Archived: Care with Care

At the last inspection in February 2016 the service was rated Good.

At this inspection we found the service remained Good overall.

People remained safe. People and their relatives told us people were safe. Staff knew how to escalate any safeguarding concerns. People were supported to take their medicines as prescribed. People were supported by regular staff that knew them well and knew how to manage the risks associated with the care delivery.

People's needs were assessed prior to commencement of the service to ensure these could be met. Staff received training relevant to their roles and they were well supported. People’s care plans outlined their dietary preferences and staff assisted people with preparing their meals if required. People were supported to access health professionals appropriately.

The team promoted and open and honest approach and a positive culture. We found the provider had ways to monitor the quality of the service; however the evidence of this was not always available. The registered manager acknowledged concerns had not always been identified by their internal governance processes and told us they were going to address these issues promptly. There was a positive approach and responsiveness demonstrated from the management to address the concerns going forward. The service worked well with other professionals and services to ensure people were safe and had good support that met their needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the staff at the service supported this practice. People’s rights to make own decisions were respected.

The service remained caring. People complimented the positive approach demonstrated by the team. People were able to build positive working relationships with staff. Staff were enthusiastic and positive about their job and working with people. The team promoted individual approach that met people’s expectations and individual, diverse needs. People’s dignity, confidentiality and privacy were respected. People were supported by staff that knew them well.

People's care records outlined the support required. People told us the service met their needs and complimented the team’s responsiveness to people’s changing needs. The provider’s complaints policy was available to people and people knew how to raise concerns. People’s feedback was sought and acted upon if required.

There was a registered manager in post who was also the owner of the company. 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.

There was a registered manager in post at the service. The registered manager was on leave on the day of our 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.

Staff were of aware what action to take to ensure people were protected if they suspected they were at risk of abuse. There were sufficient numbers of staff employed to provide care to people. Recruitment checks had been carried out to ensure only staff who were suitable and of a good nature were employed to support people.

Risks to people’s health and safety had been identified and actions had been taken to manage these risks. People had their medicine as prescribed. Arrangements were in place to ensure people were supported with the safe management of their medicine.

People were protected as staff were aware about the Mental Capacity Act and their responsibilities regarding it. People were supported to maintain good health and received support if required, with accessing health care services.

People spoke positively about the staff. They told us staff were excellent and caring in their approach. People’s privacy and dignity were respected and their care and support was provided in a professional manner.

People and their relatives were involved in care planning and regular reviews were taking place. People’s care plans contained information about their needs and preferences and staff had a good knowledge of people’s needs, history and what mattered to them.

People received support that was based on their personal needs and preferences. Changes in people’s needs were identified and their care plans were updated if required. People told us the service was flexible and responded promptly to people’s requests. There was a complaints procedure in place and people told us they felt able to raise concerns with the staff at any time if needed.

The provider had quality assurance processes and policy in place to monitor the quality and safety of people’s care. People and their relatives were able to make suggestions in relation to the support and service they received.

A single inspector carried out the inspection. The focus of the inspection was to answer five questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. If you want to see evidence that supports our summary please read the full report.

We found the service was safe.

Staff told us they had received training about safeguarding vulnerable people. They told us they would report any concerns immediately to senior staff. Staff told us they knew about the local arrangements in place for reporting to the safeguarding team within the local authority, and that all details were contained in their staff handbooks.

We spoke with people and their families who told us that they felt "safe" and "comfortable" with the staff. One person told us, "They ask for my permission and encourage me to do things for myself."

We saw that there were suitable staff recruitment and selection processes in place and appropriate checks were completed before staff commenced in post.

We found the service was effective.

We spoke with people who used the service and their families. We were told that they had been involved in the planning of their care. People told us that the manager "touched base" with them, and that they saw the manager on a regular basis. This gave people the opportunity to discuss any issues or concerns.

We spoke with staff who told us that their induction into their role had been thorough, and that they worked with other staff until they felt confident to work unsupervised. Staff were assessed and had regular meetings with the manager during their probationary period, to ensure they were working to the required standards.

We found the service was caring.

People receiving care and their families spoke positively about the service they received. We were told, "They care really well. They are brilliant," and, "[The manager] came out to discuss what was needed, and she still pops in from time to time. They all do a fantastic job."

Staff were clear in their understanding that they should treat people with respect. They told us that they always consulted with people before they delivered any care, to check that the person was still in agreement with what was in their care plan.

We found the service was responsive.

We looked at the care records for people who used the service and saw that these were detailed. The plans were reviewed every six months by the manager. The daily communication records, which were contained in a book with the care plans, were checked when the manager and senior staff visited people in their homes. When the books, which were numbered, were full, they were returned to the office. Staff were also expected to report promptly by telephone if they had any concerns about a person they were providing care for. We saw that other health professionals had been consulted and involved when required. This meant that people could be confident that appropriate actions would be taken if their care needs changed.

We found the service was well-led.

There was a registered manager in post. We saw that staff were well trained and that they were effectively supported. The staff we spoke with told us that there was always a senior person they could speak to, if they needed to report an issue, or if they had any concerns.

The manager completed all assessments for new people referred to the service and compiled their care plans.

We saw that staff were encouraged to discuss and review the care they had provided, at the weekly meetings they attended. This meant that people could be confident that the service they received was reviewed regularly with the aim of making improvements.

People experienced care, treatment and support that met their needs and protected their rights. They had positive things to tell us about the care workers, "They all try so hard and usually the same ones come so I get some continuity. I would rate them very highly. They seem busy but they have time to talk, not just do the chores, they don't appear rushed.'

We found that people were cared for by care workers who were supported to deliver care and treatment safely and to an appropriate standard. The agency also had an effective system to regularly assess and monitor the quality of service that people receive. The agency sent questionnaires to people as part of this process. One person had returned a questionnaire stating, 'I receive a very high standard of care and co-operation from Care with Care.'

We found that improvements had been made in record keeping since our inspection in January 2013. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. One person's relative told us, 'I look at the book they leave in the house and their notes are meticulous."

All people we spoke with confirmed they had care plans and that these were regularly reviewed with their input. People were supported to maintain and develop their independence. They told us that they were supported to do things for themselves like managing their own medicines. People told us that their care was delivered taking account of their wishes and preferences.

We found that the provider had arrangements in place to manage medicines appropriately and safely. We spoke with staff and they knew and implemented these arrangements consistently.

The provider had staff recruitment processes in place to ensure they recruited staff who were properly qualified, appropriately checked and able to do their job.

Staff and people supported were able to describe person centred routines that were delivered as people requested. We found the details of these personal care routines were not recorded sufficiently in care plans. Peoples care needs were identified but it was not always recorded how this care was to be delivered to ensure risk was managed. Peoples wishes were respected and their dignity upheld.