Positive Care Link

Positive Care Link is a domiciliary care agency. The service provides personal care to older people and people with physical disabilities who live in their own homes. At the time of our inspection there were 16 people using the service and three people were receiving personal care.

Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided.

People’s experience of using this service and what we found

The service did not always review people’s care plans and risk assessments to ensure that they reflected people’s changing needs and many plans were now out of date. Care workers received appropriate training to ensure they were able to deliver care effectively and safely. Medicines were managed safely by staff who had the right training to do so.

People told us they received good quality and reliable care from this service. People were treated well and with respect by a consistent care team who had been supporting them for many years and understood their needs well. A person told us “I would definitely recommend Positive Care Link, because they are reliable and do what you tell them to do”.

People were often contacted or visited by managers in the service to check the quality of their care and told us they were always able to reach a manager to discuss concerns. The service acted quickly to adapt care to meet people’s changing needs, including arranging additional care hours as needed. Staff understood people’s needs and preferences and used effective communication approaches to ensure people could make choices about their care. People told us they felt listened to and treated with respect.

People were safeguarded from abuse and poor treatment and staff were recruited to ensure that they were suitable for their roles. Some policies and procedures needed to be reviewed to ensure they reflected current guidance and legislation. There were not clear systems for auditing records of care, including medicines records, and recording of daily care was not done in a way which would let the service monitor people’s wellbeing or diets.

Staff told us they felt well supported by managers and were always able to seek advice when they needed to do so. Managers carried out frequent spot checks and telephone monitoring to ensure people were happy with the service they received. The service did not have a registered manager, but a new manager was due to start work soon.

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.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 11 February 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Recommendations

We have made recommendations in relation to how the provider meets the Accessible Information Standard and employs robust quality management systems. We will check if the provider has acted on any recommendations at our next inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Positive Care Link is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection the provider was supporting four 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

The provider had suitable systems to minimise the risk of abuse and risks to people’s health and safety were adequately managed. There were enough care staff scheduled to care for people. The provider conducted appropriate pre- employment checks to ensure candidates were safe to work with people. The provider had appropriate policies and procedures in medicines management and accident and incident to assist staff.

People’s health and nutritional needs were understood and met. People had access to healthcare services as required. 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.

Care plans covered the full range of people’s needs and staff knew how to communicate with people. People’s privacy and dignity was respected and promoted. People were involved in making decisions about their care and were encouraged to maintain their independent living skills.

People’s needs were assessed before they started using the service and care was delivered in line with current guidelines. The provider had a clear end of life and complaints policy and procedure in place. People’s relatives told us they felt comfortable raising a complaint if needed.

The provider engaged with people, their relatives and staff to obtain their views. The registered manager understood her key responsibilities and ensured an open and honest culture within the service. All staff understood and fulfilled their roles. The provider assessed the quality of the service and took reasonable action to improve the quality of care.

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 requires improvement (published 1 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the last inspection on 12 January 2018, we found that the service did not meet the regulations we inspected. We found a continued breach in safe care and treatment. We found that the provider did not have safe management of medicines systems in place. In addition, risks for people were not always appropriately assessed and plans were not in place to mitigate them. We issued a warning notice for this breach. We also found a continued breach in good governance because the provider did not maintain complete and contemporaneous records for people. We found a new breach in relation to staffing, because training for staff did not support them to carry out the duties. We issued a requirement notice for these breaches.

At this inspection we followed up on the warning notice and the requirement notices to ensure action had been taken to resolve our concerns. We found that the provider and registered manager had taken action to address some of the concerns from our previous inspection. However, we found that sufficient action had not been taken to resolve all of the concerns.

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.

Medicines were managed safely. There were records and processes in place that demonstrated people’s medicines was managed appropriately. However, we found that medicine administration recording was not always accurate.

The registered manager had systems in place that monitored the quality of the service. But we found these were not always effective because these did not find the concerns we found with some aspects of the service.

Pre-employment checks were carried out and returned before newly employed staff worked at the service. There were enough staff available to meet people’s needs safely and effectively. However, when we checked the care worker tracker system there were errors in the recording of visit times which meant the systems could not identify a missed or late visit.

The registered manager had made improvements in the identification of risks for people. Each person had a risk assessment that was associated with their health or care needs. A risk management plan was in place to guide staff to manage and mitigate risks.

The registered provider had a safeguarding policy in place. Staff understood abuse and how to manage an allegation of abuse and protect people from harm.

Each person had an assessment of their care and support needs. Staff had reviewed and updated people’s care records since our last inspection. People’s care records held information on their individual needs, likes and dislikes. Staff had access to this guidance to enable them to support people.

People had meals prepared for them if this was required. Meals provided met people’s personal choices, preferences and nutritional needs.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA). Staff completed training in MCA which helped them the identify when people lacked the mental capacity to make decisions for themselves. People are 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.

Each member of staff had completed an induction on their employment at the service. Staff received support through training, supervision and a yearly appraisal.

The registered manager and staff were aware of and understood end of life care. At the time of the inspection, there were no people receiving palliative support or end of life care.

People said staff respected them and treated them with dignity while protecting their privacy.

The registered provider had an infection control policy. This provided staff which guidance on how to protect people from the risk of infection.

The registered provider had a complaints policy. People knew how to make a complaint or discuss a concern about an aspect of the service.

The registered manager met with staff and provided them with support and advice when this was requested.

People provided feedback about the care and support they received. Staff had regular contact with people and regularly asked people for their feedback on the staff and services they received.

The registered manager informed CQC of events and incidents that occurred at the service which we should be aware of.

Staff had developed partnership working with health and social care organisations. People received appropriate healthcare when their needs changed or deteriorated.

This inspection was announced and took place on 12 January 2018 to check that the provider had followed their plan and to confirm they now met legal requirements. At this inspection we found the provider had failed to make necessary improvements.

Positive Care Link is a domiciliary care service providing personal care and support to adults. Whilst we have taken into account any wider social care and support provided to people in their homes and in the community, the Care Quality Commission (CQC) carried out this inspection only in relation to the regulated activity of ‘personal care’.

At the time of our visit the service was supporting 42 people. Of these people, 14 were receiving support and assistance with personal care tasks.

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's care and support needs were assessed by local authority social workers before a timetable of tasks was created and an appropriate package of care provided.

The provider did not consistently provide staff with information about people’s life histories, individual preferences, communication methods, likes and dislikes, cultural and emotional needs. This information can be useful for staff when meeting people for the first time and ensures that individualised support is appropriate and person-centred.

The registered manager demonstrated a poor understanding of the risk assessment process. Risks to people's health, well-being and safety were not being clearly identified during the assessment process and therefore appropriate plans to manage and minimise risks were not always in place.

Most people told us they felt safe with staff. Staff received safeguarding training and were able to explain what they would do and who they would contact if they had any concerns about people's safety.

Staff were not always following the provider’s medicines policies and procedures when supporting people to manage their medicines. Information we reviewed provided insufficient detail as to what medicines had been prompted, at what time and whether people had been observed taking their medicines.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Staff respected people's decisions and gained people's consent before they provided personal care. People using the service and their relatives told us staff were kind and caring and mindful of privacy and dignity issues.

People were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, district nurses and social workers.

People were supported with meal preparation where this task formed part of their care plan. However, care records did not provide any specific information regarding dietary requirements where people were at risk of choking due to their illness or disabilities.

There were measures in place to ensure that staff were recruited safely and were suitable for their roles and once in post, staff received a programme of ongoing training and supervision.

People's feedback was sought through spot check visits and telephone reviews and there was a process in place for ensuring that complaints were investigated and responded to appropriately.

We found that the provider was in continuing breach of regulations relating to safe care and treatment and good governance. We also found a breach of regulations relating to staff training. We are considering what further action we are going to take. 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.

We undertook this comprehensive inspection on 25 and 26 October 2016 to check that the provider had followed their plan and to confirm they now met legal requirements. The inspection was carried out by one inspector and was unannounced.

Positive Care Link is a domiciliary care service providing personal care and support to adults and children in their own homes.

At the time of our visit the service was supporting 37 people. Of these people, 15 were receiving support and assistance with personal care tasks.

There was a registered manager in place. 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’s care and support needs were assessed by local authority social workers before a timetable of tasks was created and an appropriate package of care provided. Life histories, individual preferences, communication methods, likes and dislikes did not form part of people’s care plans. This information can be useful for staff when meeting people for the first time and ensures that individualised support is appropriate and person-centred.

Risks to people’s health, well-being and safety were not being clearly identified during the assessment process and therefore appropriate plans to manage and minimise risks were not always in place. Senior staff responsible for the completion of these assessments demonstrated a poor understanding of the risk assessment process.

People told us they felt safe with staff, who had received safeguarding training and understood how to protect people from abuse. The provider had up to date safeguarding policies and procedures in place. Staff were able to explain what they would do and who they would contact if they had any concerns about people’s safety.

Not all staff were involved in supporting people with their medicines, but where they were responsible for prompting people’s medicines, staff were required to complete training in medicines administration and record this task in people’s daily logs. However, when completed daily logs were returned to the office they were destroyed. This information must be retained in line with the Data Protection Act 1998 and for the purpose of monitoring and quality checks.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Staff respected people’s decisions and gained people’s consent before they provided personal care. People using the service and their relatives told us staff were kind and caring and mindful of privacy and dignity issues.

People were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, district nurses and social workers. Staff told us they notified office staff and people’s relatives if they had concerns about people’s health and we saw evidence of this in the correspondence section of people’s care records.

People were supported with meal preparation where this task formed part of their care plan. However, care records did not provide any specific information regarding dietary requirements where people had been diagnosed with diabetes or where health care professionals had requested staff to support people with healthy eating plans.

There were measures in place to ensure that staff were recruited safely and were suitable for their roles and once in post, staff received a programme of ongoing training and supervision.

People’s feedback was sought through spot check visits and telephone reviews and there was a process in place for ensuring that complaints were investigated and responded to appropriately.

We found breaches of regulations in regards to risk management and good governance. You can see what action we told the provider to take at the back of the full version of this report.

At the time of our inspection the agency was providing support to 20 people living in their own homes. We spoke with seven people and or their relatives on the telephone to gather their feedback on the service provided to them. We spoke with the registered manager and one other management staff member based in the office and made calls to five care staff members working for the agency.

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 that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Staff employed to work at the service had been selected for their suitability, skills and experience, so they could meet the needs of the people receiving care. The provider had an infection control policy in place and staff were provided with protective equipment. People told us that the staff always used disposable gloves and aprons.

Is the service effective?

People told us that they were happy with the care they received. Staff told us they got to know people well and they understood people's care and support needs. One person told us, "staff do a good job it's all working well.'

Is the service caring?

The feedback people gave us about the staff was positive, with one person saying, 'they are very good and caring.' Relatives we spoke with told us staff were caring towards their family member and said staff were caring and kind. People were supported by kind and attentive staff.

Is the service responsive?

We saw people had signed their care plans giving consent to the care provided.

People's needs had been assessed and reviewed every six months. Records confirmed people's preferences, history and diverse needs had been recorded and care and support had been provided, which met their wishes. People told us they knew how to make a complaint. Relatives knew how to contact the provider if they needed help or advice. One person said about the care assistance 'they are attentive and make sure I am ok.'

Is the service well-led?

The manager had systems in place to monitor the quality of the service provided. Staff told us they were supported in their job, which helped to ensure people who used the service received a good standard of care and support. They felt they could raise issues or concerns with their managers and these would be acted upon. One staff member said, 'we report any problems to our manager.' Staff said they had team meetings, supervision and appraisal.

There was evidence people were provided with information on their care and their views and experiences were taken into account in the way the service was provided.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider had a safeguarding policy in place and staff were aware of their responsibilities.

There were sufficient skilled and experienced staff to safely meet the needs of people who use the service. In the staff files we looked at we saw evidence staff had received appropriate training.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.