Archived: Community Life Choices Head Office

At the last inspection in June 2016 we asked the provider to take action to make improvements because breaches of legal requirements were found. The provider had failed to ensure there

were effective systems in place to monitor the safety and quality of all aspects of the service.

At this inspection visit carried out on 01 March 2018 we have rated the service Good.

During this inspection we found the management team had addressed the issues and had implemented systems to ensure people were safe. For instance we looked at how the service protected people from avoidable harm. We found risk assessments were now more robust and completed as part of people's care plans.

During this inspection, we found the management team completed a range of quality audits including improvement of auditing medication processes. These were now taking place monthly. Any issues found on audits were quickly acted upon and any lessons learnt to be implemented to keep people safe.

A new system was now in place for the administration and recording of medicines. Staff we spoke with told us it was much better and more accurate. One staff member said, “It is a really good system much more accurate with little chance of mistakes.”

We looked at care records of two people we visited in their home. Care records had been improved and were now informative and organised so staff could identify what support and tasks were required for the person.

People who used the service and their relatives/carers told us staff were caring and kind towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

The management team deployed sufficient staffing levels to provide support people required in their own homes. There was evidence by talking with people who used the service and relatives they found staff showed concern for people’s wellbeing. They responded quickly when people required their help.

The service had systems in place to record safeguarding concerns, accidents and incidents and took necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

We found there was an appropriate skill mix of staff to ensure the needs of people who used the service were met. New staff worked alongside experienced staff members and shadowed them to ensure they understood their role in people’s homes.

The management team planned visits to allow staff members enough time to reach people and complete all allocated tasks safely.

Care plans were organised and had identified the care and support people required. We found they were personalised and informative about care people received. They had been kept under review and updated when necessary. They reflected any risks and people’s changing needs.

Where appropriate in people’s care plans, meals and drinks were prepared for them. Staff had received food and hygiene training to ensure they were confident when preparing meals in people’s homes.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People were 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.

People supported by the agency told us staff and the management team who visited them were polite, reliable and professional in their approach to their work.

People who used the service and their relatives knew how to raise a complaint and who to speak with. The management team had kept a record of complaints received and these had been responded to in a timely manner.

The service used a variety of methods to assess and monitor the quality of the service. These included staff meetings, spot checks in people’s homes, quality assurance visits, satisfaction surveys and care plan reviews.

Community Life Choices is a domiciliary care agency, which provides support to people in their own home. The agency operates from a well-equipped office in the docklands area of Preston. At the time of this inspection there were 33 people who used the service.

At the time of the inspection, a new management team had been appointed. One of the new managers had submitted an application to the Commission to become 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.

The last inspection of this service took place on 25 January 2016. During this inspection we found breaches of regulations relating to dignity and respect, safeguarding people from abuse, safe care and treatment and governance. There were also breaches identified at an earlier inspection in November 2015, in relation to medicines management, receiving and acting on complaints and staffing. During the inspection carried out on 25/01/2016 the service was rated as inadequate in the areas of safe and well led, which led to an overall rating of inadequate and the service being placed in special measures.

During this inspection we found significant improvements had been made in all areas we assessed. However, there were some areas identified as requiring further improvement. As the overall rating for this service is no longer Inadequate the service will no longer be in special measures.

People who used the service told us they felt safe and that care workers were able to meet their needs. Risks to the health, safety and wellbeing of people were assessed. However, identified risks were not always addressed by robust care planning. This meant that staff did not always have the information they needed to care for people in a safe manner.

Improvements to the way people’s medicines were managed were demonstrated. We found improvements in relation to record keeping and staff training. However, arrangements for managing medicines required further development to ensure people were protected against the risks associated with unsafe medicines practice.

Systems for monitoring the quality and safety of the service provided were significantly improved. However, we identified some areas that required further development to ensure they were fully effective.

We found that the provider took appropriate action to ensure that any restrictive practices were carried out in accordance with the Mental Capacity Act and associated legislation. People we spoke with reported being asked for their consent before care was provided. However, we found some examples where consent to care had been given on behalf of people who used the service, without it being determined that they had legal authority to give consent.

The care plans we viewed varied in quality. Some provided a good level of person centred information and were based on the individual needs and wishes of the person they belonged to. However, others were found to lack personalised guidance and did not always provide clear guidance to care workers about how people’s care needs were to be met. We also found some examples of care plans, which contained confusing and conflicting information.

Good improvements were noted in relation to safeguarding. Since the last inspection all staff had been provided with updated training in safeguarding and knew how to report concerns. Staff were confident that any issues they did report would be dealt with appropriately by the management team. Records showed that safeguarding concerns were identified and reported to the relevant authorities in a timely manner.

Previous concerns identified about the poor organisation of staffing, which had resulted in the service being unreliable, had been addressed. People reported a more reliable service and no one we spoke with had experienced any missed calls. Staff reported more manageable rotas and felt they had the opportunity to provide good quality care to people who used the service.

Staff training had improved and the provider had effective arrangements in place to ensure that staff providing care and support had the skills and knowledge to do so in a safe manner. Arrangements for staff supervision and support had also been reviewed.

People who used the service spoke highly of care staff. They told us they were treated in a kind and patient manner and with respect. People told us they felt able to raise concerns and had confidence that these would be dealt with in an appropriate way by the provider or new managers.

People reported a more reliable and consistent service. People also felt that communication with the office staff and managers had improved significantly since the last inspection.

The provider had made significant improvements to the way in which people’s complaints were managed. Any complaints made were investigated in a proper manner and viewed as important in assisting the service to continue making improvements. People were invited to express their views and opinions about the service and their views were taken into account.

During this inspection we found two breaches of the health and Social care Act 2008(Regulated Activities) Regulations 2014 in relation to Safe care and Treatment and Good Governance.

You can see what action we have taken at the end of this report. Where we have taken a higher level of enforcement we will report on this in due course.