Westwood Homecare (North West) Limited Manchester

Sedgeborough House is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older people, people living with dementia and people with physical disabilities. At the time of the inspection the service was providing personal care to 60 people.

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

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 had awareness of safeguarding and knew how to raise concerns. Steps were taken to minimise risks to people and staff where possible.

Systems were in place to recruit staff safely and staff were equipped with the skills required to provide effective care and support; this was achieved through support and guidance from the management team, regular training and observations of practice.

People and their relatives had confidence in the ability of staff to deliver care effectively. People received personalised care from staff who knew them well. People were happy with the way staff supported them to take their medicines. People were supported to make and attend health appointments when needed.

Strong emphasis was placed upon continually developing the safety of the service and learn lessons if things went wrong. Effective systems continually monitored and evaluated the quality and safety of the service provided.

People's needs had been assessed before they started using the service and people and those closest to them were involved in planning and agreeing to their care. Care plans contained detailed information to help staff provide personalised care.

The management team worked proactively with other healthcare professionals to ensure a holistic approach to care. There were systems in place to keep people healthy, hydrated and ensure medicines were administered as prescribed.

There was a clear and supportive management structure in place. Quality assurance, audits and monitoring were regularly undertaken. This meant that areas identified for improvement were acted upon in a timely manner.

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 and update for this service was Requires Improvement (report published 17 July 2018). At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

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 any concerning information is received we may inspect sooner.

Sedgeborough House is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older people, people living with dementia and people with physical disabilities. Not everyone using Sedgeborough House 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 consider any wider social care provided. At the time of the inspection the service was providing personal care to eight people.

At the last inspection we found continued serious systemic failures in the overall management of the service. This meant the service continued to be in breach of multiple regulations. In response to this, we took urgent enforcement action to prevent the service from accepting any new packages of care. Since our last inspection, the directors of Westwood Homecare (North West) Limited, set about to recruit a new management team. At the time of this inspection, the newly recruited management team was fully operational and now included a new operations director, service manager and compliance manager.

The purpose of this inspection was to ascertain the effectiveness of the new management team introduced to the service in April 2018 and to determine if all the regulatory breaches identified at previous inspections had been met. We found there had been improvements which were sufficient for the service to be rated as ‘requires improvement’ overall and good in caring and responsive, with no inadequate domains. This means the service can come out of special measures.

The service manager was in the process of applying to become 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.

We reviewed how the service sought to ensure people's medicines were managed safely. At the last inspection this had been an area of concern. During this inspection we found improvements had been made and medicines were safely managed.

We found improvements had been made by the provider to ensure newly recruited staff were suitable to work with vulnerable people. We looked at a sample of recruitment records and found the appropriate checks had been undertaken to ensure staff were suitable for the role.

The provider had ensured that all staff completed the required training to effectively fulfil their role. We found safety critical training such as moving and handling and first aid was now delivered by an external professional training provider. Newly recruited staff now received a five-day induction programme that was aligned to the Care Certificate.

People were protected from abuse and avoidable harm. People and relatives we spoke with told us they were happy with the support received from the service and they felt safe with staff. Staff knew how to identify abuse, the different types of abuse and how to report abuse.

Since the last inspection the new management team introduced a new electronic care planning system. Care plans were now personalised and reviewed to ensure people received the right care and support. People were assessed prior to receiving personal care to determine if the service could provide care and support to people.

Although the provider was aware of the Accessible Information Standard (AIS) they had not yet taken action to implement this further into people's care plans. The operations director confirmed they would ensure the agency introduced a policy for AIS and review elements of their care plans to ensure people’s communication needs were accurately recorded in a format that was accessible to the person.

Complaints had been investigated and appropriate action taken. People were aware of how to make complaints and staff knew how to respond to complaints.

At the last inspection we found the service was not operating in line with the principles of the Mental Capacity Act 2005 (MCA). At this inspection, we found documentation relating to the MCA had been reviewed and updated. This included documentation that detailed who was legally authorised to act on a person’s behalf who lacks capacity.

Quality monitoring systems were introduced since our last inspection and the recent results were positive. We found newly introduced management tools had been established for audit and quality assurance covering areas such supervision and appraisal; medication audits; recruitment and selection; accidents and incidents; compliance with the working time directive; and audits of statutory notification submitted to CQC.

The new operations director and service manager could describe a clear vision for the development of the service and were realistic about targets. They confirmed that any growth would be managed in a manner that did not compromise the improvements that they had made.

Sedgeborough House is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older people, people living with dementia, and people with physical disabilities. Not everyone using Sedgeborough House receives 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 the inspection the service was providing personal care to 10 people.

The purpose of this inspection was to ascertain the effectiveness of the service improvement plan submitted to CQC in February 2018 and to determine if all the regulatory breaches identified at previous inspections had been met. However, at this inspection, we found continued multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of; safe care and treatment; person-centred care; need for consent; good governance; staffing; and fit and proper persons employed.

The overall rating for this service continues to be 'Inadequate' and therefore the service remains in 'special measures'. We are currently considering our enforcement options in response to the regulatory breaches identified. Full information about CQC's regulatory response to any serious concerns found during inspections are added to the report after any representations and appeals have been concluded.

We reviewed how the service sought to ensure people’s medicines were managed safely. At the last inspection this had been an area of concern. During this inspection we found improvements had not been sustained and medicines were not always managed safely. Issues identified included Medicines Administration Records (MARs) not always being available in a person's own home and medicines risk assessments not always being completed when support with medicines was part of an assessed care need.

We looked at how the service sought to ensure newly recruited staff were suitable to work with vulnerable people. We looked at a sample of recruitment records and found a variety of issues including unaccounted gaps in employment history; failure to carry out a risk assessment when an employee was known to have criminal convictions; and, a failure to ensure the validity of employment references. This meant the service was not able to consistently demonstrate the suitability of candidates to work with vulnerable groups before an offer of employment was made.

In order for care to be delivered safely it is fundamental that staff receive an appropriate level of training and their skills and competency are checked. However, the service used unsupported online e-learning as the primary source of training for staff. This raised serious concerns regarding the ability of staff to process, retain and reflect upon training completed as some staff spoken with lacked awareness of the training courses they had completed and course content. Furthermore, we found serious issues in respect of moving and handling training. This training was not fit for purpose and was also delivered solely via a one hour, unsupported online e-learning and did not involve any practical sessions.

We checked to ensure staff were receiving regular supervision sessions. Staff supervision provides a framework for managers and staff to share key information, promote good practice and challenge poor practice. We found the completion of supervision sessions to be ineffective, inconsistent and not in line with company policy.

Since our last inspection the provider had introduced a mental capacity assessment tool. However, a blanket approach had been taken and the application of the assessment tool was not decision specific. This meant the service was not acting in accordance with the Mental Capacity Act (2005).

We checked to ensure people’s privacy and confidentiality was protected through the safe management and storage of records. We found care files and staff personnel records were simply stored on a shelving unit in an office that we observed to be unlocked throughout the duration of our inspection visit. This was despite the fact there were frequent visitors to Sedgeborough House in connection with the provider's other business interests which operated out of the same building.

We found some improvements had been made to the overall format of care plans and the quality of information being recorded, which included the completion of an assessment before a new package of care was accepted. However, we found care planning documentation had not been provided in an ‘easy to read’ format for people who used the service who were living with a learning disability.

We found continued systemic failures in systems and processes which provided no quality assurance of this service from the leadership, management and governance, through to its delivery. Systems such as regular audits, which seek to assess, monitor and improve the quality and safety of the service were not carried out. Furthermore, systems and processes such as recruitment, training and recording of medication which seek to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk and which arise from the carrying on of the regulated activity, remained inadequate.

Sedgeborough House is a domiciliary care service providing personal care and support to people living in their own homes including, older people, people living with dementia, and people with physical disabilities. The support hours varied from one half an hour call a day to four calls a day, with some people requiring two members of staff at each call. At the time of the inspection the service was supporting 12 people within the local community.

At the last inspection in March 2016 we identified three breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to systems not being in place to fully assess and monitor the quality of the service and staff had not received appropriate necessary training and professional development to enable them to carry out their role effectively. Mental capacity assessments had not been undertaken and the service was not operating in accordance with the Mental Capacity Act 2005.

At this inspection we identified on-going breaches of the regulations in relation to need for consent, staffing and good governance. We found a further four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, safe care and treatment, and fit and proper persons employed.

There was a registered manager in post, who was also the nominated individual. 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.

Prior to the inspection we were informed the registered manager was due to retire and the provider was actively looking to recruit a new manager. At the time of our inspection the registered manager had been asked by the director to assist with the inspection process, which she did. We were informed by the registered manager she had officially left Sedgeborough House on 14 July 2017, but assisted with the inspection process to help the director.

During the inspection the director informed us that she had taken responsibility for managing Sedgeborough House for the last two months, working alongside the registered manager until she left on 14 July 2017. However, during the inspection we noted the director did not have experience working in adult social care and had not undertaken any key training to ensure she was competent in her role. Shortly after the inspection we were informed by the director the registered manager had returned to her role as manager, until the provider recruits a new experienced manager.

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, 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.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. 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.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a lack of scrutiny and oversight by the registered manager to ensure that people received safe care and treatment. The management team did not regularly review people's daily notes so they were unaware of changes to people's support or incidents that occurred and did not follow them up to ensure that appropriate action had been taken.

People's care plans did not contain the detail needed to keep people safe including guidance for staff about how to reduce the risk of pressure sores. One person was at a high risk of developing pressure sores and we found service had not developed a pressure sore risk management plan.

We noted one person needed assistance with eating and drinking. This person had specific dietary needs to help manage their health condition. This was not recorded in their care plan. Care plans also lacked information on how to support people to move safely or remain independent. People's care plans had not been audited by the registered manager.

People's medicines were not always managed safely. We looked at people’s care plans and found gaps in information regarding people’s medicine that were supported by the provider. We found no specific medication risk assessments in place that would details the person’s ability and the support they required.

Staff reported accidents and incidents to the office however; the management team did not review them to ensure appropriate action had been taken and to reduce the risk of incidents happening again.

Recruitment was not carried out in a safe manner. The provider did not request references from the latest employers for one staff member that we looked at and we found no medical health questionnaires on file for two new staff.

The service did not follow the principles of The Mental Capacity Act 2005. Some people's relatives had signed to consent to the care provided by the service, we noted people’s mental capacity had not been fully assessed.

Staff were not supported by robust systems of training and monitoring. We found that the provider still didn’t have a clear overview of what training staff required. The provider did not follow a clear induction for new staff and the care certificate had not been introduced.

People did tell us that staff were kind and caring, and when they offered support, treated them with respect and dignity.

There was no effective monitoring of the quality or safety of the service in place, and no routine audits were being undertaken at the time of the inspection. This increased the risk that staff would not identify or be able to act on any areas where improvements were required.

Sedgeborough House is a domiciliary care service providing personal care and support to people living in their own homes. The service also works closely with healthcare commissioning teams in supporting people who have complex healthcare needs. The hours of support vary depending on the assessed needs of people. Calls range from 30 minutes or more and the service also provides 24 hour live in carers.

At the time of the inspection the service was supporting eight people within the local community. We last inspected the service on 1 October 2013 when we found the provider was compliant in all six standards inspected at that time.

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 told us they received safe care, which was reliable and consistent. The service had sufficient staff to meet people’s needs, and people were given the time they needed to ensure their care needs were met.

We saw that people were protected from avoidable harm. During the inspection we checked to see how the service protected vulnerable people against abuse and if staff knew what to do if they suspected abuse. There was an up to date safeguarding vulnerable adult’s policy in place. Risks to people were assessed and risk management plans were in place. We found that the staff we spoke with had a good knowledge of the principles of safeguarding although electronic training records we saw did not always reflect that everyone had attended formal safeguarding training.

Staff were trained to administer medication. We were told that observation of staff competencies were undertaken by the trainer and the registered maanger but these weren’t documented.

The service was not working to the principles of the Mental Capacity Act, 2005 and staff did not receive any formal training on MCA or the Deprivation of Liberty Safeguards (DoLS). The service was not assessing and documenting, where necessary, people’s ability to consent to care which meant that care staff were not always clear about supporting people to make their own choices about their care.

The service had robust recruitment processes which included the completion of pre-employment checks prior to a new member of staff working at the service. This helped to ensure that staff members employed to support people were suitable and fit to do so. People who used the service could be confident that they were protected from staff that were known to be unsuitable to work with vulnerable people. Staff knew their roles and responsibilities and were knowledgeable about the risks of abuse and reporting procedures.

We saw evidence of the induction process, and there was some training provided for caring roles and responsibilities. Not everyone had received training in mandatory elements such as safeguarding and moving and handling.

People were supported with a range of services which enabled them to continue to live in their own homes safely. People we spoke with who used the service and their relatives told us they had been involved in the assessment and planning of the care and support provided and that the service responded to changes in people’s needs.

The care records contained information about the support people required. We saw documented evidence of people’s likes, dislikes and preferences and records we saw were complete and up to date. Reviews of support packages were undertaken after the initial m onth of support and then on a three monthly basis, or more regularly if changes in need were identified. The service was not able to offer gender-specific choices for personal care and support as there were no male carers employed at the time of our inspection.

We found people were receiving care from care staff who were deployed in a way that met people’s needs. Some people who used the service lived alone and staff required the use of a key to access their house. Staff told us keys were appropriately stored in a ‘key safe’ outside a number of houses and people we spoke with receiving a service were satisfied with the way this was managed.

We found from looking at people’s care records that the service liaised with health and social care professionals involved in people’s care if their health or support needs changed. The service worked alongside other professionals and agencies in order to meet people’s care requirements.

There was an up to date accident/incident policy and procedure in place. Records of accidents were recorded appropriately within people’s care files however the recording of incidents needed formalising.

The service had a complaints policy in place and we could see that people using the service were aware of how to make a complaint. Formal complaints were acknowledged and addressed within specified timescales. Staff were made aware of any compliments received by the service.

Staff told us they felt they were able to put their views across to senior staff and to management and we saw examples of this from minutes of meetings and supervision records. The staff we spoke with told us they enjoyed working at the service and said they felt fully supported, listened to and valued.

The service undertook spot checks on staff to observe behaviour and practice but there were no formal audits in place to monitor the quality of service delivery. Feedback from people using the service and their relatives was gained at review and was mainly verbal.

The overall rating for this service is ‘requires improvement’. During this inspection we found three breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The relatives we spoke with said they were happy with the service provided. They described the staff as 'kind and respectful and 'fantastic'. One person told us, 'The staff are very good, they are all lovely. My relative is very settled with the staff who visit, we like the fact that we get the same carers. They are all very kind and respectful. Another relative said, 'The staff are fantastic, they are all very good and always aim to make my relative as comfortable as possible. The manager gives me a staff rota each week so I know who will be coming the following week so I know what's going on. The staff just do what's necessary. If things take a bit longer, it's never a problem.'

Staff were trained on how to safeguard people from abuse and harm when they were first employed, and this was part of the on-going training programme.

Thorough recruitment and selection processes were in place which meant suitable staff were employed.

People who used the service and their relatives were given a copy of the agency's complaint procedure so they knew what to do if they were unhappy with the standard of care they received.