Archived: CRG Homecare - Prescot

Updated 4 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection started on 31 October 2018. This is when we visited the registered office to speak with the registered manager and to review documentation. We made phone calls to people who used the service and spoke to service commissioners on 1 November 2018. We also requested some additional information was sent by email after the initial inspection visit.

The inspection was announced. The provider was given 48 hours’ notice as the service provides domiciliary care, and we wanted to be sure staff and people who used the service gave consent and would be available to speak with us.

The inspection was conducted by an adult social care inspector and three experts by experience with expertise of care services at home.

Before our inspection visit, we reviewed the information we held about CRG. This included looking at the notifications we had received from the provider about any incidents that may have impacted on the health, safety and welfare of people who used the service. We also looked at the Provider Information Return (PIR). This form asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. We had not requested a PIR on this occasion. Additionally, we approached local stakeholders for feedback about the service. We received one response. We used this information to help us populate our ‘planning tool’ which determines how the inspection should be carried out.

We contacted 27 people to speak about the care they received from CRG. We spoke with nine staff including the registered manager and the regional manager. We looked at the care plans belonging to 11 people and other related records. We checked the recruitment files for four staff. We also looked at other documentation associated with the running of the service.

Updated 4 December 2018

This inspection took place on 31 of October and 1 November 2018 and was announced.

We gave the service 48 hours notice of our intention to inspect, as the service provides domiciliary care, and managers and staff are often working in the community, so we wanted to be sure someone would be available to speak to us.

Castle Rock Group, known as CRG is a large domically care agency. They provide support in people’s own homes. At the time of our inspection CRG were supporting over 300 people in Merseyside.

CRG provides personal care to people living in their own houses and flats in the community as well as specialist housing. It provides a service to older adults and younger disabled adults. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks relating to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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.

People and their relatives told us that they received a safe service from CRG.

The service had processes in place to ensure that people were safeguarded against potential or actual harm. There was a safeguarding policy in place which included details from each of the local authorities safeguarding reporting processes.

Staff were recruited safely to enable them to work with vulnerable people. We saw that each staff member had been subject to a disclosure and barring service (DBS) check.

Medication was well managed and administered safely to people in their homes. We saw that people’s needs in relation to medication were assessed at the start of the care package which determined what level of support they required from CRG. People who required support with medication had a medication administration record in place which was completed accurately and in full by staff.

There was enough staff employed by the service to provide safe and consistent staffing numbers. People we spoke with told us the staff arrived on time and were rarely late.

There was an electronic call monitoring system (ECM) in place. Staff members had a smartphone, which they would use to electronically ‘log in and out’ of people’s homes once they had completed all care tasks as required.

Incidents and accidents were well documented and analysed to ensure that appropriate action had been taken. We saw the number of incidents per month was documented and there was a description of the type of incident and what action would be taken to prevent this from reoccurring.

There were robust risk assessments in place for each area of care which were regularly reviewed and met the needs of the person. Records we viewed evidenced that risks had been assessed at the time the care package commenced and as an ongoing monthly action.

Staff had the right skills and training to enable them to complete their roles effectively. The training matrix showed that most of the staff had undergone mandatory training. We queried the gaps in the training matrix, as some staff were showing as being ‘red’ which meant training had expired. The registered manager explained that some of the staff had left or were on long term sick or maternity leave.

Staff completed an induction before they started working at the service.

Staff were regularly supervised and received an annual appraisal. Our conversations with staff confirmed that they regularly met with their line manager to engage in one on one discussions. We checked the supervision schedule in place and saw that each staff member had a supervision every other month in line with the registered providers policy.

The service was working within the principles of the Mental Capacity Act 2005 (MCA).

People’s capacity was assessed at the time the care package commenced and their ability with regards to decision making was clearly recorded in their care plans. We saw that most people had capacity to consent to their own care and treatment.

People we spoke with told us they were always encouraged by staff to make their choices and decisions and the care plans we viewed had adopted this culture.

Initial assessments took place when new care packages commenced with CRG which considered people’s individual outcomes and what they wanted from their care.

Each person had a care plan which described their preferences for food and drink. This included where in the house they sat to eat their food and what foods they liked and did not like.

Medical advice and attention was sought when people required this type of intervention. Everyone we spoke with said the staff would always call the GP or District Nurses for them if they required.

The service delivered caring and compassionate care in line with people’s preferences.

The service involved people in decision making about their care and support. Care plans we viewed had been signed by the person themselves or by their relative if they were legally allowed to do this.

Everyone we spoke with said that they were treated with dignity and respect by staff.

People received care which was responsive and personalised to meet their needs. Care plans we viewed were based around the needs of the person and not the organisation, this is often referred to as person centred.

People’s equality and diversity needs were respected and catered for.

Information was available for people in alternative formats. We saw copies of care plans and polices which could be provided in different formats when requested to support people’s understanding.

Complaints were handled and responded to appropriately. The registered provider had a complaints policy which contained details of how to raise a complaint and how the complaint would be dealt with including timescales for completion.

There was training in place around end of life care. Staff knew the process of how to care for someone who was on an end of life pathway.

People confirmed the managers were friendly and approachable.

The service undertook three monthly telephone surveys with people to ensure they were happy with their support.

The vision and culture of the organisation was clear. All the organisations promotion material was strap lined with the vision and mission statements of CRG.

There were robust governance framework arrangements in place which highlighted areas of underperformance and produced detailed action plans for areas of improvement.

Other innovative ideas had been trialed and were now successful within the service. Such as male and female welcome home baskets.

The service worked in partnership with the local authority and various other fundraising organisations.

There were policies and procedures in place and staff knew their roles within them. Polices were available for staff in the office and via the company’s secure intranet site.

The registered manager knew what was expected of them and their roles and responsibilities regarding reporting any information to CQC. We discussed this with the registered manager during our inspection.