Archived: Coastal Care Limited

• Caremark New Forest is a domiciliary care service that provides care and support to people living in their own homes in the community.

• When we inspected, Caremark were providing regulated services to 14 people.

People’s experience of using this service:

• People told us that the staff who provided their support made them feel safe and secure.

• Staff were trained in safeguarding and told us they would not hesitate to whistle-blow to the manager or to external agencies if they were concerned about the standard of care delivered.

• The provider had a comprehensive business continuity plan that detailed how the service would manage to provide support to people in a range of eventualities such as inclement weather or widespread power cuts.

• Staff were safely recruited and necessary pre-employment checks were completed before staff commenced in post.

• Staff were knowledgeable about infection control.

• Staff were trained in the Mental Capacity Act 2005 and assumed people had the capacity to make decisions unless they had been assessed as being unable to do so. People’s mental capacity had been considered as part of the care planning process.

• Before working with people, staff completed an induction and mandatory training courses. They shadowed more experienced staff members until they were confident they could safely support people.

• Staff were supported by regular supervision sessions with the registered manager who also completed spot checks of staff to ensure they were providing a high standard of care.

• People told us that staff members were kind and caring and they looked forwards to their visits.

• The provider had policies in place that ensured that peoples diverse needs were met and that care was delivered in line with their cultural or religious requirements, or as they wanted it to be delivered.

• Staff encouraged people to have an active role in their care. They were supported to complete aspects of their carethat were within their abilities.

• People were involved in their care reviews, they were given plenty of notice of the review so they could invite representatives to attend with them, and consider questions and concerns they may want to raise.

• Staff told us they maintained people’s dignity and privacy and promoted their independence.

• We were told of a number of successful interventions by the provider and how they had made a significant difference to peoples wellbeing.

• People knew how to complain about the provider however there had been no complaints since we last inspected the service.

• The provider supported people with end of life care in partnership with local GP’s and district nurses.

• We received positive feedback about the registered manager and people told us they believed the service to be very well-led.

• Audits completed by the provider ensured that all aspects of care were in line with best practice and safe.

• The provider sought feedback from people receiving a service using an annual quality assurance survey.

• The service met the characteristics of good in all areas.

Rating at last inspection: Good (report published 19 August 2016)

Why we inspected: This was a scheduled inspection based on the services previous rating.

Follow up: We will continue to monitor information that we receive about the service and will return to inspect as per our re-inspection programme or sooner if we have concerns about the service.

When we last inspected in February 2014 we found that the service was not assessing and monitoring quality standards, records were not always accurate and peoples views were not being sought about the quality of the service. Risk assessments had been carried out but care plans did not contain details of actions to take to minimise a persons risk and records were not always accurate. We asked the provider to take actions and at this inspection we found that there had been improvement.

The service provides personal care to older people living in their own homes. At the time of our inspection there were 25 people receiving a service from the agency.

The service has a registered manager. 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 and their families told us they felt safe. Staff had completed safeguarding training and understood what types of abuse people could be at risk from, what signs to look for and the actions they needed to take if they suspected abuse.

Assessments had been completed that identified risks people experienced. When a risk had been identified actions had been put in place to minimise the risk and this was reviewed regularly.

There were enough staff to consistently meet the needs of people. Staff had been recruited safely and there were processes in place to manage any poor or unsafe practice.

Staff had completed medicine administration training and regularly had their competencies checked by a member of the management team.

Staff received an induction and on-going training that enabled them to effectively carry out their roles. Supervision took place regularly and included spot checks with staff whilst working in people’s homes. Staff had opportunities to develop their skills, knowledge and personal development.

We found the service was working within the principles of the MCA. Staff understood how to support people to make their own decisions. When a person lacked the mental capacity decisions had been made in the persons best interests.

People were supported with their food and drink requirements. Staff had a good understanding of people’s likes and dislikes and food allergies.

People had access to healthcare which included GP’s, district nurses, mental health practitioners and occupational therapists.

People and their families described the service as caring. Staff had a good knowledge of people and what was important to them. Care was provided by staff that people knew and felt relaxed with and who respected their privacy and dignity. Staff had found effective ways to communicate and support people who had sensory or cognitive impairment.

Care and support plans were individual and centred around how the person wanted to be supported. Plans were reviewed regularly with people. People felt listened to and had a good understanding of how to make a complaint.

Notifications had not always been sent to CQC. A notification is the action that a provider is legally bound to take to tell us about any changes to their regulated services or incidents that have taken place in them. We discussed our findings with the management team who advised they would review the regulation immediately.

Staff were positive and enthusiastic about the service and spoke highly of the teamwork and management team. Staff felt valued and that their achievements were recognised.

Audits had been completed and had been effective in providing data about practice. The last annual quality assurance survey had been completed in 2015 and the overall outcomes had been shared with people and staff.

During the inspection we were unable to find any evidence that action had been taken to improve the service following the review of annual quality assurance questionnaires. We were unable to find any evidence that telephone reviews for people using the service and staff spot checks were being completed on a regular basis in the last twelve months.

In all six of the care plans we looked at we found that risks had been identified during the assessment process but risk assessments had not been completed. Where risk assessments were in place, we found that they had not been signed by people using the service or by staff and several had not been reviewed in the last twelve months.

One person using the service told us "the staff are wonderful and I look forward to them visiting me each day. They are always smiling" and another said "the girls took time to get to know me and how I liked things to be done".

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We looked at people's records which included personal care needs, risk assessments and daily routines and found that they encompassed the safety and well-being of people who use the service.

Training records showed that staff had received all relevant training with on-going training for new staff. We noted that staff received regular supervision with annual appraisals in place.

People who used the service and staff told us they knew how to raise a concern or complaint and felt confident in doing. They said if they had any issues or concerns they were able to discuss "anything with the manager or the field supervisor."

We reviewed the medication process and found that the provider had systems in place to address the administration and recording of medication.

The quality of the service was monitored at local and provider level through regular checks. People who used the service and their families were provided with the opportunity to give feedback and influence the way the service was run.