The Garden of Kent Homecare LTD t/a The Garden of England Homecare

The Garden of Kent Homecare is a domiciliary care agency. It provides personal care to adults who want to remain independent in their own home in the community. Most of the people who use this service are older adults. This inspection looked at people's personal care service.

There was a registered manager in post who was present during the inspection. 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 registered manager was also the provider.

At the last inspection in October 2017, the service received a rating of requires improvement. The provider was in breach of five regulations of the Health and Social Care Act 2008. At this inspection we found that the provider had made the required improvements and was compliant with all the regulations.

People and their relatives told us they felt safe and comfortable. Staff continued to receive training in how to safeguard people and understood their responsibilities to report any incidences or suspicions of abuse.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required.

Risk assessments were carried out to enable people to keep their independence and receive care with minimum risk to themselves or others. People received their medicines when they needed them from staff who had been trained and had their competency checked.

The provider made sure there was enough staff on duty. We found recruitment procedures were safe with appropriate checks undertaken before new members of staff commenced their employment. This helped to ensure, they were suited to work with people.

People received effective care and support from competent and well-trained staff. Staff were knowledgeable about their roles and responsibilities. They had the skills and knowledge required to support people with their care needs. Staff received a thorough induction at the start of their employment. All staff received regular supervision and annual appraisals.

Staff knew the people they were supporting well and provided a personalised service. Care plans were in place detailing how people wished to be supported and included people's likes and dislikes.

People's health and nutritional needs were assessed and staff contacted relevant health care professionals for advice as necessary to help maintain people's wellbeing.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005. The provider and staff had received training on these. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

There was also a policy on the Mental Capacity Act which was accessible to staff.

People were cared for with kindness and compassion. They were treated with dignity and respect and supported to maintain their independence.

People were supported to maintain their health, access health services and were given advice about how to eat healthily.

People had access to a complaints procedure and were confident any concerns would be taken seriously and acted upon.

The registered manager conducted regular quality assurance assessments to help raise standards and drive improvements.

People and their relatives told us the registered manager was a good manager. The culture of the service was open and positive. The registered manager was very supportive and was committed to providing quality services to people.

Further information is in the detailed findings below.

The Garden of Kent Homecare Ltd t/a The Garden of England Homecare is registered as a domiciliary care agency providing personal care to people living in their own homes. The agency was centrally situated in Maidstone town centre and provided a service to people living in Maidstone and the surrounding area. There were 58 people receiving support to meet their personal care needs on the day of our inspection.

At our last inspection, in August 2016, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the management of risk to individuals' safety, management of peoples’ medicines and governance systems. The registered provider sent us an action plan telling us they would become compliant with the regulations by 14 November 2016. This inspection took place to check that the registered provider had made improvements in these areas. We found that some improvements had been made, but the registered provider continued to breach two regulations and was also in breach of a further three regulations.

There was a registered manager based at the service who was supported by a general manager and an assistant manager. The registered manager was also the registered provider. 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 felt safe using the agency however, we found that the agency was not always managed in a way that ensured their safety. Risks to people's safety and welfare had not always been managed appropriately to ensure they were minimised. Where people had been assessed as being at risk of falls there was not an effective plan or guidance in place to inform staff of the action to take to minimise the risk of falls. Other records showed that people who had been assessed with specific medical conditions did not have guidance in place to inform staff how to meet their needs, and the action staff should take in the event of an emergency.

People's care was not planned in a personalised way. People's care plans were limited in the information they provided and did not reflect their individual preferences. Staff were not provided with information about people's specific support needs to ensure they could meet their needs in a personalised way. People were at risk of an inconsistent approach to their care, because there was a lack of clear instructions for staff to follow to meet all areas of their needs. We have made a recommendation about this.

Staff did not always have clear information or guidance to support people with their medicines, in a safe way. People who received time-specific medicines did not have information and guidance to inform staff of the support they required with this. People’s Medicine Administration Record (MAR) did not show that these had been audited by the registered manager to ensure the safe administration and reduce the risk of a medicine error. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely. However, effective information systems were not in place to ensure these were also managed safely.

The systems that were in place for monitoring the quality and safety of the service and assessing people’s experiences were not always effective. These included telephone reviews, face to face reviews and annual questionnaires. People, staff and others feedback was sought and sometimes acted on to improve the quality of the service being provided to people. However, the overall governance systems had not been effective at identifying the number of concerns that were found during this inspection.

Recruitment practices in place were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support. However, these had not been followed on a consistent basis by the registered manager. We have made a recommendation about this. Staff were supported by the management team who they saw on a regular basis through supervision and an annual appraisal. The management team ensured effective communication between the registered office and staff working out in the community.

An induction programme was in place which all new staff completed. Staff had a clear understanding of their roles and people’s needs. Staff had not always received refresher training as required and had not received training and guidance to meet people’s specialist needs. We have made a recommendation about this.

The registered manager and staff had not always met the requirements of the Mental Capacity Act 2005 (MCA). Staff had not received training and there was a lack of understanding by the staff about the principles of the MCA. People’s capacity had not been formally assessed or recorded prior to decisions made by others on their behalf. However, on a day to day basis staff sought people's consent before they provided care.

People were treated with dignity and respect whilst receiving care and support from the agency. People told us staff were kind and caring and respected their privacy.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

The Garden of Kent Homecare Ltd t/a The Garden of England Homecare was registered as a domiciliary care agency providing personal care to people living in their own homes. The agency was centrally situated in Maidstone town centre and provided a service to people living in Maidstone and the surrounding area. There were approximately 60 people receiving support to meet their personal care needs on the days we inspected.

There was a registered manager based at the service. The registered manager was also the registered provider. 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.

Some people required the support of staff to administer their prescribed medicines. Medicines were not managed safely. The records kept to document when prescribed medicines had been administered were poorly recorded with many gaps that were unaccounted for. Care plans were not always clear whether people required support with their medicines or were able to manage this themselves. This meant that staff appeared to be confused whether they should be administering medicines or not in some cases. Guidance was not available for staff regarding medicines to be taken ‘as and when necessary’.

Individual risks had not been always been identified so risk assessments were not in place to keep people safe. Where individual risks had been identified, risk assessments did not contain the detailed information necessary to ensure people received safe care.

There were suitable amounts of staff employed to deliver the care people were assessed as requiring. However, staff were not deployed appropriately as people and their family members said they did not have consistent staff supporting them. We have made a recommendation about this.

People were kept safe from abuse by staff who had received the correct training and had access to guidance and advice through an up to date safeguarding procedure and a hand size booklet. Staff understood their responsibilities in safeguarding vulnerable adults.

Environmental risk assessments had been carried out in and around people’s homes to ensure the safety of people and staff. Emergency plans were in place to ensure the continuation of the service should a major emergency occur.

Robust and safe recruitment records were in place to ensure that only suitable staff were employed to support vulnerable people.

Evidence of induction for new staff was not available to make sure that new staff had received the knowledge and support required to be able to support people in their own homes. Staff supervision and assessment to provide staff with the support and development required to carry out their role was not regular or often. We have made a recommendation about this.

There was an understanding of the basic principles of the Mental Capacity Act 2005, however detail was missing from people’s care plans. We have made a recommendation about this.

We had good feedback from people and their family members saying that they found all staff to be kind and caring. Staff always stayed for the amount of time people had allocated and they were only occasionally late. People told us staff found the time to have a chat while supporting them.

People had an initial assessment before support started that they and their family members were involved in. Care plans were in place to describe the care and support people were assessed as needing. However these were basic and did not have the individual detail required to make sure all staff knew exactly how people liked to be supported. Regular reviews of people’s care and support had not taken place.

People knew how to make a complaint if they needed to. Some complaints had been made over the last year and the registered provider had responded well to these, recording the action taken.

A customer satisfaction survey had been undertaken in 2015 and a 2016 survey was about to be sent out. Telephone surveys to ask people if they were happy with their support were meant to be carried out regularly. One telephone survey had been carried out with some people recently, however these had not happened regularly. No satisfaction survey had been undertaken with staff or any other people involved with the service to gain their views.

The registered provider did not have any auditing processes in place to check the quality and safety of the service provided. This meant that some of the concerns highlighted had not been picked up sooner, or if they had, a process was not in place to improve the area of concern.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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 told us they felt safe being cared for by staff from the service. One person said, 'I feel safe' when they were supported by staff from the service.

People were cared for by staff who had received appropriate training and guidance concerning how to protect them from the risk of abuse. All of the staff had received training concerning Safeguarding Vulnerable Adults.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

We saw that risk assessments had been completed as part of the initial assessment of people's needs that was completed when they started using the service. This meant that risks had been identified and measures to minimise risk could be implemented.

Is the service effective?

People's health and care needs had been assessed before they started using the service and we saw these assessments were reviewed if their needs changed. People told us they could make requests if they wished to have changes made concerning how they were supported. This meant they were involved in the planning of their care.

Systems were in place to make sure that workers were trained and supported to carry out their duties effectively.

Is the service caring?

People we spoke with told us that the service was caring. One relative said that they 'Can't speak highly enough of the staff'. All of the people we spoke with as well as their relatives told us that staff were friendly and one person commented that, 'They seem to really care'.

People using the service and their relatives had been asked for feedback concerning the service in both a written survey and using telephone surveys. Where shortfalls or concerns were raised these were taken on board and dealt with.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that steps had been taken to respond to recent concerns about staffing levels. The service had also implemented additional quality control measures that identified issues in a timely manner.

People told us that they were able to request changes such as asking for the time care was delivered to be changed if they needed to attend a hospital appointment for example. This meant the service was responsive to their needs.

Is the service well-led?

Staff we spoke with were positive about the support they received from their managers. We saw that they were supervised regularly and they told us that they were confident they could raise issues and these would be addressed.

We saw that there was a detailed compliments and complaints policy in place and detailed records of complaints were recorded. This included the response of the service and the resolution that was reached.

We visited on 17 April 2014 in response to concerning information. We received information that people may not be receiving the support they needed due to staff shortages. We found that the service had already identified this problem and they were taking steps to address the issue. We spoke with the registered managers and they told us that they were waiting for Disclosure and Barring Service (DBS) checks to be completed for staff starting with the service. We saw evidence that they had been in contact with the DBS service to try to resolve delays. We also saw that the service was actively recruiting staff through a number of different avenues.