Archived: Leicester Community Care Services DCA

The service had 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 told us they felt safe with the staff team from Leicester Community Care Services DCA. Both the management team and support workers working for the service had received training on the safeguarding of adults. Everyone we spoke with were aware of their individual responsibilities for keeping people safe from abuse and avoidable harm.

Risks associated with people’s care and support had been assessed. This enabled the management team to identify and minimise any risks and enable the support workers to provide people’s care and support in the safest possible way.

Staffing rotas were being monitored to make sure that their were sufficient numbers of support workers to met the needs of the people using the service.

The majority of people we spoke with told us that they received a consistent service from regular support workers. However four people raised some concerns regarding the timeliness of their calls and that they had not always received these from regular support workers. We shared these concerns with the management team for their information and action.

A robust recruitment process had been followed when new members of the staff team had been employed. This made sure as far as possible that only suitable people worked for the service. All new members of staff had been taken through a comprehensive induction and training relevant to their role had been provided. This made sure that the staff team had the skills and knowledge needed to properly support those in their care.

All of the support workers and members of the management team we spoke with felt that there was always someone available to talk with should they need help or advice and were confident that any concerns would be listened to and acted upon. The majority of support workers we spoke with felt supported by the registered manager and the management team.

A comprehensive assessment had been carried out prior to people’s care and support packages commencing. The people using the service and their relatives had been involved in this process and in the development of their plan of care. People’s plans of care were centred on them as a person and included their likes and dislikes and preferences in daily living.

People were always asked for their consent before their care and support was offered. The staff team had been provided with training on the Mental Capacity Act 2005 (MCA) and both the management team and the support workers we spoke with understood its principles.

People using the service were supported with their nutritional and health needs. They were supported to access healthcare services when they needed them.

Support workers we spoke with understood their responsibilities for supporting people with their medicines in a safe way. They were aware of what they could and could not do with regards to people’s medicines and only supported people with medicines that were prescribed by their GP.

People using the service told us that the staff team were caring and kind and treated them with dignity and respect.

People using the service and their relatives knew what to do if they were unhappy with the service they received. They knew who to speak with if they had a concern and were confident that any concerns would be dealt with properly. A formal complaints process was in place and this had been followed when a concern had been raised with the management team.

People using the service and their relatives had the opportunity to be involved in how the service was run. They were asked for their opinions of the service on a regular basis. This was through regular telephone calls and visits to people’s homes and through the use of annual surveys. This showed us whenever possible people’s views of the service were sought.

Monitoring systems were in place to monitor the service being provided. Members of the management team were regularly auditing the documentation completed by the support workers and the provider had a quality team in place to monitor the service as a whole. This enabled the provider to monitor the service on an on-going basis.

The registered manager was aware of and understood their legal responsibility for notifying the Care Quality Commission of deaths, incidents and injuries that occurred or affected people using the service.

Following our visit to the office, we contacted people who used the service and relatives by telephone for their views, and this represented 20 per cent of the total number of people who used the service. However, not everyone chose to speak with us. We spoke with 12 people who used the service and eight relatives. We also contacted a random selection of additional care workers for their views and experience, and gave care workers the opportunity to contact us. We spoke with a total of eleven care workers.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.

Is the service safe?

People who used the service told us they felt safe. Relatives said they felt assured that care workers visited on a frequent basis. People had emergency contact numbers should they be required.

People told us they felt safe because care workers wore identity badges and uniforms.

The provider had a medication policy that provided staff with information, guidance and support with regard to the safe handling of medication. Staff told us they received medication training, followed by refresher training each year and observational competency assessments. People told us they received support from care workers to take their medication as prescribed by their doctor. The provider had monitoring systems in place that checked people's medication records had been completed appropriately.

Is the service effective?

We spoke with the provider about how they assessed people's capacity to consent to the care and support provided. The provider told us this was an area that required improvement. We were shown documentation, and told of the plans in place to assess people's capacity to consent to the care and support provided. This showed the provider was aware of their responsibility under the Mental Capacity Act.

From the sample of care files we looked at, we saw the provider had assessed people's needs and developed care plans. We saw the provider had review systems in place that ensured people's needs were reviewed that enabled care plans to be amended as required.

People told us that they felt their needs were well met, and that care workers were friendly, caring and supportive.

We saw the induction process for new care workers and the training opportunities provided. Care workers told us that the training they received was appropriate for the needs of the people they cared for. Care workers also told us that the support they received from the management team had begun to improve.

Is the service responsive?

People told us that they felt care workers responded to their needs well, and described some care workers as 'They go the extra mile.'

People told us that they knew how to make a complaint if they were unhappy with the service. On the whole people said they were satisfied with the response they had received to their complaints. Some people told us that they had experienced some problems contacting the office staff, and that calls had not always been returned.

We looked at a sample of complaints made by people. We saw what action had been taken to improve the service delivery. We saw examples of good outcomes for people.

People told us they had been made aware by the office management, of staffing difficulties earlier this year. On the whole people said that improvements had started to happen. Some people said that they had a regular care worker which was important to them. Other people said they still experienced different care workers but effort was made to try and provide some consistency.

Is the service caring?

People spoke positively about care workers and described them as friendly, caring and supportive.

The care workers we spoke with we, demonstrated they had a caring approach and were knowledgeable about the needs of people they cared for.

The provider had a person centred approach to care delivery and strived to provide a service that was caring and supportive.

Is the service well-led

We found some concerns at our last inspection in December 2013 about the frequency of missed calls. We saw what action the provider had taken to improve service delivery. This included calls permanently allocated to named care workers, the recruitment of additional staff within the office management, care workers, and improved monitoring systems in place.

Records showed that people's views, wishes, preferences and concerns were sought, listened to and responded to. There was effective management in place which ensured the delivery of person-centred care, supported staff learning and development.

Whilst the service was without a registered manager, the provider had made suitable arrangements for the service to be managed in the short term. The manager that had day to day responsibility during this interim period, had worked hard to address the issues and concerns and had made a positive impact and developed an open culture.

We found that the provider had made improvements to their planning and delivery of care since our last inspection. Seventy three per cent of visits (compared to 60 per cent when we last inspected) had been at times that people expected and people had been visited by regular care workers most of the time There had been three missed visits since our last inspection. Twenty seven per cent of visits were more than 30 minutes outside the time that people expected. One person had experienced 23 calls that were over 30 minutes late in the space of six weeks. Some people still had concerns about the quality of care provided by non-regular care workers. One relative told us, "My mother has exceptionally good care from her main carer but others are average." Another relative told us, "My mother gets nervous when each day different carers arrive. It would be kinder to her to have the same carer as often as possible." Nevertheless, most people were satisfied with the care and support they had experienced.

The provider's quality assurance processes were effective because they identified areas that required improvement.

After our last inspection in February 2013 we required the service to make improvements towards ensuring that the needs of people who used the service were met through effective planning and delivery of care.

We found that the service had made some improvements. People who used the service told us that they were generally satisfied with the quality of care they experienced from care workers who visited them regularly but they were not as satisfied with care workers who visited them occasionally. Another concern was that they had to tell non-regular care workers about what they should do. People also told us that they had not always been informed that their regular care worker would not be visiting them.

We found that the service had steadily improved the planning and delivery of care but only 60 per cent of visits by care workers had been made within 30 minutes of the times expected by people who used the service. People felt that the quality of care provided by non-regular care worker had not been as good as it should have been. One person's comments were representative of what people told us. They said, "The worst thing is when they send someone who has not been before."

Nearly all respondents to the survey had said that they had been treated with dignity and that care workers had been polite and helpful. We found that people had been involved in assessments of their needs and reviews of their care plans.

We found that care workers had received relevant and appropriate training and that there were enough care workers to meet the needs of the people who used the service. However, delivery of care had been compromised because more often than not care workers had not attended at times that people expected. The provider had already identified this as problem.

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.