Care24Seven

Care24Seven is a domiciliary care agency providing a range of services including personal care to people in their own homes. At the time of our inspection, there were 36 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

Incidents and accidents were recorded appropriately, and appropriate action taken, but records did not always include an analysis or evidence of lessons learned. However, the provider was transparent and there was clear communication within the team, so they learnt from mistakes and made improvements when things went wrong.

People's care and risk management plans set out the care tasks they required help with and these contained information about people and their preferences for how they liked to be supported.

People told us they felt safe. Where there were risks to people’s safety and wellbeing, these had been assessed and the provider had done all that was reasonably practicable to lessen those risks.

There were systems in place to monitor the quality of the service and recognise when improvements were required.

We received positive feedback from people and their relatives about using the service. Staff sometimes provided extra support and assistance to people when this was not part of people's contractual care arrangements.

The provider made sure there were enough staff deployed to support people and staff usually arrived at people’s homes on time. Staff received induction, training and supervision and felt supported in their roles.

The provider sought feedback from people, relatives and staff and used this to develop the service. People and staff were confident they could raise any concerns they had with the registered manager and felt they would be listened to.

The registered manager and senior staff were responsive to and worked in partnership with other agencies to meet people’s needs.

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.

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 11 March 2020) and there were multiple breaches of regulation. Since this rating was awarded the service has moved premises. We have used the previous rating to inform our planning and decisions about the rating 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

We received anonymous concerns in relation to the standard of care people received. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

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

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care24Seven 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.

Care24Seven is a domiciliary care agency providing a range of services including personal care to people in their own homes. At the time of our inspection, there were 45 people using the service, 29 of whom were receiving personal care. The agency is owned by Eager Health Limited, a private organisation set up by a family.

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 they felt safe. However, risk assessments were not always completed when a risk had been identified and support plans were not always in place to indicate how to manage the risk. Information in care records was not always consistent and some records had not been reviewed and updated. Care and support plans lacked detail and adequate guidelines for staff to know how to support the person according to their needs.

Staff did not receive regular supervision and staff meetings were irregular. The provider had a complaints policy and procedure in place, but people did not always feel listened to. There were systems in place to monitor the quality of the service but these had not always been effective and had not identified the issues we found during our inspection.

The provider was transparent and there was good communication within the team, so they learnt from mistakes and made improvements when things went wrong.

We received positive feedback from people and their relatives about using the service. People said staff were caring and treated them with dignity and respect. Staff sometimes provided extra support and assistance to people when this was not part of people's contractual care arrangements.

There were enough staff to support people and staff usually at people’s homes arrived on time. Staff received induction and training and told us they felt supported in their roles.

The provider sought feedback from people and used this to develop the service. Staff were confident they could raise any concerns they had with the registered manager and felt they would be listened to.

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.

The registered manager and senior staff were responsive to and worked in partnership with other agencies to meet people’s needs.

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 good (published 17 August 2017). Since this rating was awarded the service has moved premises. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, person-centred care and good governance at this inspection.

We made a recommendation in relation to the management of complaints.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Care24Seven provides a range of services to people in their own home including personal care. Most people using the service were older people, although there were also some younger adults who had learning disabilities and mental health needs. At the time of our inspection 53 people were receiving personal care in their home. Most people were paying for their own care, and a small number of people were funded by their local authority.

The agency is owned by Eager Health Limited, a private organisation set up by a family.

There was 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.

People's needs were assessed by a senior member of staff prior to receiving a service and care plans were developed from the assessments. However, some care plans did not contain the necessary information for staff to know how to support people and meet their needs and were not written in a person centred way. We have made a recommendation with regards to improving care planning to make these more person centred.

The risks to people's wellbeing and safety had been assessed, and there was information on people’s records about how to mitigate these risks.

There were procedures for safeguarding adults and the care workers were aware of these. Staff knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

Feedback from people and their relatives was positive. Most people said they had regular staff visiting which enabled them to build a rapport and get to know them.

People we spoke with and their relatives said that they were happy with the level of care they were receiving from the service.

The registered manager was aware of their responsibilities in line with the requirements of the Mental Capacity Act 2005 (MCA) and told us that all staff had received training on this. People had consented to their care and support and had their capacity assessed prior to receiving a service from Care24Seven.

There were systems in place to ensure that people received their medicines safely and the staff had received training in the management of medicines.

The service employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff’s absence. Recruitment checks were in place to obtain information about new staff before they supported people unsupervised.

People's health and nutritional needs had been assessed, recorded and were being monitored.

Care staff received an induction and shadowing period before delivering care and support to people. They received the training and support they needed to care for people.

There was a complaints procedure in place which the provider followed. People felt confident that if they raised a complaint, they would be listened to and their concerns addressed.

There were systems in place to monitor and assess the quality and effectiveness of the service, and the provider ensured that areas for improvement were identified and addressed.

People, staff and relatives told us that the registered manager and senior team were approachable and supportive. There was a clear management structure, and they encouraged an open and transparent culture within the service. People and staff were supported to raise concerns and make suggestions about where improvements could be made.

There were 38 people receiving the regulated activity of personal care at the time of our visit. We spoke with four people who used the service and two relatives. We spoke with the provider and two members of staff. We reviewed care records for people who used the service and records relating to the management of the service, which included four staff files.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us and the records we looked at.

Is the service safe?

The relatives we spoke with told us they felt their family member was safe with care workers. There were good recruitment procedures in place, ensuring the safety of people receiving care was fully considered. Staff experience and expertise was fully considered and there had been staff training in the past year, which included safeguarding adults.

There were up to date care plans in place for each person and there was evidence potential or actual risks had been assessed and plans put in place to manage such risks. Care plans included details of health professionals involved in the delivery of each person's care.

Is the service effective?

People who used the service were involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. A member of staff told us, "I always ask what the client would like me to do." We saw records, which indicated staff were being observed by the provider to ensure they were caring for people with dignity.

Is the service caring?

Staff told us how they cared for the people who used the service, working to meet the needs of people as individuals. A person who used the service told us, "My care worker is very caring, accommodating, friendly and honest.' Another person told us, 'We are very pleased with them.'

Is the service responsive?

People's individual needs had been assessed by suitably experienced staff. The staff we spoke with were aware of the needs of people who used the service and how to meet their care needs. The relatives we spoke with told us they were aware of how to make a complaint. The provider told us two complaints had been made in the past year and they had been investigated.

Is the service well-led?

Staff told us they had regular meetings with the provider and also had spot checks. Written feedback had not been obtained from people who used the service in recent years; however people who used the service were asked for verbal feedback during quality assurance checks.

At the inspection in May 2013 we also found that care workers did not receive a comprehensive induction, training and supervisions to ensure they were skilled and competent to provide care and support to people who use the service.

Our findings from this inspection were that the provider had taken appropriate steps to ensure that people who use the service were protected from the risks associated with medicines. Similarly, people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

During this inspection we found that the provider had not made the improvements we asked them to make to ensure that risks to people were minimised, and for people to receive safe and appropriate care. They did not have appropriate arrangements in place for the management, safe handling and administration of medicines that were prescribed for people. Care workers did not receive a comprehensive induction, training and supervisions to ensure they were skilled and competent to provide care and support to people who use the service.

The provider had not met the compliance actions and had failed to ensure that risks to people were minimised. This is being followed up and we will report on any action when it is complete

Relatives said that the staff were committed in their work and showed a respectful attitude towards people who use the service. People told us that they liked the staff who supported them as they were reliable and treated them kindly. Where people had live-in packages of care, or were suppported with companionship, there was a dedicated team of care workers who provided this.

People we spoke with said they felt the care workers and office staff listened to them and took action regarding any concerns they had. People told us that the office staff were responsive to their requests and any changes to support requirements were met promptly.