We carried out a review of the data available to us about Creative Living Care Services on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Creative Living Care Services, you can give feedback on this service.
Creative Living Care Services is a domiciliary care agency. It provides personal care to people in their own houses or flats. At the time of the inspection there were 17 people receiving personal care.
Not everyone using Creative Living Care Services receives a regulated activity; the CQC only inspects the service being received by people provided with ‘personal care’; help with tasks in relation to personal hygiene and eating. Where people receive personal care, we also take into account any wider social care provided.
People’s experience of using this service:
People were happy with the service they received and liked the staff who they found to be kind and caring. People felt safe while receiving care and support. Management and staff had an awareness of their responsibility regarding reporting any actual or suspected abuse.
People received a consistent and reliable service, provided by staff who they were familiar with.
Risks to people’s care were assessed and reviewed in the event of changes. These assessments provided guidance for staff and involved people and family members where appropriate. Care plans were detailed, and person centred to match the individual needs of people using the service.
People were supported with their medicines as prescribed. People received the care and support they needed to ensure they received meals and assistance with their healthcare needs if this was part of their support package.
Recruitment checks were made before staff commenced working with people. New staff undertook shadowing experiences with more experienced members of staff to introduce them to people and their role. Staff received induction training and ongoing training to meet the needs of the people they supported. Staff felt supported.
Staff and management worked with other agencies and professional where required, for example people’s doctors and chemist.
People were treated with respect and dignity and could make choices about their care and support. Staff ensured people consented to care being given. Staff had knowledge about infection control procedures and used protective equipment to reduce the risk of cross infection.
People and their relatives told us any concerns or complaints made would be listened to. Staff felt well supported by the management. The provider had systems in place to monitor the service.
Rating at last inspection:
At the last comprehensive inspection, the service was rated as Requires Improvement (The last report was published 5 June 2018). Enforcement action was taken. Following this inspection, we carried out a focused inspection on the key question, “Safe” (The last report was published 21 August 2018).
At this comprehensive inspection the overall rating had improved to Good.
Why we inspected:
This was a planned inspection to look at improvements the service had made following the previous rating. At this inspection we found improvements had been made.
Follow up:
We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns, we may bring our inspection forward.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
At the previous inspection mentioned above, we found repeated concerns in respect of how the service was ensuring the risks associated with people’s care was being assessed and planned. We served a Warning Notice which told the provider what they had to put right by the 29 June 2018. On this focused inspection the team inspected the service in respect of the Warning Notice only and did not inspect whether the service was effective, caring, responsive and well-led. We also did not review the rest of the safe section.
The ratings from the previous comprehensive inspection are not affected by this inspection. Therefore, the rating for all Key Questions will remain until the next comprehensive inspection. This means the service remains requires improvement overall and in the Key Questions of being safe, effective, responsive and well-led. Caring was rated as Good.
This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It currently provides personal care to 15 older adults.
A registered manager was employed to manage the service locally. 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 improvements had been made in respect of the provider and registered manager ensuring they assessed and acted to reduce the likelihood a person could come to harm when their staff were giving personal care. The risk assessment process had been reviewed involving more people and their representative, but not everyone said this was taking place. We have recommended the provider sources reputable guidance on how to involve and record how people are active or represented in their own risk assessments.
Our full findings and the previous inspection report can be found on our website at www.cqc.org.uk.
Creative Living is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. Not everyone using Creative Living receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’. This is help with tasks related to personal hygiene, medicines where staff a role and eating. Where people do receive personal care we also take into account any wider social care provided. The service had 20 people registered to receive personal care at the time of this inspection. However, three were currently staying in residential care for respite.
We previously inspected the service on the 14 November 2016. We rated the services as Requires Improvement overall, and in the areas of being safe and well–led. There was a breach of Regulation 9 personalised care due to the concerns that staff not having sufficient travel time was impacting on people’s personal care. Regulation 12 safe care and treatment was also found to be breached because risks to people’s health and safety were not assessed, recorded. This meant staff would not have the required information available to mitigate these risks.
Following the last inspection, the provider submitted an action plan which told us how they would make improvements. They told us they would have achieved improvements by 31 March 2017.
The service has two registered managers with one being also the provider. 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. One manager had day to day management responsibility and was the one referred to throughout the report. The provider has submitted a cancellation of their registered manager status but will retain being the nominated individual.
Following this inspection we have continued to rate this service as Requires improvement.
People’s records did not include the required level of information in respect of people’s risks and personalised care. People told us they were happy with how staff kept them safe and responded to their needs. However, we heard from people they were concerned about the skills and abilities of new staff. Also, staff did not have the details on how to meet people’s health, food and hydration needs. Without this essential information staff would not know how to support people safely, and in line with their wishes and preferences.
Staff did not have the necessary information to understand people’s health and medical needs. There was no information about what staff should be aware of if a person became ill. For example, there was no information to help staff to understand when someone with diabetes was having a low or high blood sugar episode.
People were not being assessed in line with the Mental Capacity Act 2005 to ensure their ability to consent to their own care was clearly recorded. This meant people’s human rights were not being respected or promoted.
People’s medicines records were not always accurate. The service’s medicine policy was not in line with current guidance and regulations. There was no system in place to ensure staff knew a person’s current prescribed medicines. One person had an allergy to an antibiotic but this had not been recorded in their care plan. The system in respect of “as required” (PRN) medicines was not robust enough and staff were not ensuring they kept accurate records of how many tablets were taken and when. Where staff gave some PRN medicine, there was no system operating to ensure people, family and the service were all recording when PRN they had taken or given them. People’s prescribed creams were not recorded and there was no method in use to tell staff where the cream should be used and how much should be used.
People’s records showed a staff member had been “potting out” medicine and leaving this for people to take “later”. Other staff were not then identifying this practice to be incorrect. This can put people at risk of overdose and/ or having their medicines with the required gaps to meet their health needs. The registered manager took immediate action, and sent a message to all staff to cease this practice and remind them of their responsibilities.
Systems of quality assurance were not robust and the provider was not seeking to ensure they listened to people or their families using the service. For example, there were no current audits of aspects of the service and although people’s views had been last been requested in 2017, there was no evidence of what action had been taken on that which was negative.
People told us the staff were caring and treated them with respect. People felt able to say how they wanted their care given and staff listened to them. People added that their independence and ability to do things for themselves was encouraged by staff. Staff, were recruited safely and there were sufficient numbers. At times of high staff demand two handed visits could be completed by one staff member. Records showed this had been discussed with people and their family however, professional advice had not been sought to ensure this was completed as safely as possible. This had now been requested.
Records about staff training, supervision, competency checks and appraisals were not all immediately available. There were concerns raised with us about the ability and skills of new staff. We heard from the registered manager what they had in place however, we have recommended they review this to ensure people are confident in new staff member’s ability to meet their needs.
Staff understood how to identify abuse and keep people safe. People and families felt the service would act to protect them. Staff followed safe infection control practices. Protective equipment such as gloves and aprons were provided.
People felt able to raise their concerns and complaints. Staff, people and their families were positive about the registered manager who they described as “approachable”. They all stated she and the office staff were proactive in putting issues right.
We found breaches of the regulations. You can see some of the action we have told the provider to take at the back of the full version of the report. We are also considering our response in line with our enforcement policy which we will report on at a later date.
The service is required to have a registered manager and there were two registered managers 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. One of the registered managers was also the provider and nominated individual for the service. They had stepped down from the registered manager role and told us they would put in an application to cancel this officially.
Creative Living Care Services is a domiciliary care agency that provides personal care and support to people in their own homes. They support adults with a variety of disabilities and health conditions. At the time of our inspection the service was providing a service to 57 people, 37 of these were receiving support with their personal care needs. The Care Quality Commission has responsibility for regulating personal care and this was the area of the service we looked at. The number of hours of support people received varied from two hours a week up to 24 hours per day.
Risk assessments were generic in nature and not accurately reflect people’s individual needs. For example, one person had been identified as being at risk of falls but there was no assessment in place to guide staff on how they could minimise this risk.
People told us they felt safe while receiving care and support and reported that staff always respected their privacy and dignity. Comments included; “They’re more like friends coming in to help”, “I feel like I’ve known them for ages” and “They’re a pleasure to have come in.”
Visit schedules did not always include travel time between consecutive visits. This meant carers had to cut visits short in order to stay on schedule. Staff felt the lack of travel time impacted on their opportunity to spend time talking with people. No-one reported any missed visits.
The service operated safe recruitment practices and all staff had received safeguarding training. The service safeguarding policy contained details of contact numbers for staff to use if they needed to raise a safeguarding concern. Policies and procedures were provided to staff in a staff handbook.
All staff received induction training when they joined the service. Training was regularly refreshed and appropriate additional training was provided to help ensure staff remained sufficiently skilled to meet people’s individual needs. Staff supervisions and staff meetings were not taking place as regularly as planned but staff told us they were well supported. The deputy manager carried out ‘spot checks’ to observe staff working practices. The service operated an on call manager system to provide staff with any necessary guidance outside of office hours. Staff told us, “There’s always someone at the end of the phone.”
Care plans lacked detail and did not reflect people's individual needs. The care plans outlined what basic care and support people required but there was a lack of information regarding people’s preferences in how care was delivered. We have made a recommendation about developing personalised care plans.
Systems for gathering the views of people, their relatives and staff were not robust. Staff meetings were held infrequently. Surveys to gather people's views had not been circulated since mid 2015. There had been no formal analysis of the results.
The registered manager valued the staff team and was keen to develop incentives to help retain staff. Staff told us they were well supported and encouraged to develop skills and work towards additional qualifications.
The registered manager had a clear vision for the development of the service and was keen to maintain a personal approach to supporting people. Members of the management team attended regular forums held by the local authority.
We identified breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.
During the inspection on the 29 September 2014, we found that the provider had made improvements to recruitment procedures within the service.
The inspection was carried out by an adult social care inspector. During the inspection we looked at the evidence to answer one key question; is the service safe?
Creative Living Care services provided personal care and support to people within their own homes. The Registered Manager was not available on the day of the inspection. We did speak to a senior member of the staff team and looked at the recruitment records of ten staff currently working in the service.
Below is a summary of what we found.
Is the service Safe?
A senior staff member told us that since the last inspection a full review had been undertaken of the service's recruitment records and procedures.
We saw that all new staff were required to complete a full and detailed application form, which included a health declaration and employment history. Applicants were invited to attend a formal interview with the service when further questions would be asked about their skills and experience. This provided the service with information about the person's ability to work with and safeguard vulnerable adults.
We saw that the provider had sought evidence of previous conduct. All of the files we looked at included two written references, and where possible the provider had requested references from the applicant's previous employer.
The ten records we looked at provided evidence that criminal records checks had been carried out. This was to ensure that staff were suitable to work with vulnerable people. The senior staff member we spoke to told us that a criminal records check had been carried out for all staff currently working in the service.
The evidence found during this inspection confirmed that the provider had an effective recruitment and selection process, which protected people who used the service.
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well led?
Our inspection team was made up of two inspectors. This is a summary of what we found. The summary is based on speaking with eleven people who used the service, seven relatives of those who used the service, seven staff supporting them, the manager, the Registered Manager and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People we spoke with told us they were happy with the arrangements that had been made in relation to security and staff entering their homes. They told us that they felt safe while care was being delivered, comments included: 'I feel very safe when the carers come to help me' and 'safety is important to me and the carers that visit, help make me feel safe'.
Staff we spoke with had completed training in safeguarding. Staff were clear about their responsibility to report concerns and how they would do this.
Medication systems in use meant people had their medicines at the time they needed them and in a safe way. Records showed that all staff had completed medication training.
Recruitment practice was not thorough. Two staff files did not contain any evidence that a criminal record check had been carried out. This meant people may have been placed at risk of harm from staff who may be unsuitable to work with vulnerable people.
Is the service effective?
People who used the service and their relatives told us they were happy with the care they received. Comments included: 'I think the carers are great, they bring a bit of sunshine to my morning' and 'When I was unwell, they were wonderful, they helped me so much'. Staff told us they received individual verbal handovers that told them about each person's needs and how to meet them. When we spoke with staff it was evident they knew people well.
Is the service caring?
When we spoke to people who used the service, feedback about the staff was very positive. Comments Included: "the staff are lovely' ; 'they make sure I'm happy and comfortable.' and 'The carers are first class, I've been quite ill recently, they have looked after me and been marvellous.' When we spoke with staff they showed genuine compassion for the people they supported and demonstrated they knew people's needs well.
Is the service responsive?
People were assessed and information was gathered about people's needs prior to them receiving care from the service. Comments included: 'The manager is very pleasant, she came to see me, introduced herself and said if there's anything I need, I can just call her.' and 'The manager came to see me, she talked with me and listened to my thoughts, she is a very nice friendly person'.
A complaints procedure was available in people's care plan folders in their homes. People we spoke with, and their relatives, told us they knew how to raise concerns and felt able to do so. We found that where concerns had been raised, these issues had been dealt with sufficiently.
Is the service well-led?
Staff told us they had seen improvements since the previous inspection. Comments included: 'twelve months ago I would have said there was a lot I was unhappy with, but not now, I think it's really good and I enjoy my job.' and 'things have changed for the better recently, I now have my regulars, they get to know me and I get to know them, I love it and feel very supported'.
People who used the service told us they were asked about the quality of the service. People told us that their comments were listened to and acted upon. Comments included, "I've got no complaints' and 'nothing could be better'.
Staff told us they had meetings every month with the manager. Staff confirmed that their comments and suggestions were listened to and implemented. One member of staff said, 'I did not feel I had enough time to carry out all my duties in the time I had, I phoned the office, they contacted social services on my behalf and got the visit time increased, I thought this was really supportive'. This helped ensure people received a good quality service at all times.
During our visit we found significant improvements were underway to improve the care and welfare of people using Creative Living. Assessments and care plans were more detailed and person centred. Reviews were being organised and the staff we met were knowledgeable about the people they were caring for. The information we reviewed in people's homes was in date and reflected their needs.
We found improvements had also been made to the staff induction process with a new staff booklet and staff having the opportunity to shadow an existing senior carer. Many staff had completed training in core topics in the past four weeks. Staff meetings had been held to keep staff up to date with the changes being introduced. The provider was working towards providing all staff with individual supervision by the end of September 2013.
We found people had mixed views about the agency. They told us 'very nice' staff who visit, 'all staff are respectful and polite', 'couldn't get anybody better' 'honest, efficient, wonderful'. They also told us some staff were 'rude and abrasive', 'quite bullying' and 'abrupt'; 'can't promise continuity of staff' and staff were not always on time.
We found care plans and assessments were poor, and appropriate and timely action to involve health and social care professionals did not happen. This meant some people experienced poor quality care.
We found there were insufficient numbers of staff to provide care required and staff were working without induction, training, supervision and appraisals and no clear lines of accountability. This meant people were at risk of harm from unsafe care, including the management of their medicines.
We found there were no effective systems in place to check people were receiving appropriate care and their needs were being met.
We found complaints were not being responded to appropriately or action taken to ensure people were kept safe from harm.
People said they felt their care was at risk of being compromised particularly when care workers did not have an understanding of the person's health condition.
We found the daily records kept in people's homes were brief. This meant that by omission of information, it was difficult to know how care workers were following the care plan.
We found care plans were not reviewed regularly by the agency staff. This meant people's changing needs were not being monitored and appropriate changes to care being met.
One person said they felt safe with the care workers who came into their home. Three people said they would contact the person commissioning their care if they felt unsafe about any aspect of their care.
We found the provider did not did not operate effective systems for managing risk for people's health, welfare and safety.
We found people were unaware of the complaints procedure.