Archived: Notaro Homecare Limited

People’s experience of using this service: People were supported by staff who they felt were kind and caring.

Feedback was sought by the local authority contracts team however the provider had no system in place to monitor feedback from people, relatives and staff.

Staff had good relationships with regular carers who knew them well, although people, relatives and professionals all felt some improvements could be made to receiving regular staff who knew them well.

People’s care plans had risk assessments in place.

Recruitment procedures were completed before new staff began work.

Supervision, appraisals and enabling staff to undertake the care certificate required improving.

Records relating to the recording of medicines administered, cream charts and body maps and having records available to staff required improving.

The service provided a reablement service so that people could receive support to regain their independence following a fall, being unwell or a hospital admission.

People were supported by staff who demonstrated dignity and respect, however improvements could be made to not sharing personal information with other people using the service.

Care plans were personalised and contained important information relating to people’s likes and dislikes. One person required their care plan updating with their change in visit information.

Some actions had been identified through audits and an action plan was in place.

Rating at last inspection: Requires Improvement (April 2018)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we made two recommendations around handling and acting upon complaints and care planning that reflects people’s end of life wishes. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will review the report on actions the provider intends to take following the inspection. We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

This inspection was to check that improvements had been made to meet legal requirements after our unannounced focused inspection of this service on 18 and 28 September 2017.

At the November 2017 inspection we found a breach of legal requirements due to people not receiving their medicines safely. After the focused inspection, we used our enforcement powers and served a Warning Notice on the 8 November 2017. This required that the provider had to meet one legal requirement relating to medicines management by 20 November 2017.

This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Notaro Homecare Ltd on our website at www.cqc.org.uk

At this focused inspection the members of the CQC medicines team inspected the service against one of the five questions we ask about services: is the service Safe.

Notaro Homecare is a domiciliary care agency. It provides personal care to people living in their own houses in the community. At the time of the inspection the agency was supporting approximately 250 people who received personal care in their own home.

There was 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.

At the last inspection we found a breach of legal requirements as people's care plans, risk assessments and medicines administration charts were not always complete and accurate to reflect people's support needs.

At this inspection we found action had been taken to improve the management of medicines in the service and we were satisfied that the requirements of the Warning Notice had been met. We have made one recommendation relating to the sustainability of these improvements through regular policy review.

We found action was taken following shortfalls found in medicines audits undertaken in the service. When members of staff had not completed accurate records the provider had identified the shortfalls and placed the care staff on a training programme.

The provider carried out an assessment of competence for all new members of care staff so that all new members of staff were competent at administering medicines.

The provider’s medicines policies and procedures were not always up to date and required a review following actions identified on the action plan.

Notaro Homecare is a domiciliary care agency. It provides personal care to people living in their own houses in the community. At the time of the inspection the agency was supporting approximately 250 people who received personal care in their own home.

There was a registered manager in post 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.

We carried out a responsive inspection due to concerns we had received about the service. The provider had taken a number of additional care packages at very short notice and this had impacted on the service delivered to people. Concerns included various complaints about missed and late visits, missed medicines, not receiving a rota or knowing what care worker was visiting. We inspected the service against two of the five questions we ask about services: is the service safe and well led.

We undertook our last full comprehensive inspection in April 2017. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

People were experiencing missed and late visits. This included not receiving support with their personal care, meals and medicines.

The provider was not ensuring their registration was accurate following the agency moving offices. Following the inspection we issued a letter and the provider submitted an application which was being processed.

People were not always familiar with staff supporting them and people felt their choice was not always taken into account.

People’s care plans, risk assessments and medicines administration charts were not always complete and accurate to reflect people’s support needs.

The provider was currently experiencing shortfalls with staff and was using agency to support this shortfall.

The provider had experienced IT and phone line problems this had affected the running of the service. We had not received these notifications without prompting their action.

The provider’s complaints procedure was out of date and did not ensure people were familiar with the complaint procedure and who to go to.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are considering the action we are taking and will produce a further report.

This service is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to adults over the age of 18 year old. We only looked at the service for people receiving personal care during this inspection as this is the service that is registered with the Care Quality Commission. Personal care included; assistance with bathing, dressing, meals and medicines. At the time of the inspection the agency was supporting approximately 170 people who received personal care in their own home.

There was a registered manager in post 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 provider at the time of the inspection was not following the conditions on their registration. This was because the service was running two offices. Following the inspection the provider moved the ‘live in care service office’ back to the main office. The provider's statement of purpose required additional information relating to the live in care service. The registered manager confirmed they would action this.

People felt safe and felt supported by staff who they knew. Care workers knew how to identify abuse and knew who to go to should they suspect abuse. People were supported by staff who had pre-employment checks in place prior to starting work in the service.

People were happy with how staff administered their medicines and staff had received training to enable them to administer medicines safely. Records relating to medicines needed improving as there was no guidelines for staff to follow with where creams should be administered and where. The registered manager took action during the inspection and a new chart was implemented.

There were suitable staffing arrangements in place to ensure people’s needs were met. The service identified risks to people’s safety and had risk assessments in place to reduce the risk. Incidents and accidents were well managed to prevent similar incidents from occurring again. People felt supported by staff who knew them well and who would call for medical attention should they require it.

People and relatives felt positive about the caring attitudes of the care staff. All confirmed they were happy and that staff treated them with kindness, respect and with dignity. People and relatives felt there was a good standard of care and all were happy with the service. Staff enjoyed working for the agency and were positive about the support they received from the service and management.

People’s care and support was planned in partnership with them and regular reviews were undertaken. Care workers had a consistent rota that provided people with continuity of care staff. Most people received a copy of their rota for the coming week.

People were supported by staff who received training in order that they could carry out their roles and additional training relating to people’s individual needs was provided. Staff had supervisions and spot checks on their work and all staff felt well supported and happy in their roles. There was a positive culture that was person-centred and that aimed to provide people with good care. People had their feedback sought and all were complimentary about the care workers. The service had a complaints procedure in place.

Quality assurance systems were identifying shortfalls and the registered manager took action when required. The service was notifying us when required.