Archived: Age UK Dover Community Support

Age UK Dover Community Support is registered to provide personal care to people living in their own homes in the community. The support hours varied from half hourly calls upwards and ranged from one to three calls a day. The service office is based in the local Age UK day centre in Dover. They offer care in the Dover, Deal, Sandwich and surrounding areas, and support a wide range of people, including, older people and people living with dementia. At the time of this inspection there were 46 people receiving support with their personal care.

The service is run by a registered manager, who was present at the inspection visit. 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 and associated Regulations about how the service is run. The registered manager had overall responsibility for this service, as well as being the Chief Officer for the Age UK local branch. The registered manager was being supported by a consultant, two care co-ordinators in the office and a care assessor.

We last inspected Age UK in January 2015 when four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. The service was then rated ‘Requires Improvement’. The provider sent us an action plan telling us what they would do to meet the requirements of the regulations. At this inspection we followed up on four previous breaches of regulations. Two breaches had been met with two breaches of regulations only partially met and one additional breach was found at this inspection.

At the previous inspection in January 2015 the provider had not ensured that sufficient guidance was in place for staff to follow to show how risks were managed. There was a risk of people not receiving their medicines safely or as prescribed. People were not receiving care from staff that had the training, regular supervision and appraisal to carry out their roles effectively.

Risks associated with people's care had been identified, and detailed guidance was in place to ensure that people were supported as safely as possible. Some people could display behaviours that challenged due to their anxieties and detailed risk assessments were in place to guide staff to the strategies to adopt to positively support people when this occurred.

Although some improvements had been made to the systems in place to administer medicines safely there were still areas which remained unresolved. Staff were not recording individual medicines accurately and completing records properly. One staff member was administering medicines without any training or competency assessment to confirm they had the skills and competencies to give people their medicines safely.

The registered manager was carrying out audits on the quality of the service every three months; however these were not fully effective as the checks had not identified the shortfalls found at this inspection.

Staff had not been recruited safely, as the required checks had not been completed to ensure they were suitable to work with people. There was enough staff employed to give people the care and support they needed. New referrals were not being taken until new staff had been recruited. The registered manager told us that there was an ongoing recruitment drive to maintain staffing levels and improve the continuity of the service.

Staff training was up to date and there was a system in place to alert managers when staff needed training or further updates. New staff had induction training, which included shadowing experienced staff. Staff were supported by senior staff through regular one to one meetings and ‘spot checks’ to assess their skills and competencies to carry out their role. Each member of staff had received as appraisal to give them an opportunity to discuss their training and development needs.

Staff had received mental capacity training and ensured people were supported to make decisions. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. Deprivation of Liberty Safeguards (DoLs) provides a process by which a person can be deprived of their liberty, in a care home or hospital, when they do not have the capacity to make certain decisions and there is no other way to look after the person safely. However, in domiciliary care these safeguards are only available through the Court of Protection. At the time of the inspection no one was subject to an order of the Court of Protection.

People were supported to make their own decisions and they told us their consent was gained at each visit. People and relatives had also signed and agreed with the care to be provided as part of their care plan.

People told us they felt safe when staff carried out their visits. Staff had received safeguarding training and were aware of how to recognise and report safeguarding concerns.

People were supported to maintain good health and appropriate arrangements were in place to monitor people’s health care needs. Care plans were person centred and detailed with personalised information staff needed to make sure people received the care they needed. The plans included comprehensive details of people’s preferred routines, their wishes and preferences, skills and abilities. People told us that they chose what they wanted to eat and were supported by staff to prepare their meals.

Staff supported people to go out and encouraged them to use local community facilities such as the Age UK day centre. They told us there were lots of people who visited the day centre and they enjoyed the social activities provided.

The provider had a complaints policy and process. Complaints were managed effectively and responded to appropriately, in a timely manner and in line with the policy. People and their relatives told us they would speak with the registered manager or staff if they had a concern and they would be listened to.

Some people had equipment in place to aid their mobility, such as bathing aids. Staff ensured that equipment that was kept in people’s homes was checked regularly and safe to use.

There was a business continuity plan in the case of an emergency, such as fire, flood or the breakdown of the technical systems at the agency office. There were on-call arrangements in place, which people and staff could access if they needed support outside of office hours.

People told us their regular carers were very kind and caring. They said their privacy and dignity were protected and they were encouraged to be as independent as they were able. Staff knew people’s daily routines and were polite and respectful, when talking about people they were supporting.

People told us that staff mostly arrived on time, stayed for the duration of the call, and always stayed longer if they needed more time. People received a rota of staff to confirm who was completing their visits and had never experienced missed calls.

Staff understood the visions and values of the service and they also understood the ethos of the service by treating people as individuals, with compassion, and with dignity and respect. Improvements had been made to ensure people were not protected against the risk of unsafe and inappropriate care arising from the lack of proper records.

We found a number of breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

Age UK Dover Community Support are registered to provide personal care to people living in their own homes in the community. The support hours varied from one to three calls a day. The service office is based in the local Age UK day centre in Dover. They offer care in the Dover, Deal, Sandwich and surrounding areas, and support a wide range of people, including, older people and people living with dementia. At the time of this inspection there were 65 people receiving support with their personal care.

The registered manager was new and had only been in post since August 2015. 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 and associated Regulations about how the service is run. The registered manager had overall responsibility for this service, as well as being the Chief Officer for the Age UK local branch. The care co-ordinators in the office and care assessor were also new in post. The registered manager told us that they were aware that improvements needed to be made in the service and were in the process of implementing action plans in some areas to address the issues.

The majority of risks associated with people’s care had been identified, but there was lack of risk assessments regarding bathing and showering. The guidance in the risk assessments for staff to follow was not always clear to ensure that people were being supported as safely as possible. Some people could display negative behaviours due to their anxieties but there were no risk assessments in place to guide staff to the strategies to adopt to positively support people when this occurred.

Care plans were being reviewed and were up to date, however they did not have all of the personalised information staff needed to make sure people received the care they needed. The plans did not always include comprehensive details of people’s preferred routines, their wishes and preferences, skills and abilities.

People told us they received their medicines when they should. However, care plans did not clearly show how medicines were being managed safely and there were shortfalls in some medicine records to confirm people had received their medicines. Not all staff had received medicine training.

People were supported to maintain good health. People told us staff were observant in spotting any concerns with their health. We observed staff checking that people’s medicines had been delivered and they also contacted doctors or community nurses when needed.

People told us that they chose what they wanted to eat and were supported by staff to prepare their meals. Some people were living with diabetes but this information was not linked to their dietary needs recorded in their nutritional care plan.

There was enough staff employed to give people the care and support that they needed. The registered manager told us that there was an ongoing recruitment drive to maintain staffing levels and improve the continuity of the service. A system of recruitment checks were in place to ensure that the staff employed to support people had the skills and experience to carry out their role. Further details of how decisions were made to employ staff who may need to be monitored were not in place to ensure they did not pose a risk to people when carrying out their calls.

The programme in place for staff to receive regular one to one meetings with a senior member of staff and the arrangements for ‘spot checks’ to be carried out on their skills and competencies, had lapsed. Staff appraisals had also not taken place to ensure that the training and development needs of all staff were being discussed and updated. This had been recognised and an action plan was in place to bring this up to date to make sure staff were caring and supporting people safely.

Not all staff training was up to date and there was a lack of accurate information to show that staff had received appropriate training in line with their role. There was no system in place to alert managers when staff needed training or further updates. New staff had induction training, which included shadowing experienced staff, until they were competent to work on their own.

Although not all staff had received their updates in safeguarding training, staff spoken with told us how to keep people safe and demonstrated a good understanding of what constituted abuse and how to report any concerns.

Some staff needed to receive updated mental capacity training to ensure that they had understood the current guidance to support people to make decisions, and consent to care and support. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time.

Deprivation of Liberty Safeguards (DoLs) provides a process by which a person can be deprived of their liberty, in a care home or hospital, when they do not have the capacity to make certain decisions and there is no other way to look after the person safely. However in domiciliary care these safeguards are only available through the Court of Protection. At the time of the inspection no one was subject to an order of the Court of Protection. People were supported to make their own decisions and they told us their consent was gained at each visit. People had also signed and agreed with the care to be provided as part of their care plan.

Some people had equipment in place to aid their mobility, such as bathing aids. Staff were aware that the equipment needed to be serviced to remain safe, but there was no system within the office to show that the equipment was being serviced according to the manufactures guidelines.

Although staff told us there had been no accidents and incidents in the last year we noted that an accident had occurred, which had not been followed through. There was a system in place to record accidents, however this system did not include a process to summarise any events to look for patterns and trends to reduce the risk of any further occurrences. There was a business continuity plan in the case of an emergency, such as fire, flood or the breakdown of the technical systems. There were on-call arrangements in place, which people and staff could access if they needed support outside of office hours.

People told us their regular carers were very kind and caring. They told us they knew their daily routines and were always polite and respectful. People we visited were relaxed with the staff and chatted to them about their care. They told us that the staff upheld their privacy and treated them with dignity at all times.

People told us that staff arrived on time, stayed for the duration of the call, and always stayed longer if they needed more time. Some people told us that they had different staff completing their calls quite often and although this did not cause them any concern they said they would prefer a better consistency of staff.

There was a system to address any complaints made, which included a complaints log, timescales to respond and details of what action had been taken to address any issues raised. People told us they knew how to complain and they had information on how to complain in their care folders in their homes. There had been no complaints during the last year.

The registered person was open and transparent and recognised that there were shortfalls in the service. They had a consultant to advise them on how to meet and sustain the required regulations.

Staff understood the visions and values of the service and they also understood the ethos of the service by treating people as individual’s, with compassion, and with dignity and respect.

There were systems in place to monitor the safety and quality of the service, and actions plans had been developed and implemented to improve the service.

We found a number of breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

We found that individual care plans were in place to make sure people were receiving the care they needed. Suitable arrangements were in place to make sure medication was managed and administered safely.

Staff we spoke with had a good knowledge of people's needs and knew how they liked their care provided. People using the service said that the staff were reliable, arrived on time and stayed the full duration of the call.

Staff recruitment records showed that new staff had been checked to make sure they were suitable to work with vulnerable people. There were systems in place to check that the service was being effectively managed. People told us that did not have any complaints but would speak to the manager if they had any concerns.