Deeper Care Escrick

Deeper Care Escrick is a domiciliary care agency providing personal care to people living in their own homes. The service was supporting 44 people at the time of the inspection. 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

The service predominantly supported older people but also supported one person with a learning disability. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Culture

Medicines were not always managed safely. Record keeping and medicines care planning was not sufficiently robust. Safe and appropriate recruitment practices were not always followed. Some audits and checks took place however systems to assess, monitor and improve the service were not sufficiently robust. Some records relating to the management of the service were not present. External agencies had concerns about governance and leadership at the provider. Staff said they felt well supported

Right Support:

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Risks to people’s health and safety were assessed and mitigated. People said they felt safe, and that staff had the right skills and knowledge to care for them. Safeguarding procedures were in place and we saw evidence they had been followed. There were enough staff to ensure people received timely care and support.

Right Care

People told us they received appropriate care from familiar staff at times that suited them. Most people’s care needs were assessed although we found some areas where care plans were not appropriate or in place. Overall, people said they were happy with the care they received and spoke positively about the management team. People said they felt able to raise issues with the provider and felt involved in their care.

Rating at last inspection

The last rating for this service was Good (May 2021).

Why we inspected

We received concerns in relation to recruitment practices, training and risk management. Placements had also been suspended by the local authority as a result of concerns other agencies had identified. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well Led. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Deeper Care Escrick on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines management, recruitment practices, consent and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Audrey Burton House is a domiciliary care agency providing personal care to people living in their own homes. The service was supporting 23 people at the time of our inspection.

Not everyone who used the service received personal care. The Care Quality Commission (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 gave generally positive feedback about the safe care and support staff provided. Disclosure and Barring Service (DBS) checks were completed to help make sure suitable staff were employed.

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 27 October 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about recruitment practices. The overall rating for the service has not changed following this targeted inspection and remains Good.

The CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Audrey Burton House 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 reinspection programme. If we receive any concerning information we may inspect sooner.

Audrey Burton House is a domiciliary care service providing personal care to people living in their own homes within the town of Harrogate and surrounding areas. At the time of our inspection there were 21 people who received care and support from the agency.

Not everyone who used the service received personal care. The Care Quality Commission (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

The assessment, monitoring and mitigation of risk towards people who used the service had improved. This meant risks to people's health and safety were reduced. The registered manager carried out regular reviews and spot checks to ensure the quality of the service, and the safety of people who used it, were maintained to a high standard.

Care plans and risk assessments had been reviewed and updated; these covered specific medical conditions such as dementia and diabetes.

We received very positive views from people and their relatives about the support provided to them. Without exception, people said they felt safe and staff were respectful.

People received their medicines safely and their health was well managed. Staff had positive links with healthcare professionals which promoted people’s wellbeing.

People received good consistent care from friendly staff who went out of their way to assist them. Relatives said the service was reliable and efficient. They had good communication with the office and were given information about which staff would be making their visits each week.

Staff had received appropriate induction, training and support to enable them to carry out their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People, relatives and staff told us the management team were approachable and listened to them when they had any concerns. All feedback was used to make continuous improvements 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)

The last rating for this service was requires improvement (published 8 February 2020) and there was a continued breach of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve quality assurance and care records as part of their governance of the service. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led, which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion 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 Audrey Burton House 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.

Deeper Care Solutions Ltd Harrogate is a domiciliary care service. It mainly provides personal care to people in Harrogate and Knaresborough. At the time of the inspection the registered manager told us the service supported 27 people.

Not everyone who used the service received personal care. The Care Quality Commission (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

Since the last inspection the provider had reviewed their systems, together with the local authority to address shortfalls. Not all systems were consistently implemented. For example, we found instances where people receiving support did not have a robust care plan and/or risk assessment in place to guide staff. The issues had not been highlighted by the provider. The provider had not yet embedded the new governance system to ensure the safety and quality of the service was monitored and improved where needed.

Since the last inspection staff had received the training, supervision and support they needed to fulfil their roles effectively. We found staff were enthusiastic about their roles and were keen to learn and develop their skills.

People who used the service and relatives reported positive changes since the last inspection. 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.

Staff were knowledgeable about the people they supported and understood their care preferences and how to meet their needs. Staff were eager to promote people’s health and wellbeing and improve their quality of life and independence.

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 8 November 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made or sustained and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continuing breach in relation to governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Deeper Care Solutions Ltd Harrogate is a domiciliary care agency. It provides personal care to people living in their own houses and flats. The service can support older people, younger adults and people who may be living with a physical disability, dementia, a learning disability or autistic spectrum disorder.

Not everyone using Deeper Care Solutions receives a regulated activity; the Care Quality Commission (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. At the time of our inspection the service was being provided to 32 older people or people living with dementia.

No one with a learning disability was using the service. Therefore, we have not assessed whether the care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance at this inspection. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. We will look at this aspect of the service at our next inspection.

At the last inspection on 27 July 2017 there was a breach of regulation regarding the governance of the service. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good.

At this inspection effective management systems and processes to monitor and improve the quality and safety of the service were not fully established. We identified a continuing breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured staff were trained and supported to carry out their roles effectively. This was a breach of Regulation 18(2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This is the second consecutive time the service has been rated Requires Improvement.

The service was jointly run by the directors of Deeper Care Solutions Ltd, one of whom was the registered manager. A registered manager is a person who has registered with the CQC 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.

Staff inconsistency, poor timekeeping and lack of communication had impacted upon the quality of care people received throughout the service. Since the last inspection the service had increased the number of people for whom they were providing care. They were also supporting people with an increasing level of dependency through the ‘Fast Track’ assessment process for people with a primary health need approaching the end of their life. We found staff sometimes provided this level of care without appropriate care needs assessments in place. Care planning and risk assessment documentation was generic and did not provide staff with sufficient guidance to deliver person-centred care. This placed people at risk because people were not always provided with a consistent team of care staff. We have arranged to meet with commissioners of the service and the provider to discuss the required improvements.

Audits were not being effectively used to identify patterns or trends, prevent re-occurrences and drive improvement. We found similar issues to those identified at the last inspection regarding records management and the provider’s quality assurance systems had not identified or resolved these issues. There was an overall deterioration in people’s reported levels of satisfaction in the service they received.

Records required further improvement to include more detail for those authorised to legally act on people’s behalf, and to ensure they were fully completed and updated in a timely way.

Staff received training and felt they had sufficient support to fulfil their roles effectively. Although improvements were required to record keeping, staff understood how to help people make decisions wherever possible. People told us staff were polite and kind. Staff supported people to maintain their independence and we received positive feedback about how staff respected people’s privacy and dignity when delivering personal care.

We inspected this service on 27 July 2017. The inspection was announced. The provider was given 48 hours’ notice of our inspection, because the location provides a domiciliary care service and we needed to be sure that someone would be at the location offices when we visited. At the time of our inspection, the service was providing care and support to seven older people or people living with dementia.

At our last inspection of the service in July 2015 we rated the service ‘Good’.

The service was jointly run by the directors of Deeper Care Solutions Ltd, one of whom was the nominated individual and had recently completed an application and become the registered manager. We have referred to the registered manager as 'manager' throughout our report. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found that improvements were required to ensure the service was safe. We identified that detailed care plans and risk assessments were not in place to ensure staff provided safe care and support to a person who used the service and around the management of medicines. We found gaps on Medication Administration Records (MARs) so could not be certain people had received their prescribed medicines. The provider’s audits had not identified and addressed the issues we found. We received mixed feedback about staff’s punctuality and found evidence that staffing levels had impacted on the provider’s ability to provide care and support at people’s preferred times. Accidents and incidents were not analysed to identify patterns or trends and prevent similar re-occurrences.

We found records were not always well-maintained. This included recruitment records, MARs, observation records and documentation around people’s mental capacity and with regards to best interest decisions. The provider’s quality assurance systems had not identified or resolved these issues.

This was a breach of regulation regarding the governance of the service. You can see what action we told the registered provider to take at the back of the full version of this report.

Despite these concerns, people who used the service told us they felt safe. Staff understood their responsibility to identify and respond to safeguarding concerns.

Staff received ongoing training and support in their role. Supervisions and appraisals were completed. Staff supported people to ensure they ate and drank enough and to access healthcare services where necessary. Consent to care was considered and staff were mindful of the principles of the Mental Capacity Act 2005 although clear and complete records had not been maintained. Mental capacity assessments and best interest decisions had not been documented and the provider had not explored whether powers of attorney were in place. We have made a recommendation about this is in the body of our report.

Staff were generally described as kind and caring. Staff supported people to maintain their independence and we received positive feedback about how staff respected people’s privacy and dignity.

Care plans contained person-centred information about people’s needs. People told us staff were responsive and provided support which met their needs. Care plans were regularly reviewed and updated and there were systems in place to gather and respond to feedback about the service. People told us they felt able to speak with the manager if they needed to complain or express concerns.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary please read our full report.

This is a summary of what we found:

Is the service safe?

People spoke positively about the care they received and about their care workers. People said they knew who to speak to if they had any worries or concerns and were confident that action would be taken if they raised any issues. One person said 'I always feel safe with the carers.'

People told us that they felt their rights and dignity were always respected.

Effective management systems were not always in place to make sure the manager and staff learned from events such as analysing accidents and incidents, complaints, concerns and investigations. The service had completed individual comprehensive risk assessments for the environment and people's physical and mental health. However the agency had no monitoring systems in place to check and ensure that the people they provided care to were safe.

People we spoke with confirmed they received their medication as prescribed. Some people told us that they could administer their own medication safely with minimal support from staff. However there were no audits being carried out to check that people received their medication safely.

Is the service effective?

People told us that carers asked them about everything and sought their permission. People's files we looked at contained consent from people before they received a service.

People we spoke with confirmed they had a care plan in their home, which was followed by carers when they visited. People did not know if their care plans were up to date and reflected their current needs. One person said 'They (carers) are all very good indeed.'

Some staff had not received training to meet the needs of the people they support in the community. This was because training for some staff including mandatory training such as first aid, moving and handling and safeguarding was out of date.This meant that people could potentially be put at risk because staff did not have appropriate training.

Staff we spoke with told us they felt supported by the management from the agency.

Is the service caring?

People we spoke with told us that they were well supported by the service. We asked them for their views about the staff that supported them. Feedback from people was very positive. We spoke with seven people who were using the service and two relatives who had relatives using the service.

Everyone we spoke with told us they were satisfied with the care they received and spoke positively about individual care workers. People described carers as being 'professional and very kind'. People said 'They (carers) are all really, really nice. They (carers) are helpful, understanding and caring.' Another person told us, "I can't say a bad word about them. I like to have a joke with them. They do everything that I ask them to do' and 'The carers are all very pleasant and amicable, friendly and kind.'

Is the service responsive?

People told us their care workers generally arrived on time and they stayed for the correct length of time that had been agreed. When carers were running late people told us that they would phone to let them know.

People told us if they had any problems they would contact the senior person in charge or the manager who would make sure any issues were sorted out. People said whenever possible they were kept informed about any changes to the usual care workers who attended to them.

People we spoke with told us they knew how to make a complaint if they were unhappy. Everyone we spoke with told us they would ring the agency office. People also told us that complaints would be investigated and action taken as necessary. One person said 'I would ring the office and X would sort it out.'

People were not given the opportunity to share their views about the agency.

Is the service well-led?

People we spoke with told us that the service they received from the agency was good and the carers were 'very caring'.

We saw that there was not an effective and robust quality assurance system in place which meant that the service was learning from any audits to make continuous improvements at the service.

Effective management systems were not always in place to promote and safeguard people's safety and welfare. This was because the agency did not regularly support the staff team through regular one to one supervisions, appraisals, staff meetings and the necessary training of staff to ensure current and best practice was being followed. The registered manager of the service was absent and CQC had not been notified of this absence as required. We have asked for further information about this issue.

People experienced care, treatment and support that met their needs and protected their rights. We saw on the care records that each person had an individual care and support agreement and a range of supporting documentation including risk assessments and a clear list of what care and support was required at each visit. One person told us "They make sure I have everything I need."

People told us that the care was of a good standard and that in the main staff arrived on time. Comments included, "The agency are flexible and staff seem competent and friendly."

The agency had clear systems in place for supporting people with medication and staff were trained in the safe handling of medicines.

We saw that appropriate checks were undertaken before staff began work. The files contained the relevant pre-employment checks which included application form, interview record, references, police checks and authorisation to work in the United Kingdom, where necessary.

The provider had effective systems in place to regularly assess and monitor the quality of service that people received. This included checks undertaken by the manager at the agency whilst staff were providing support in peoples homes.