Archived: CASA Liverpool

CASA Liverpool is a domiciliary care service that provides personal care and support to people living in their own homes. At the time of our inspection the service was supporting 147 people.

People’s experience of using this service:

People told us they felt safe being supported by staff and there were systems in place to safeguard people from the risk of abuse. People and their relatives said staff were usually on time and always stayed for as long as they were needed. Comments included, “[The staff] are usually spot on, only very occasionally are they late but they’re polite and let me know.”

People and their relatives told us they were involved in the assessment process and staff effectively met their needs. One person said, “I can’t fault them, they know what help I need.” People and their relatives also felt staff were well-trained. One relative told us staff had undertaken some additional training to better support the specific needs of their relative.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People, relatives and staff had developed good and caring relationships. When asked if staff were caring people commented, “Very much so, it’s like having friends call in to see I’m ok.” People and their relatives said the staff supported them to live as independently as possible at home. One person said, “[The staff] think of doing extras for me, they’re very supportive. They’ve noticed things I’m struggling with and helped.”

Care plans contained the basic information staff needed to support people safely and effectively. Care plans were regularly reviewed and people and their relatives were involved in this process. Complaints were appropriately recorded, responded to and, where necessary, acted upon. People and their relatives also told us they felt comfortable raising concerns with staff if needed.

The service had made improvements to its governance structure, along with more robust and effective quality assurance systems to monitor the quality and safety of the service. Significant improvements had also been made to the call scheduling system used at the service, ensuring that staff were able to provide people with the care they needed at the planned times.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

At the last inspection the service was rated requires improvement (report published 1 December 2018) and we found a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Care and Share Associates (CASA) Liverpool is a domiciliary care agency. At the time of our inspection it was providing personal care to 132 people living in their own homes across Liverpool. CASA was established in 2004 and now operates domiciliary care services across the North West, North East and Yorkshire.

Not everyone supported by the service received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where personal care is undertaken we also take into account any wider social care provided.

During this inspection we identified a breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is because the service had failed to adequately monitor, assess and improve the quality and safety of the service provided. You can see what action we told the provider to take at the back of the full version of the report.

The service did not have a registered manager at the time of our inspection. However, a new manager had been appointed since the previous registered manager had left the service. We noted that the new manager was in the process of registering with CQC. 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We reviewed seven staff rotas and found evidence of ‘call cramming’. This is when carers are scheduled to complete more calls than is physically possible within the timescale provided. For example, we saw that the times of carers’ calls were scheduled ‘back-to-back’ and allowed no time for carers to travel between calls, regardless of the distance between their calls. We also saw evidence on the service’s electronic records system to show that staff did not always stay for the scheduled amount of time, known as ‘call cutting’. We acknowledged that there were several reasonable explanations for some of these instances. However, there was a lack of documented evidence to support these explanations nor could they reasonably account for every instance. This potentially left people at risk of not receiving all the care and support they need at the times they need it.

We discussed these concerns with the manager who acknowledged that they were not aware of this problem and explained that this had been the historical approach to rota scheduling at the service. During the days that followed our inspection the manager provided us with evidence to demonstrate that action had been taken to resolve these issues.

The service had systems in place to protect people from abuse and staff were able to explain what actions they would take in the event of a person being at risk of harm. Records showed that safeguarding concerns were promptly and effectively managed by the manager. However, we had not always been notified of safeguarding concerns as we should have been.

Medicines management systems were in place. All staff had undertaken medicines training and had their competency regularly assessed. People told us they received their medicines correctly and on time. However, when we reviewed the service’s electronic medication administration records (MARs) we saw that there were numerous gaps where staff had failed to confirm they had given people their medication or record any reasons a medication was not given. This meant that the service could not be assured that people always received their medicines as prescribed.

We found that the service’s quality assurance and auditing processes were not always robust and effective. Overall, the service’s approach to assessing, monitoring and improving the quality and safety of the service being provided required improvement, as it lacked organisation, structure and oversight.

People we spoke with gave us positive feedback about the quality of care they received from the service. People told us they felt safe with the staff and they received care from regular staff who they had got to know well.

Staff were safely recruited at the service ensuring that only staff suitable to work with vulnerable people were employed. All new staff completed a thorough induction process, which included office-based training and completing shadow shifts at the start of their employment.

All staff were up-to-date with training relevant to their roles and the staff we spoke with gave positive feedback about training provided at the service.

Staff told us they felt well supported in their roles. We saw they were supported with regular supervision and appraisal meetings, as well as ‘spot check’ observations to monitor the quality of their work.

Staff treated people with respect and helped them to maintain their dignity. Staff also supported people with their eating and drinking needs.

Complaints were managed appropriately. We saw that the service received very few complaints but when it did they were responded to promptly and effectively.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We found that the service was working within the principles of the MCA. We saw that the service had training, policies and guidance available for staff in relation to the MCA. This meant they were working within the law to support people who may lack capacity to make their own decisions.

The care plans we reviewed were person-centred and gave staff the information that they needed to safely and effectively meet people’s needs.