Archived: Somerset Care Community (North Hampshire)

On the day of our inspection the service was providing care and support to 180 people in their homes and employed 87 staff to meet people's needs. During our inspection we spoke with the provider's community base manager, who was responsible for managing the service on a daily basis. We also spoke with the provider's operations manager, the business manager, the community customer supervisor, a community staff supervisor, two planners and 11 care workers.

We spoke with 12 people who use the service and eight relatives of people who use the service. We visited four people in their homes and spoke with eight people on the telephone.

This inspection was carried out by an adult social care inspector whose focus was to answer five key questions; Is the service safe, effective, caring, responsive and well-led? This is a summary of what we found;

Is the service safe?

We found that people who use the service were not always cared for safely. We reviewed the care plan of a person being supported at home after a period in hospital. The person was also being supported by other health professionals. We read daily notes which identified that this person had become ill and required treatment. However, we found that staff had not responded quickly having identified the deterioration in the person's health to ensure their care needs were met.

People's needs had not always been assessed and care had not always been planned and delivered in accordance with their individual care plan. Seventy two people had not had their support plans and risk assessments reviewed annually, in accordance with the provider's policy. Of these 36 people had not had their support plans and risk assessments reviewed for 18 months. This meant that the provider could not be assured that people experienced safe and appropriate care that met their needs.

We found that people had been safeguarded and were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The provider had ensured that staff handling medicines had the competency and skills needed to do this safely. We observed staff administer medication to people safely, in accordance with the provider's policy and people's medication plans.

The service ensured that people were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to domiciliary care agencies. We found the service to be meeting the requirements of the DoLS. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one. the community base manager told us they were reviewing whether any applications needed to be made in response to the recent Supreme Court judgement in relation to DoLS.

Is the service caring?

We found the service was caring. We saw that a member of care staff had worked during planned leave to support a person when there had been an urgent staffing issue.

People were supported by kind and compassionate staff, who spoke to people in a friendly, caring manner. One person recovering from a serious illness told us, 'The carers have been so kind and caring which has helped me to make such a good recovery. They are really friendly and cheerful and always make me feel better.'

We observed that staff enabled people to make their own daily living choices and to be as independent as they were able to be. This promoted people's self-esteem and gave them a sense of achievement. The care staff we spoke with enjoyed working with people they supported. One care worker told us, 'It really makes everything worthwhile when you see people out enjoying a full life rather than just laying in bed watching TV.'

Is the service effective?

The service was effective. Staff were knowledgeable about people's specific health and personal care needs and had received training to update their skills to ensure they could provide appropriate support for people with complex needs.

Staff had received training to meet the specific needs of the people. Such training included catheter care and percutaneous endoscopic gastrostomy (PEG) feeding. PEG feeding is a form of tube feeding for people who are unable to or have difficulties in swallowing.

We found that the service effectively promoted a good quality of life and placed people at the centre of all decisions regarding their care and support. Where people had been assessed as lacking the mental capacity to make a specific decision best interest meetings had been held with people who knew and understood them, which ensured their human rights were protected.

Is the service responsive?

The provider was not always responsive. Most of the people we spoke with told us that they had repeatedly asked 'the office' for rotas identifying which staff were attending and when. Although repeated requests had been made we were told that rotas rarely arrived on time.

The provider took account of complaints and comments to identify trends and improve the service. People we visited told us that they knew there was a complaints system and had a copy of it in their care file. We found that there had been twelve complaints since the last CQC inspection, which had received a swift response from the provider. This meant that the service had a system to ensure complaints and comments were handled appropriately.

Is the service well-led?

The service had not always been well-led. When staff identified that care plans and risk assessments needed to be urgently reviewed they had not been supported by the provider to prioritise and expedite this work.

The provider had effective systems in place to monitor and assess the quality of the service. We found the service had mostly operated these systems effectively, other than in relation to care plan reviews.

not in post and not managing the regulatory activities at this location at the timeof the inspection. Their name appears because they were still a registered manager on our register at the time. At the time of our visit, both the Operations Manager and another registered manager were managing the Basingstoke branch.

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We found that the service involved people in planning their care. Care plans were detailed and supported by risk assessments. People were provided with a wide range of different types of support according to their needs. People we spoke with told us that staff had discussed and explained the service and their care clearly with them.

People felt safe and the provider had procedures in place to identify any risks to the vulnerable adults supported. Staff had been trained in safeguarding.

Training was planned and was in line with industry standards. The agency had a training plan and maintained appropriate records of staff training needs and achievements.

The manager had systems to monitor the operation of the service and the views of the people being supported were sought and acted upon. People were very happy with the support they received.

Overall, records were well documented, stored and readily accessible.

Care plans included the life history of people and limited information about peoples likes and dislikes. People's care was given in accordance with their care plans. People told us that staff understood their needs and they were well cared for.

People who used the service were protected from abuse. The provider trained staff in safeguarding and all staff knew who to report any concerns to. People told us that they felt safe with the care staff they saw.

All the staff we spoke with had attended an interview process and appropriate pre employment checks were made. We saw evidence of a comprehensive induction training. People told us that staff were competant and good at their jobs.

The manager had an effective system in place to monitor the quality of the service. We saw evidence of the quality assurance process. Staff were able to tell us about the feedback they had given and how their suggestions for improvements were acted upon.