Cera - Plymouth

Cera Plymouth is a domiciliary care agency providing personal care to people in their own homes. The service provides care and support to people which include personal care, food preparation and medication support. At the time of this inspection, the manager informed us they were providing personal care to 354 people who used the service.

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 and what we found

Most people were happy with the staff who supported them. However, some people told us they were unhappy about the timings of and, communication around their visits.

People told us they were happy with the support they received with their medicines. People’s medicines support needs were documented in care plans. We have made a recommendation about the management of some medicines.

Risks assessments were in place and gave staff guidance on how to reduce risks and actions to take. People told us, “My wife is safe in their care. I can tell that just by the general care they show during the professional activities they do” and, “I feel safe as the carers make sure that I don’t fall.” People and their relatives confirmed staff followed good infection control practice in their homes. They said they felt safe and staff wore personal protective equipment (PPE) appropriately.

A new provider took over the service in July 2020. The nominated individual told us they had a number of actions to complete when they took over the service and some remained in progress, mainly due to challenges they faced during the pandemic. They had made improvements in relation to risk assessments, care plans, and medicines. The provider had quality assurance systems in place. Although they had identified issues relating to timing of visits and communication, these had not been resolved. Following our inspection, the nominated individual assured us they had already made improvements to the scheduling of visits and the introduction of a new system had been brought forward.

People gave mixed feedback when asked if the service was well-led. A new manager started working at the service at the end of March 2021 and was in the process of applying to register as manager with CQC. They were keen to make improvements and were responsive during our inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service under the previous provider was Requires Improvement (published 9 January 2020). The service remains rated requires improvement.

Why we inspected

We carried out an announced focused inspection of this service in December 2019. Two breaches of legal requirements were found. The previous provider completed an action plan after the last inspection to show what they would do and by when to improve and meet the regulations relating to safe care and treatment and good governance.

We undertook this focused inspection to check they had followed the previous provider’s action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cera-Plymouth on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified one continuing breach in relation to governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Gemcare South West Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older and younger adults within Plymouth.

At the time of the inspection the agency supported people with physical disabilities, sensory impairments, mental health needs, and people living with dementia. The service also provided care and support to people who were at the end of their life.

In September 2019, the provider worked in close partnership with Plymouth City Council when a large provider within Plymouth had not been able to continue their domiciliary care service. The action of the provider meant people affected continued to receive a service and staff remained in employment. The recent acquisition increased the size of the agency from providing care and support to 481 people to 900 people. In addition, the provider acquired seven supported housing units.

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. At the time of the inspection the agency supported 900 people with personal care.

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

People told us staff were kind and caring, respected their privacy and dignity and promoted their independence. However, a significant amount of people we heard from were dissatisfied with staff arriving late, rota administration, inconsistency of staffing and communication with office staff. People who needed time critical visits, experienced delays.

Risks associated with people’s care continued to not always be detailed in their care plans, which meant staff may not always know how to support them safely and with continuity. Despite records not being in place, staff told us they felt they had enough information to meet people’s needs, and we found no evidence that people had come to harm.

People told us they felt safe when staff entered their homes. Staff were knowledgeable about what action to take if they suspected someone was being abused, mistreated or neglected.

Staff were recruited safely; a new human resources manager had been employed. Staff received the required training to ensure they could meet people’s individual needs.

There were systems in place to obtain feedback from people and their families about the quality of care and support they were receiving. However, whilst people’s views were respected and used to help improve the service, changes were not always sustained.

People had their needs fully assessed when they started to use the service, so a care plan could be created. Overall, people’s care plans were reviewed with them, but they did not always contain essential information, and were not always personalised to how people wanted their care and support to be delivered.

Overall, people received their medicines safely, and now had records in place. However, some records relating to the application of topical medicines (creams and lotions) were not always in place and some people did not get their time specific medicines on time, due to experiencing late visits.

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.

People told us the service was well managed. New governance systems had been introduced to help highlight when improvements were required, however whilst some improvements had been made, systems were still not fully effective in highlighting where improvements were required.

We found one continued breach of the Health and Social Care Act 2008 (Regulated Activities 2014) and have made some recommendations.

We recommended that people’s care plans are personalised to ensure they reflect how a person wants and prefers their care and support to be delivered.

During the inspection, the registered manager provided a comprehensive action plan outlining how improvements would be made. It detailed how new training modules and record templates would be created for key areas such as the completion of care plans and risk assessments. In addition, action was being taken to improve complaint management, communication, and improvements to the control and monitoring of staffing consistency and visit times. The registered manager and Directors told us they were fully committed to making improvements and wanted to get it right for people.

More information is in Detailed Findings below.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Please see the action we have told the provider to take at the end of the report.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 24 December 2018), and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, whilst we found some improvements had been made, further action was still required.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. In addition, we will request an action plan for the provider to understand what they will do to improve the standards of quality and safety.

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last comprehensive inspection in February 2016, a breach of a legal requirement was found so we issued a requirement notice. This was because the provider had not ensured people’s care plans were effectively reviewed, met their needs and preferences and were reflective of the care being delivered. We also asked the provider to make improvements to how people’s complaints were recorded. After the comprehensive inspection the provider submitted an action plan to tell us what they would do to meet the legal requirement in relation to the breach.

On 21 July 2017, we undertook an announced focused inspection to check that improvements had been made in these areas. We found the provider had met the legal requirement notice as issued at the previous inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older and younger adults within Plymouth. At the time of the inspection the service was providing personal care to 481 people, including those with physical disabilities, sensory impairments, mental health needs, and people living with dementia. The service also provided care to people who were at the end of life. The provider had taken action when other providers were not able to continue their services, to provide care to the people affected and employ the staff members concerned. They told us they did this with the aim of maintaining quality services across the city of Plymouth.

A registered manager was employed to manage the service locally. 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.

When people had risks associated with their health or care needs, these had not always been assessed. Information was not always available to staff detailing how to help reduce these risks. When people had mental health needs, individualised information was not always available to staff to help reduce risks to people or recognise concerns. Clear information about people’s medicines needs were not always available, particularly in relation to prescribed creams and lotions. Staff had received training to administer medicines but had not had regular assessments of their competency.

Staff had not always been recruited safely. There was an ongoing training programme, however not all staff whose training was out of date had been identified as needing refreshing; and the provider did not have evidence that some staff who had transferred from another organisation had up to date training in place.

The registered manager and providers had not monitored the service effectively. They had not ensured they had oversight of work delegated to other staff members. They had not identified the concerns highlighted during the inspection.

People told us they felt safe using the service. Staff had received training in how to recognise and report abuse and were confident in reporting concerns. We received mixed feedback about the consistency of staff people were supported by and whether they received communication about any changes. People told us calls were not missed and staff were not rushed.

People told us they received support from staff who had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided and told us staff treated them with care. People were treated with dignity and respect and the service was working to increase staff knowledge of human rights. People’s care plans contained information about their likes, dislikes and preferences and people confirmed these were respected by staff.

Staff told us they felt supported in their role. They confirmed they could contact the office for advice when needed and were listened to.

The providers were keen to develop a positive culture in the service which reflected the services vision and values. Staff confirmed they felt valued by the organisation, and people and their relatives gave positive feedback about how they were treated by the staff and the organisation as a whole.

The registered manager and providers sought information that would help them improve the service. They attended external social care forums, sent surveys to people and staff and reflected on the outcomes of inspections for similar services. This information, along with outcomes from complaints and suggestions from the staff team, were used to plan improvements for the future.

We found breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report. We also made recommendations.

We carried out an unannounced comprehensive inspection of this service on 02 and 03 February 2016. A breach of a legal requirement was found so we issued a requirement notice. This was because the provider had not ensured people’s care plans were effectively reviewed, meet their needs and preferences and were reflective of the care being delivered. We also asked the provider to make improvements to how people’s complaints were recorded. After the comprehensive inspection the provider submitted an action plan to tell us what they would do to meet the legal requirement in relation to the breach.

We undertook this focused inspection on 21 July 2017, 01 and 02 August 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gemcare South West Limited on our website at www.cqc.org.uk

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 had care plans in place which were reflective of their needs. People’s care plans were reviewed with them to ensure they reflected their needs and preferences. People told us they felt that their care plans were effective and provided good, current information about their care needs and that staff referred to them when they visited to provide care and support.

People’s complaints were effectively recorded. Records detailed whether people had been satisfied with how their complaint had been resolved. People’s complaints were listened to and used to help facilitate ongoing change. People told us they knew who to complain to and that when they contacted the agency, they felt that they were listed to and that proactive action was taken to resolve their unhappiness.

This meant that the provider had met the legal requirement notice as issued at the last inspection.

Gemcare South West Limited provides domiciliary care services to older and younger adults within Plymouth. On the days of the inspection the service was providing personal care to 450 people, including those with physical disabilities, sensory impairments, mental health needs, and people living with dementia. The service also provided palliative care to people who were at the end of life.

The service had 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 told us care staff were kind, caring and compassionate, commenting “The care is unequivocally superb for both myself and my wife, I can’t say a single bad thing about it” and describing the interaction from staff as “Excellent”. People also told us staff were respectful of their privacy and dignity, and promoted their independence, one person telling us, “They are first class. I was just sitting all day but they said to me, let’s see what we can do, and they’ve changed my life completely”. Staff spoke about people in a caring way and how they enjoyed brightening up a person’s day. Staff were inspired by the caring values of the Directors.

People were supported by a small staff team which helped to provide continuity of people’s care and assisted in the development of positive relationships. Staff had been recruited safely, which meant they were suitable to work with vulnerable people. The Directors and staff had a good understanding about safeguarding procedures and were able to tell us what action they

should take if they felt some one was being abused, mistreated or neglected.

The vision of Gemcare South West Limited was to ensure people were at the heart of the service. Their vision was underpinned by strong leadership, inclusiveness and communication. The service values of, “Inclusion”, “Integrity”, and “Competence” were demonstrated by the management team, and reflected in staffing practice, culture and care delivery.

The registered manager and Directors all took an active role within the running of the service and had a good knowledge and a passionate approach, for the staff and for the people they supported. There were clear lines of responsibility and accountability within the management structure which staff understood.

People felt safe when staff entered their home. Staff arrived on time and when they were going to be late, people were generally informed of this. However, some people told us they did not always get a call, which meant they were left wondering when staff may arrive. The Directors told us this was an ongoing problem which was continually discussed with staff, but they would strive to make improvements. Staff felt there were enough staff to meet people’s needs and had adequate travelling time. Staff were protected from risks associated with lone working. People were protected from the spread of infection because staff followed infection control procedures.

People were supported by staff trained to meet their needs, and who were motivated and inspired by the Directors to provide quality care. All staff were trained to meet people’s needs and had regular supervision to focus on their development. New staff received a through induction. Staff told us they enjoyed working for the organisation, were well supported and that there were adequate opportunities to obtain further training and qualifications. Pre-assessments of people’s care were carried out to help ensure staff had the right skills and experience to meet people’s needs prior to people joining the service. When staff did not have the right skills, specialist training was arranged.

People were involved in decisions about their care and had care plans and risk assessments in place. These provided guidance and direction to staff about how to safely meet a person’s needs. However, care plans were not always reflective of the care and support required of staff, for example how people wanted to be supported with their personal care or with mobility. The Directors were receptive to our feedback and started to take immediate action at the time of our inspection. Staff were aware of the importance of obtaining people’s consent prior to carrying out care and support. People’s consent and mental capacity was demonstrated in care plans to help make sure people who did not have the mental capacity to make decision for themselves, had their legal rights protected.

People who required support with their medicine received them safely. At the time of our inspection the provider was taking action to improve the accuracy of documentation as well as ensuring people’s care plans provided guidance and direction to staff.

People were encouraged to eat and drink. When staff were concerned about whether a

person was not eating and drinking enough, they took action, reported any concerns to health care professional or to management. Staff were observant of the deterioration in someone’s health

and wellbeing and took the necessary action, for example contacting the person’s GP or a district nurse. The service worked positively with external health and social care professionals as required to ensure people’s needs were being met effectively.

People’s feedback was obtained, valued and used to facilitate change and make improvements to the running of the service. People did not always know who to complain to and had not always been satisfied with the response. Immediate action was taken at the time of our inspection to address this by contacting those affected.

There was a strong emphasis for continued improvement and development. Quality assurance systems in place helped to achieve this. The Directors had positive relationships with other organisations, such as local authority commissioners and other service providers in the local area. The service had notified the Care Quality Commission (CQC) of all significant events which had occurred in line with their legal obligations.

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