Archived: inTouch Home Care

The service did not have a registered manager at the time of this 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. The registered manager of the provider’s other homecare agency based in Coventry was managing the agency on an interim basis in conjunction with the operations director.

At our previous inspection of this service, in July 2016, breaches of legal requirements were found. These were in respect of staff recruitment processes, staffing numbers, complaints handling, and the need for consent to care. At this inspection, we found all these matters had been addressed.

There were enough suitably recruited and skilled staff to meet people’s overall needs. The service had many ways of ensuring staff had the knowledge and skills for their care roles, including regular checks of staff knowledge and practices.

People generally had the same small team of care staff visiting them. New staff were often introduced to people through known and experienced staff members. This all helped positive and trusting relationships to develop, and for people’s needs and preferences to be well attended to.

People were treated well. Their privacy and dignity was respected and promoted, and their independence was enabled where possible. Consent to care was appropriately sought.

Good attention was paid to people’s health, nutrition, medicines, and welfare, both at care visits and in feeding back concerns to the office so that further action could be taken. Staff felt supported and valued, which in turn helped them to provide the quality care service that people and their representatives told us about.

The service identified and addressed care delivery risks. This included protecting people from abuse, reviewing accidents and incidents, and considering complaints.

Our overall findings demonstrated the service provided high-quality care that was open to learning and improving. There were robust systems of auditing quality and compliance with regulations. The views of people and their representatives, and care staff, were incorporated into audits. The service operated a positive, open and empowering culture.

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.

At the last inspection in March 2015, we found that the service met the regulations we inspected against. At this comprehensive inspection the provider was not meeting four regulations.

We found that there were not always enough staff with the right skills to meet the needs of everyone using the service. This resulted in some staff being sent to provide care without sufficient training, and of people cancelling planned care visits due to there being no staff available that met their needs and preferences.

Some staff were supplied to provide care to people before appropriate recruitment checks were completed to ensure they were suitable to be employed, which compromised the safety and welfare of people using the service.

The service had not embedded the principles of the Mental Capacity Act 2005 into its practice. Many consent forms were signed by relatives who had no formal authority to consent on people’s behalf. There were no mental capacity assessments or best interest decisions highlighting that people did not have capacity to sign their care plan consent forms.

Whilst there was a complaints system, it was not always effective at ensuring concerns and complaints were listened to, documented and learnt from.

Most people and their relatives provided positive feedback about the service and said they would recommend it to friends and family. No-one said they would not recommend the service.

The service provided support for people’s health and nutritional needs. There were effective safeguarding and risk management procedures in place that staff understood, and staff received training on supporting people to manage their medicines safely.

The service promoted people’s privacy and dignity. People usually received the same staff members, which helped positive and caring relationships to develop. Most staff were provided with good support for their roles and there was an extensive induction process for new staff.

The provider audited the quality of the service and took action to address concerns that were identified through that process or by other means. There were good management systems in place.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

During this visit on 12 March 2015, we found that the provider had taken appropriate steps to ensure people received care and support to meet their needs. The service had greatly reduced in size and had installed a new computerised log-in system that meant coordinators could quickly address issues as they arose. People told us they received support at the times they were supposed to and records showed that the service had addressed the problem of late and missed visits.

We also found that the provider had improved their process for care assessments, planning and review. This meant that people's needs were identified and reviewed to ensure they received effective and appropriate care that met their needs.

Before this inspection, that provider had responded in detail to the findings of our last inspection report. At this inspection, there was clear evidence of efforts to attempt to resolve concerns. For example, there was analysis of some recently scheduled visits, which identified a number of visits that appeared to be too early, late or missed. These were being further investigated. There was ongoing recruitment of care workers so that the agency had enough staff to meet people's needs at all times. Staff supervisions were now taking place regularly and when needed to help ensure people using the service received care and support that met their needs. The provider had also recently sent surveys to everyone using the service. They had received approximately 90 responses at the time of our visit, and were in the process of analysing these and taking action in response to individual and collective concerns. We were assured that the provider was taking concerns about the quality of care, and missed visits, seriously.

However, we also found that people continued to experience instances where their scheduled care visit did not take place and that the agency was failing to take sufficient steps to address these instances.

We spoke with six people using the service and their relatives as part of this inspection. Most people were happy with the agency's services when familiar care workers visited. Comments included, 'I'm very happy with the regular carers.' However, five of the people we spoke with told us of occasions in the four weeks before our inspection visit when care workers turned up too late or not at all. Their comments included, 'Sometimes they're short of staff. My mother-in-law has to help hoist my father despite having arthritis' and 'Weekends are worse, they hardly work. Sunday care workers turn up late and frustrated, and so we end up helping with hoisting.'

We checked 15 people's electronic care-visit logging records and other supporting documents. Our findings confirmed people's experiences. We found that on average, a person scheduled to receive two care workers together in support of their personal care did not receive a second care worker to assist the first at six percent of visits. A person scheduled to receive a single care worker for personal care support, did not receive them at three percent of visits on average. This meant that the planning and delivery of care visits remained inconsistent and failed to meet people's needs or to ensure that their safety and welfare was protected.

In view of the major concerns identified and the continued breach of the relevant regulation, we are taking further enforcement actions to ensure that the registered provider becomes compliant with the regulations.

Everyone spoke positively about the attitude of care workers overall, for example, 'my regular carers are fantastic' and 'they're careful and kind.' However, everyone told us of occasions this year when care workers turned up too late, too early, or not at all. Comments included, 'if there's only one they manage the hoisting alone' and 'it's rare for the two care workers to come together.' We found that scheduled care visits did not always take place, which failed to protect people against the risks of receiving care that was inappropriate or unsafe.

We found that systems of quality monitoring and risk management were not being effectively implemented. The provider did not have due regard to our previous inspection report and records of the care provided to people, which meant that missed visits to people continued to occur without the agency recognising the extent of these occurring. This failed to protect people against the risks of inappropriate or unsafe care.

We found some improvements had been made since our last inspection. For example, people newly using the service now received a timely assessment visit by senior staff, and there were more frequent checks on people's views of the quality of the service they received. However, we found that many care workers had not received appropriate supervision and support to enable them to deliver care to people safely and to an appropriate standard.

The provider has sent us a plan to address concerns that we raised at the end of our inspection visit.

We are taking action to ensure the provider becomes compliant with the regulations.

Most people we contacted were positive about the support they had received when care workers visited. Comments included, 'the carers are brilliant.' We found that people's privacy, dignity and independence were respected.

We found that there were effective recruitment processes in place to help ensure that people were cared for by suitable staff who were adequately supported by the agency.

However, several people and relatives told us that they had experienced a number of problems with care workers arriving late or not at all. We found that visit scheduling did not always result in people receiving their expected care visits, which failed to ensure their welfare and safety.

Systems to assess and monitor the quality of service were not effective. People's views on service quality were not routinely asked for or acted on, and risks to people from missed and late visits were not always identified and addressed.

We also found that when some people started using the service, their needs and risk factors were not assessed promptly by the agency. Individual care review visits did not always take place in a timely manner. This put people at unnecessary risk.

People who use the service spoke well of staff. They said they felt safe with carers and they had no complaints. They knew who to complain to if they felt unhappy with staff or the care provided. Staff we spoke with were aware of the procedure to follow when responding to allegations or incidents of abuse.

People indicated that they had been consulted regarding their care. They informed us that monitoring visits and spot checks had been carried out by the agency and the care provided was of a good quality.

The views of people and their relatives can be summarised by the following comment, 'I am very happy with my carer. They not only do what is agreed, but sometimes do more.'