Archived: Thirsk Community Care

Thirsk Community Care is a domiciliary care service providing personal care for children and young people aged four to 18. Volunteers provide a sitting service for children and young people with disabilities. A sitting service is where a child or young person is supported for a few hours at a time, providing their parents with a break from their caring role. Staff arrange the visits and support the volunteers. The service was supporting five children and young people at the time of the inspection.

Not everyone using Thirsk Community Care receives regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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

Systems were not in place to monitor the quality and safety of the service children and young people were receiving. Up-to-date records were not in place to reflect the current needs of children and young people and inform the support volunteers provided. Reviews were not documented to consider the effectiveness of their support.

There was an increased risk to children and young people as safe recruiting processes for staff and volunteers were not always followed. Children and young people were put at risk as staff and volunteers had not always received training relevant to their roles or updated their training to ensure they were following current best practice guidance. The registered manager did not complete observations or competency assessments of staff or volunteers.

Children and young people were not supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The provider did not follow the Mental Capacity Act 2005 when children and young people turned 16 years old to consider if they could consent to their care and support.

Volunteers understood children and young people’s behavioural needs and how to manage these. When incidents occurred these were used to improve the service and identify where support from other services may be needed.

Children and young people looked forward to visits from their regular volunteers, with whom they had formed close relationships. The service was valued for the practical, compassionate support it provided to families.

Volunteers had a detailed understanding of children and young people’s needs and routines, enabling them to provide person-centred care. Visits from volunteers provided parents with valuable respite away from their caring roles.

The service was well regarded in the local area and was looking at ways to develop and extend the support it offered to children, young people and their families.

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

At the last inspection the service was rated requires improvement (published 10 April 2018). The service remains rated requires improvement. The service has been rated requires improvement for the last two consecutive inspections.

Previous breaches

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection sufficient improvement had not been made and sustained. The provider is still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified four breaches in relation to consent, governance, staffing and fit and proper persons employed. Please see the 'action we have told the provider to take' section towards the end of the report.

Follow up

We will meet with the provider 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 any concerning information is received we may inspect sooner.

Thirsk Community Care Association is a domiciliary care agency. They are registered to provide personal care to children 0-18 years, younger adults and older people. The service supports people who may be living with dementia, a learning disabilities or autistic spectrum disorder, a physical disability, sensory impairment or mental health needs.

Thirsk Community Care Association provides a range of services to people in the local community. Not everyone using Thirsk Community Care Association receives support with a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We inspected the support provided with personal care through the adult and children ‘sitting service’. These services aim to give parents and family carers a break from their caring role. The service uses a mixture of paid staff and volunteers to support adults or children to go out and access their wider community or to stay in their own homes whilst their family carer has a break. For the adult sitting service, support was typically provided once or twice a week and for the children’s sitting service once a month for between one and a half and four hours per visit. At the time of our inspection, there were 11 children and 15 older people using the sitting services.

At the last inspection in June 2015, we rated the service ‘Good’. At this inspection, improvement was required to ensure the service was safe, effective and well-led.

The service had a registered manager. They had been the registered manager since August 2011. 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 was supported by an operations manager. The registered manager was primarily responsible for managing the adult sitting service, whilst the operations manager coordinated the support provided with the children’s sitting service.

For people using the adult sitting service, consent to care was not documented in line with relevant legislation and guidance on best practice.

A wide range of training and learning opportunities were available to staff and volunteers. However, courses were provided when available and not necessarily before staff or volunteers started work. The registered manager did not document formal observations or competency checks to ensure and evidence staff had the knowledge and skills to safely meet people’s needs. Supervisions and appraisals had not been regularly completed for staff and volunteers. We received consistently positive feedback about the knowledge, skills and experience of staff and volunteers. However, the provider’s systems and processes did not evidence a robust and transparent approach to ensuring staff had the necessary skills to safely meet people’s needs.

Records were not always well-maintained. Care plans and risk assessments did not always contain person-centred information or guidance about how risks should be managed. Recruitment records did not always provide a transparent account of how staff and volunteers had been assessed as suitable for their role. Work was on-going to update policies and procedures. The provider needed to develop a policy and procedure around managing and minimising the risk of spreading infections.

These concerns were a breach of regulations relating to consent, staffing and the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

People told us the service was safe and sufficient staff were deployed to meet people’s needs. We received consistently positive feedback about the staff and volunteers and the service they provided. Issues and safeguarding concerns were shared with the local authority to keep people safe.

Health and social care professionals gave positive feedback about the effective working relationships they shared with staff. The registered manager actively sought to engage with other organisations and to share information about any issues or concerns to ensure people’s needs were met. Staff and volunteers supported people when necessary with meals and drinks.

Staff and volunteers were kind and caring. They treated people with respect and supported them to maintain their privacy and dignity. Staff and volunteers respected people’s rights to make decisions.

Care and support was person-centred. Staff and volunteers were matched to people who used the service. This meant people received consistent support from someone who understood them, their needs and how best to support them.

There were systems in place to gather feedback about the service and respond to complaints if necessary.

The people we spoke with told us they had received all of the information they needed prior to receiving care and support. And that they had been very involved with the development of their particular care package.

People told us they felt safe when volunteers were in their homes. We saw there were effective systems in place to reduce the risk of harm.

We were told by the people using the service that they knew who was coming and when and if there were any changes to this then the co-ordinator informed them.

We found the provider had systems in place to monitor the quality of the service they provised.