Archived: Cheviot Care Limited

Cheviot Care Limited is a domiciliary care agency providing personal care to people in their own homes in Wooler. There were seven people receiving personal care at the time of the inspection.

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

At our previous inspection we identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found that insufficient action had been taken to improve.

There were continued shortfalls relating to recruitment, the assessment of risk, care records and staff training. New shortfalls were identified in relation to medicines management and records relating to the Mental Capacity Act [2005]. The provider’s governance system had not highlighted these issues.

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. However, records did not always evidence this.

Action had been taken in relation to the provider’s safeguarding system. Staff had undertaken safeguarding training and knew how to report any safeguarding concerns. Infection control and COVID-19 training had also been carried out. Staff were knowledgeable about how to put on and take off PPE safely to reduce the risk of cross infection. One relative said, “When I have gone into the house unexpectedly they are wearing masks, aprons and gloves and I know when they take [relative] shopping, both the carer and [relative] are wearing masks as I see them when I am out and they pass me by in the car.”

Although we identified shortfalls in many aspects of the service, people and relatives spoke very positively about the care and support provided. Comments included, “They are very patient in fact marvellous with me whilst caring for me” and “I would recommend this company to anyone looking for good reliable care.”

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 was inadequate (published 12 January 2021) and there were multiple breaches of the regulations.

The provider has failed to achieve a rating of good at the last five inspections.

Why we inspected

We undertook this inspection to check that improvements had been made and confirm whether they now met legal requirements.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, recruitment, training and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service remains ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Cheviot Care Limited is a domiciliary care agency providing personal care to people in their own homes in Wooler. There were six people receiving personal care at the time of the inspection.

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

At our previous inspection we identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to training, recruitment and good governance. At this inspection, we found that action had not been taken to improve.

An effective safeguarding system was not in place. Risks relating to Covid-19 had not been assessed and staff had not completed training in the management of the Covid-19 virus and the use of Personal Protective Equipment (PPE). Action had also not been taken following our last inspection to ensure effective recruitment systems were in place. Recruitment checks were not in line with legal requirements.

There were enough care staff deployed to meet people’s needs. However, there were insufficient management hours to oversee and monitor the safety and quality of the service. The registered manager worked full time providing care and support to people.

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. However, records did not always evidence this and up to date policies and procedures regarding the Mental Capacity Act 2005 and consent were not in place.

An effective system to ensure staff were suitably trained was still not fully in place. We identified concerns relating to safeguarding, the management of risk and the maintenance of records. Further training was needed in these areas to ensure staff were suitably trained.

Care records continued to lack detail and did not always reflect the care which was provided. Action had also not been taken since our previous inspection to ensure an effective system was in place to review people’s care.

An effective quality monitoring system was still not in place. Medicines audits were carried out; however, no other audits were completed to check that staff were following best practice guidelines and that the service was delivered safely and effectively.

Although we identified continued shortfalls in all aspects of the service, people and relatives spoke very positively about the care and support provided. One person told us, “They are very caring, I wouldn’t want to be without them.”

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 was requires improvement (published 9 August 2019) and there were multiple breaches of regulation. We issued a warning notice following this inspection, in respect of the breach in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, highlighting to the provider that they needed to improve. The provider completed an action plan which stated what they would do and by when to improve. At this inspection action had not been taken to improve and the provider was still in breach of the regulations.

The service has been rated requires improvement at the last four inspections.

Why we inspected

We undertook this focused inspection to check the provider had met the requirements of the warning notice, followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which are the key question areas in which the warning notice and requirement notices were issued following our last inspection.

The rating from the previous comprehensive inspection for the Key Question Caring, which was not looked at on this occasion was used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. 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 Cheviot Care Limited 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding people from abuse, safe care and treatment, recruitment, training and good governance. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

People’s experience of using this service: At our previous inspection we identified two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. There were shortfalls with medicines, risk management, the maintenance of records and the overall management of the service. At this inspection, we found that some improvements had been made, however further action was required and the provider remained in breach of the regulations.

There were three full time members of staff, including the registered manager. All three were directors of the service. The registered manager was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. One part-time member of staff was also employed.

People told us they felt safe. There were safeguarding policies and procedures in place. However, records were not fully available to demonstrate that all staff had completed safeguarding training.

Safe recruitment procedures were not followed. Recruitment checks had not been carried out for one member of staff before they commenced work. The registered manager/provider explained that they knew the staff member well and considered they were trust worthy.

Improvements had been made with the recording of medicines administration. However, further action was required.

An effective system to assess and monitor risks was still not fully in place. We found continued shortfalls relating to people’s care documentation and records did not evidence that all staff were suitably trained. Medicines audits were now recorded; however, no other documented audits or checks were carried out. The registered manager/provider told us that one of the main issues was finding time to carry out management tasks because she was involved in care delivery.

We did not identify any major impact of these omissions and shortfalls upon people's health, safety and wellbeing. People were very complimentary about the service and the care and support provided. One person told us, “They are a great team, I am very, very happy.”

People told us that staff helped ensure their health needs were met and contacted the GP or nurse if required.

The service was part of the local community. Staff and people lived in the same area so they shared a common interest in amenities and events in Wooler and the surrounding areas.

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

Rating at last inspection: Requires improvement (published 25 April 2018).

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. We have previously met with the registered manager/provider to discuss the improvements required.

Why we inspected: This was a planned inspection based on the previous rating. We also followed up on the action we told the provider to take at the last inspection.

Enforcement: We have identified three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing, fit and proper persons employed and good governance. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: 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 also meet with the registered manager/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 return to visit in line with our re-inspection programme. If any concerning information is received, we may inspect sooner.

Cheviot Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older and younger adults living in Wooler and the immediate surrounding area. At the time of the inspection the service was providing care and support to 22 people. CQC only inspects the service being received by people provided with ‘personal care.’ Personal care involves help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. Cheviot Care Limited also provided other services such as housework and enabling, which CQC does not regulate.

At our previous inspection in December 2016, we identified three breaches of the regulations relating to safe care and treatment, staffing and good governance. An effective system to manage medicines was not in place; there was limited evidence that recent training had taken place; care records were not always detailed or available and formal documented audits to monitor the quality and safety of the service were not completed. We rated the service as requires improvement. We requested an action plan describing what actions the provider was going to take to improve. This was not provided .

The service had a registered manager in post who had been registered with the CQC since July 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 service was co-ordinated from a small office in the registered manager’s own home.

Cheviot Care Limited consisted of three full time members of staff, including the registered manager. All three were directors of the service. Two part-time staff were also employed. All staff, including the registered manager delivered care and support. People told us there were sufficient staff deployed. We accompanied the registered manager and one of the directors on visits and saw that they carried out care and support in a calm unhurried manner.

We found continuing shortfalls with the management of medicines. An effective system to manage medicines was not in place. Risks were not always assessed or documented.

People told us they felt safe with the staff who supported them. We raised a safeguarding alert regarding the management of one person’s medicines and another concern which was not related to the care and support provided by staff at Cheviot Care Limited.

Staff told us there was sufficient training and felt supported. We found that further training had been carried out. However, records were not always available to demonstrate this. In addition, an effective system was not fully in place to monitor and review staff training.

The registered manager was aware of the Mental Capacity Act (2005). She said no one using the service was subject to any restrictions placed on them by the Court of Protection.

People and relatives told us that staff were very caring. They said their privacy and dignity was respected during the delivery of personal care and support. People told us they felt involved in their care and said the service kept their relatives up to date with any issues.

We found that care records still lacked detail. This did not affect the responsiveness of staff, because people were supported by the same small group of staff who knew them very well.

There was a complaints procedure in place. No formal complaints had been received.

No formal documented checks were carried out to monitor the quality and safety of the service. The registered manager told us that one of the main issues was finding time to carry out management tasks because she was involved in care delivery.

We did not identify any major impact of these omissions and shortfalls upon people's health, safety and wellbeing. All people and the relatives with whom we spoke were very complimentary about the service and the care and support provided. However, we considered that an effective system was not fully in place to assess, monitor and review the quality and safety of the service and ensure accurate records were maintained.

We have rated the service as requires improvement at our last three inspections. At this inspection, we found that improvements had not been fully made. This meant that systems were not fully in place to ensure compliance with the regulations and achieve good outcomes for people.

We have organised a meeting with the provider to discuss our concerns, improvements needed and support that may be available.

We found two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These relate to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Cheviot Care Limited provides home support and personal care to people living within the local community in Wooler. At the time of the inspection 26 people were being provided with services, although this figure will fluctuate due to the nature of the service.

The service had a registered manager in post who had been registered with the CQC since July 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.

We found issues with the management of medicines and medicines records at the service. There were several unexplained gaps in the recording of medicines and some medicines detailed on the medicine administration records (MARs) were not complete or sufficiently detailed. Care plans to support people with their medicines were not specific and lacked detail.

The service had recruited one additional member of staff since the last inspection. Whilst there was evidence of an application and interview process the provider had failed to follow and secure references for the staff member. A Disclosure and Barring Service (DBS) check was in place. People told us they were well supported by staff and there were never any missed calls.

People told us they felt safe when receiving care. They told us they trusted the care workers who supported them and looked forward to them visiting. The registered manager told us there had been no safeguarding events in the last 12 months. Not all care records contained an up to date risk assessment.

There was limited evidence staff had received recent training or refreshing of skills. The registered manager told us the service had recently contracted with Sunderland College to provide future training. She told us supervisions and appraisals had been undertaken but documentation was not immediately available as it was being assessed as part of her own management training.

The registered manager was aware of the Mental Capacity Act (2005). She said no one using the service was subject to any restrictions placed on them by the Court of Protection. She was aware of one relative having formal Lasting Power of Attorney on behalf of a person who used the service.

People were also supported to maintain their well-being, as staff supported people to contact their general practitioner or other services, when necessary. People told us staff supported then to access sufficient meals and drinks throughout the day. Staff also supported people with shopping.

People told us they found staff caring and supportive and praised the staff highly. They said their privacy and dignity was respected during the delivery of personal care and support. People told us they felt involved in their care and said the service kept their relatives up to date with any issues.

Copies of the local authority assessment documents were available in people’s care records, although there was limited documentary evidence that the service had carried out its own assessment of needs. Daily living plans contained some highly personal and individual information to help staff to support people. However, there was a lack of detail in other areas, such as the support people required with medicines. Care plans were not always formally reviewed. Although there was evidence in staff meeting minutes that changes to people’s care needs were discussed.

The registered manager told us there had been no formal complaints within the previous 12 months. People we spoke with told us they had not raised any complaints and were happy with the service.

The registered manager told us she did not carry out any regular audits or checks on the quality of the service. She said she would check details of care records and MARs as she went around people’s homes. These checks had not identified the shortfalls found at this inspection.

Some quality questionnaires were available and were overwhelmingly positive. However, the responses were not always dated to show they were the most recent questionnaires returned.

Care records were not always securely stored and daily records of care delivery were sometimes limited and repetitive.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, good governance and staffing. You can see what action we told the provider to take at the back of the full version of the report.

We found people's needs were assessed and care was planned in line with their needs. One relative told us, 'We are very happy with the support we receive. The carers are really good and always arrive on time.' Care plans were regularly updated and contained clear information about individuals' care.

We found care workers were aware of infection control policies and procedures. All staff had completed relevant training.

We were satisfied the provider had effective recruitment systems in place to safeguard people who used the service. People told us the care workers were experienced and skilled at their jobs.

People's personal records were accurate, fit for purpose and held securely. Staff records were kept in an appropriate form.

We found people were treated with respect and were involved in making choices about their care.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Systems were in place to protect people from the risk of infection because the provider had followed appropriate guidance.

Staff were well supported by the provider and had appropriate opportunities to access training relevant to their roles.

We found people had their comments and complaints listened to and acted on, without fear they would be discriminated against for making a complaint.