Archived: Care Rangers Limited

Care Rangers is a domiciliary care service providing a range of services including personal care for people in their own homes. They provided 49 hours of care to seven people at the time of our inspection. Care was delivered by the registered manager and two care workers. The service provided support to both older and younger people with diverse needs. For example, people who may be living with dementia, physical disabilities and learning disabilities.

The service had a registered manager who was also the owner / 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.

Relatives of people told us the service was safe and they were confident in the staff that provided care and support to people.

People were safe because staff understood their role and responsibilities to keep them safe from harm.

Staff had a good knowledge of the provider's whistleblowing policy and procedures which meant they were able to raise concerns to protect people from unsafe care.

Recruitment processes were in place to make sure people were cared for by suitable staff.

People were supported by staff who received regular training, support and supervision to help them provide effective care.

Staff understood the requirements of the Mental Capacity Act 2005 and their responsibilities to ensure that people who were unable to make their own decisions about their care and support were protected.

People and relatives had good relationships with the staff and were treated with dignity and respect.

The registered manager had failed to ensure incidents of possible abuse were reported to The Care Quality Commission.

We identified one breach of the Care Quality Commission (Registration) Regulations 2009.

Care Rangers is a domiciliary care service providing 120 hours of care to 19 people in their own homes with diverse needs. For example, people living with dementia, older people and physical disabilities.

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. The registered provider is also the registered manager.

After our inspection in January 2016 we served a warning notice in respect of Regulation 19 (1) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We told the provider they must meet the requirements of these regulations by 13 June 2016. The provider sent us an action plan tell us how they would make improvements.

We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements in respect of fit and proper person employed.

The inspection took place on the 3 August 2016 and was unannounced.

At our comprehensive inspection in January 2016, we identified that the registered manager had not taken all reasonable steps to ensure that the recruitment of staff were of suitable character to care for people. Application forms were not always fully completed and staff employment histories had large gaps.

There was no evidence that the provider had carried out Disclosure and Barring Service (DBS) checks for three members of staff who provided care to people in their own homes. The provider’s brochure stated, ‘Our care workers are carefully selected, and undergo rigorous vetting procedures, including police records checks’. However three members of staff had been providing care to adults at risk without any formal checks as to their suitability. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with people who are at risk.

Employment and character references had not always been requested. The provider had failed to follow their own recruitment policy to ensure they only employed fit and proper person’s to provide care and treatment.

The service had improved their recruitment practices. We looked at the recruitment records for all the care staff (six) currently employed by Care Rangers. The registered manager had recruitment systems in place to assess the suitability and character of staff before they commenced employment. Documentation included previous employment references and pre-employment checks. Records also showed staff had undergone a Disclosure and Barring Service (DBS) check before providing care to people at risk.

The provider had met the requirements of the warning notice issued following our comprehensive inspection in January 2016.

This report only covers our findings in relation to the focused inspection of 3 August 2016. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Care Rangers on our website at www.cqc.org.uk.

We did not inspect the other breaches of regulation at this inspection and will do so when we return to carry out our next comprehensive inspection.

We could not improve the overall rating for this service because to do so requires consistent good practice over time. We will consider whether it is appropriate to revise the overall rating awarded to this service during our next planned Comprehensive inspection.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Our inspection took place over two days. On the first day we visited the agency's office. We looked at documentation such as care plans, visit schedules, policies and procedures, training records, staff records, surveys and audit material. We spoke with the registered manager and manager. We visited and spoke with four people who used the service in their homes and two relatives.

On the second day we spoke with four people who used the service in telephone interviews and two relatives. As part of our inspection process we also spoke with four care workers. This is a summary of what we found -

Is the service safe?

In December 2013 we found that the service failed to meet some people's individual needs because care plans did not always contain relevant risk assessments. The provider did not have appropriate arrangements for the safe administration and recording of medicines used for the purpose of the regulated activity. The provider did not keep accurate and up to date records and documents in respect of risk assessments which would protect people who used the service from receiving unsafe care.

At this inspection we found that there was a system in place for planning people's care and support. The people we spoke with said they had an individual plan which set out the care that had been agreed. We looked at four people's care records when we visited the agency's office. The records set out the actions taken by care workers to effectively assist each person with their range of care needs.

People's medicines support was assessed to support the way in which it was delivered. People's care plans stated that people should only be prompted to take their medicines. The provider had carried out assessments of people's medicines arrangements in all cases.

We saw evidence to support that care workers had received refresher training in safeguarding of vulnerable adults and moving and handling during January and February 2014. Medication update training was ongoing through a local college. There was a training plan in place to ensure that all care workers received ongoing training for their professional development.

We found that people's care records were up to date, accurate and included the necessary risk assessments. We saw that people's care plans contained the information staff needed to care for people safely and was easy to read.

Is the service effective?

During our previous inspection we found that the provider did not have suitable arrangements in place to obtain best interest decisions in respect people who lacked mental capacity. The provider failed to ensure that care workers were given appropriate development training in respect of safeguarding of vulnerable adults.

At this inspection we found that when there had been some concerns about capacity a Mental Capacity Act (MCA) assessment had taken place. One person did not have capacity to make some decisions. We saw that a mental capacity assessment had been undertaken by the provider and best interest decisions made around the persons care and support and followed the five principles of the MCA. This was documented in the persons care plan and involved the person receiving care, the person's relatives, and health care professional, for example, occupational therapist.

Six people told us care workers were punctual and they saw the same care workers on a regular basis. Four care workers we spoke with told us that having regular people to care for helped them have a greater understanding of their care needs.

There were records of practical assessments to demonstrate that care workers were competent following training. This meant that there was a system in place to ensure that care workers were able to deliver care to a safe appropriate standard.

Is the service caring?

During our inspection in December 2013 we found that the provider had failed to identify how risks should be managed to ensure the welfare and safety of people who use the service.

We read that advice had been sought from a healthcare professional to ensure the care plan reflected best practice in relation to the person's health condition.

People told us that the care workers treated them with dignity and respect. One person said: 'The carers are nice to me they put a towel around me and dry me quite well'. Another person said: 'The carers are lovely. I really don't know what I would do without them'

Is the service responsive?

We saw, for example, that one person with complex health needs had a care plan in place that explained how staff assisted them with their personal care and nutritional needs.

Care plans detailed peoples preferences for example, how they liked their tea and by what name they preferred to be called. Care plans also had detailed risk assessments on how people should be mobilised and how risks to tissue viability concerns should be managed.

Is the service well led?

There was a system in place for planning people's care and support. The people we spoke with said they had an individual plan which set out the care that had been agreed.

The deputy manager told us that quality assurance systems were in place to review and monitor care records. We looked at 31 customer survey questionnaires that had been completed during January, February and March 2014. Comments from people who used the service were generally very positive, for example: 'The care and support is excellent. Lovely group of carers. Always willing to do that little bit extra' and: 'My carer always arrives on time. I can set my watch by her.

One person who used the service had requested an earlier call in the mornings to enable them to attend hospital appointments. The provider had changed the timings of the calls for those days to accommodate the person's needs.

Where it had been documented that people lacked capacity to make certain decisions, we did not see evidence to demonstrate that best interest meetings had taken place. Care workers were not able to describe the principles of the Mental Capacity Act (MCA) 2005 and were not knowledgeable about the questions to ask when assessing people's capacity to consent to care and treatment. There was no evidence that staff received training or were given information about the Mental Capacity Act (MCA) 2005, which meant that staff may not be aware of their responsibilities in caring for people who lack capacity.

We asked one care worker how they ensured the care and welfare of people they were caring for and if the care records in people's home enabled them to provide person centred care, they told us: 'I am proud of the care I provide, the service user must always come first. We looked at 10 care plans. Each contained an initial assessment of the person's needs and background information relevant to their care. Five of the care plans we looked at contained a copy of the local authority's plan of care that detailed the person's needs. However we found that the providers own care plans lacked detail and did not always provide sufficient information to meet people's needs.

People's medicines support was not always adequately assessed to support the way in which it was delivered. Care plans stated that people should only be prompted to take their medicines; however, the provider had not carried out assessments of people's medicines arrangements in all cases. Care plans did not detail the requirements of how people needed to be prompted, or when they needed prescribed creams or eye drops to be applied.

In the eight care worker files we reviewed we could find no evidence to support that care workers had received any refresher training in safeguarding after their initial induction training. There was no evidence that a training plan was in place to ensure that all care workers received ongoing training for their professional development.

We looked at 14 customer survey questionnaires that had been completed during November / December 2013. Comments from people who used the service were generally very positive, for example 'I cannot fault the care I receive it is top notch' 'Very nice girls. Always help when asked' and: 'My carer is really nice and friendly. I don't know what I would do without them'.

We could not establish how often care workers were visiting people or for how long the duration of the visit was meant to be. Whist we could establish some people's identified needs, we did find people's care folders in the home to be dis-organised. Information was not filed in sequence and this made the care plan difficult to follow.

Four people we spoke with told us that care staff arrived on time or within ten minutes of the scheduled arrival time and stayed the full amount of time. People described the agency and staff as, 'very good' and one said that they 'had no reason to criticise'.

The agency had its own policies and procedures in place regarding the safeguarding of vulnerable adults. The staff we spoke with demonstrated a good understanding of the signs of abuse and how to report their concerns.

We spoke with people who told us that they experienced care provided by a small number of staff, which meant that staff knew them well. We saw records which confirmed this. One person said the staff who visited them was 'very nice'. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The agency ensured that views were regularly sought from people using the service. Staff we spoke with were happy working at the agency and felt they were well supported by management