively with them.

People and family members were involved in the development of care plans, which enabled staff to provide the care and support each person had agreed was appropriate to them.

The management team were aware of their role and responsibilities in meeting their legal obligations. The provider worked with key stakeholders to facilitate good quality care for people, by accessing training and shaping the provision of domiciliary care. They worked with key organisations to share and keep up to date with good practice.

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 13 November 2018) and there was one breach of the regulations. 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.

The inspection took place on 14 and 18 September. The inspection was announced because we wanted to make sure that the registered manager was available at the time of the inspection.

At our last comprehensive inspection in May 2016 we rated the service as 'Good'. On this inspection improvements were needed to ensure that people were comprehensively safe, that the service was effective, responsive and that quality assurance systems were effective in driving improvements in the service. Because of these issues, the overall rating for this inspection has reduced to 'Requires Improvement.'

A registered manager was in post. This is a condition of the registration of the service. 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 and associated Regulations about how the service is run.

We identified concerns about a number of issues. A requirement notice has been issued due to a breach of regulation in relation to the service not meeting the requirement for good governance.

Staff was not deployed in a way that would always provide people with the safe personal care they needed. Risk assessments were not always comprehensively in place to protect people from risks to their health and welfare.

Not all staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives.

Staff had largely received training to ensure they had skills and knowledge to meet people's needs, though training on a number of other relevant issues had not yet been provided and an effective check on whether staff were competent following training was not always in place.

Care plans did not always contain detailed information individual to the people using the service, to ensure that their needs were always met.

People and relatives were not always confident that concerns had been followed up. They were not always satisfied with how the service was run.

Some staff members said they had not been fully supported in their work by management.

Management had not carried out comprehensive audits to check that the service was meeting people's needs and to ensure people were provided with a quality service.

People and relatives told us that most staff were friendly, kind, positive and caring and said they had been involved in making decisions about how and what personal care was needed to meet any identified needs.

Care plans were available to people and staff, which helped to deliver a service to meet people’s care needs.

Staff recruitment checks were in place to protect people from receiving personal care from unsuitable staff.

Most people and their relatives told us that they thought staff provided safe personal care.

Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

People and relatives told us that medicines had been supplied so that people could take their medicine safely.

Is the service safe?

People who used the service told us that they felt safe with the care staff who supported them. They were confident that the care staff were trained to look after them. One person said “I’m quite happy with my carers and I have no complaints.” Another person explained that they were supported by a team of care staff because they needed several calls each day, said “I feel safe with my carers, they know what to do especially as I’m an expert in being hoisted.”

Relatives we spoke with also praised the care staff that looked after their family member. One relative whose family member had only recently started to use the service told us that they found the care staff were caring. They said, “So far it’s good, … [person using the service] really likes him [care staff], he’s always on time and does everything that’s needed.” Another relative said “As a family we know she [person using the service] is safe now and she can continue living in her own home.”

Care staff we spoke with showed a good understanding of each person’s needs and how they wished to be supported. Support plans and risk assessments were personalised and provided the care staff with the guidance to help keep people safe.

Is the service effective?

People told us they were satisfied with the care and support they received. One person explained that they had used this service for many years and were supported by a team of regular care staff. Another person said, “It’s a very good service. The times are flexible to suit me and the carer knows what to do.”

People’s care needs were identified and measures put in place to minimise risks. People’s care was reviewed regularly to help ensure any new needs could be met properly and risks managed. Care records and staff training records we looked at showed that people’s care needs were met by trained staff.

Care staff understood the needs of people they supported. They received up to date information about people’s needs and could refer to the up to date support plans kept in people’s own homes.

Care staff told us they were well supported and were trained to deliver care and support safely. Practical training was provided in the use of specific equipment to help support people, such as a hoist and a stand aid amongst others. Personal protective equipment was available for care staff to use including disposable gloves and aprons. This helped to ensure care and support provided was in line with the infection control procedures and protected the health, safety and wellbeing of everyone.

Is the service caring?

People told us that they were happy with most of the care staff and the support they received. They found care staff were kind, caring and that they were treated with respect. One person said, “Most of my carers are very caring. There was one that I was unhappy with and the office stopped sending her when I told them.”

Relatives also expressed no concerns about the care staff or the support provided to their family member. One relative said, “He [care staff] is very caring towards my …. [person using the service] and you always hear them both laughing, which is a good sign.”

Is this service responsive?

People’s needs had been assessed before the care arrangements started. This helped to make sure that the service would be able to provide the care and support they needed. People’s care needs were regularly reviewed to help ensure any new needs would be met reliably.

The provider had systems in place to support care staff and people who used the service in the event of an emergency. An ‘on-call’ service operated outside of the normal office hours, which meant that a manager or a senior staff member was available to support staff and to deal with any queries that arose.

Is this service well led?

People received a ‘service user welcome pack’ that included a copy of the provider’s statement of purpose. These documents explained the aims and objectives of the service, what people could expect from the service themselves and how to make a complaint. This helped to assure the provider that people were fully informed about the service.

The provider had a range of systems in place to assure themselves that the quality of care and support provided was monitored. Audits and checks were carried out routinely. The provider took account of all complaints, compliments and learnt lessons from incidents to help prevent it from happening again. Satisfaction surveys had been used. This provided people who used the service and their relatives with an opportunity to share their views about the support they received and enabled the provider to monitor the quality of service being provided.

Care staff received support to carry out their job role effectively, safely and reliably because they were trained. Care staff were confident to approach the manager if they had any concerns. A care staff explained that they were new to care work and found the training was valuable to enable them to be confident to provide the care and support people needed. They said “It’s so nice to get positive feedback from people because you’ve made a difference to their life.”

People we spoke with told us they were satisfied with the care and support being provided and that their choices were respected. Staff had a good understanding of the needs of people who used the service and said they felt valued and supported in their roles. People we spoke with were complimentary about the carers and office staff and felt comfortable with the care being provided.

We looked at the records of five people who used the service and found care plans provided clear guidance to carers about how the persons’ care should be delivered. The provider may find it useful to note that moving and handling risk assessments were not always updated to reflect changes to the person’s needs.

Staff had been appropriately screened to ensure they were suitable to work with vulnerable people and we found there were sufficient numbers of suitably experienced and trained staff to meet the needs of people using the service.

The service had an appropriate quality assurance system.

We looked at feedback from people using the service that had been obtained from an annual questionnaire. This asked people for their views and comments about the service received. Most comments were positive and included: - “I have been very pleased with the service provided by Care 4 U staff” and “very happy with service provided, steady improvements being made”.

We found that the service was compliant with the essential standards of quality and safety that we inspected.