Archived: Coastal Carers

Coastal Carers is a domiciliary care agency which is registered with the Care Quality Commission (CQC) to provide regulated activities of personal care to people living with dementia, mental health, older people, physical disability and sensory impairment in their own homes. At the time of the inspection, regulated activity was provided to 36 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People told us they felt safe with the staff who supported them. Staff were clear on types of abuse to look out for and how to raise any concerns they may have. Processes were in place ensured any incidents were routinely investigated with outcomes and actions implemented to help keep people safe.

Risks associated with people's care were assessed and recorded with information for staff to follow to provide safe care and support. Staff had good access to personal protective equipment to manage the risks associated with the spread of infection including CVOID-19 and adhered to government guidance to protect people.

Where people required support to take their medicines, this was done safely as prescribed with appropriate record keeping checked for accuracy.

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

People received appropriate induction, training, professional development, supervision and appraisal as necessary to enable and support them to carry out the duties they were employed to perform.

Management completed a range of audits and checks to maintain standards of service. Provider oversight supported the sharing of best practice for the benefit of individuals who were supported.

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

The last rating for this service was requires improvement (published 2 January 2020 and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At our last inspection we recommended that the provider reviewed and followed medicines best practice guidance. At this inspection we found the provider had acted on our recommendations and had made improvements.

Why we inspected

We undertook this focused inspection to check the service had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Coastal Carers on our website at www.cqc.org.uk.

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.

Coastal Carers is a domiciliary care service providing personal care to people across Scarborough and the surrounding area. The service was supporting 46 people at the time of our inspection including those living with dementia, learning disabilities and/or autism, physical disability and older people.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The provider’s quality assurance systems were not effective in identifying areas requiring improvement across the service. This led to shortfalls in records not being addressed. The provider took action following our feedback. New systems and processes introduced during the inspection had yet to be embedded.

People received support from regular care workers, who understood their care and support need and provided effective care. The provider did not have up to date training records in place to identify staff training requirements and when staff were due for refresher training.

People felt safe with their care staff. We found gaps in medicines records. This put people at risk of not receiving their medicines given as prescribed. We have made a recommendation about the management of some medicines.

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

Care was provided in dignified, respectful ways. People’s emotional needs were understood by staff and were well supported. Staff were committed to helping people to maintain their independence and live in their own homes.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities to gain new skills and become more independent.

Care was organised around people’s wishes and preferred routines. Staff encouraged people to pursue their interests and encouraged them to participate in community activities.

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

Rating at last inspection

At the last rating for this service was requires improvement (published 19 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staff training and support and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Coastal Carers provides care for people living in the Scarborough and outlying areas including Cloughton, Snainton and Hunmanby. At the time our inspection 46 people were being supported by the service. Care visits were provided between 07:30- 21:30.

The service was run by a single provider in day to day control of the service. It was therefore not required to have a registered manager. The provider is an individual ‘registered person’. 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. The provider was supported to run and lead the service by two assistant managers.

At the last comprehensive inspection in May 2016 the service was rated good overall with requires improvement for the safe domain. At this inspection we found the service had not maintained this standard and rated it requires improvement. This is the first time the service has been rated requires improvement.

The provider had not submitted statutory notifications to the commission to notify us of the deaths of people using the service. This has been reviewed outside of the inspection process and is not being pursued.

The service supported people with medicines. Medication competencies were not in place to assess the ability of staff to deliver this care safely. On day two of the inspection we saw the assistant manager had added medication observations to the spot check form and had observed some staff providing this care.

Staff received training to provide them with the knowledge and skills required for their role. The service did not have any set mandatory training courses. We made a recommendation about training requirements.

Care documentation was not always in place. Where a person could present with behaviours that could challenge the service there was no positive behaviour support plan to help staff provide safe, consistent care to the person. Staff knew people’s life histories but this was not always recorded in people’s care files.

Care visits were provided at people’s chosen times and took into account any preferences they had for staff. The service was responsive when changes were made to people’s care arrangements due to changes in their needs or circumstances.

The service worked effectively as a team in partnership with people, their relatives and other organisations. Information was communicated within the staff team. Memos sent out to staff and team meetings were used to remind staff of best practice and discuss people’s needs. Staff knew when to contact health professionals if there were concerns about people’s health.

Representatives from the service attended multi- agency meetings such as safeguarding meetings and risk management meetings.

Staff built good, professional relationships with people. They understood their interests and supported them to participate in activities of their choice. Staff helped people maintain relationships with their family members.

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

Staff promoted people’s independence and encouraged them to use and maintain their skills. People and their relatives appreciated this support was vital to enabling people to remain living in their own homes.

People received support to ensure they had a balanced diet and received a satisfactory nutritional intake.

Quality standards were monitored within the service through the use of spot checks and audits. People and their relatives were sent questionnaires six- monthly to consider their views of the service. Senior members of staff provided care to people in the community, which gave people the opportunity to highlight any issues through face to face contact.

A complaints procedure was in place and had been used effectively to address one complaint.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Coastal Carers on our website at www.cqc.org.uk.

Coastal Carers provides a domiciliary care service offering support and personal care to adults who live in their own homes in Scarborough and surrounding area. On the day of inspection they were providing a service to 76 people.

There was a registered manager in place. 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.

At this focused inspection we found that action had been carried out to improve the safety of staff recruitment. We examined recruitment records of the staff who had been employed since the last inspection. The registered manager ensured that they received information from the Disclosure and Barring Service (DBS) confirming that a full check had been carried out before permitting staff to begin their induction. The DBS check assists registered providers to make safer recruitment decisions by checking that prospective care workers are not barred from working with people who need social care support. This meant the registered provider now met legal requirements.

We have not improved the rating for safe from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Coastal Carers provides a domiciliary care service offering support and personal care to 76 adults who live in their own homes.

There was a registered manager in post at this service. 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.

Recruitment processes were not safe at this service and staff had started work before checks were completed to ensure they were suitable to work with people in their own homes. The provider had not followed robust processes to gather appropriate information about people they employed. You can see what action we told the provider to take at the back of the full version of the report.

Staff received training that was relevant to their roles. There were sufficient staff employed to meet people’s needs. They were supported through regular supervision with senior staff.

Care plans were detailed, had associated risk assessments in place and people were involved in their content and review. Medicines were managed safely and we found there had been a reduction in medication errors.

People who use the service were encouraged by staff to live as independently as possible and people told us they felt they were treated with dignity and respect. People told us the staff approach was caring and made positive comments about the care they received.

The service was led by a registered manager and team of supervisors who had experience of working with people and held appropriate qualifications.

The registered manager had historically made appropriate notifications to CQC. However, we found an oversight relating to notifications not being made promptly and the registered manager rectified the issue immediately.

Audits were completed regularly and people who used the service were asked for their views and suggestions via questionnaires. Responses were recorded and actioned in order to maintain the quality of the service. People told us that the management team were approachable.

People who spoke with us said that they either administered their medication independently or that staff supported them in taking their medication. They told us that staff made sure that medication was taken at the correct time. We saw that the provider had worked with the North Yorkshire and Humber community support pharmacist and the local authority to make improvements to practice.

There were effective recruitment and selection processes in place. When we spoke with people who used the service one person told us that staff were,"Excellent",another said "They are well trained and do everything I ask" and a third said," I think staff are pretty well trained.The majority are caring and careful".Staff received appropriate professional development.

Most of the staff had completed training in Manual handling,safe administration of medicines,food hygiene,fire safety, infection control,health and safety,safeguarding,deprivation of liberty,dementia awareness and first aid during the current year.

We found that the service had worked hard to develop a robust quality assurance system for monitoring and assessing the service.

One person had said," I have found no faults with anyone.They work hard and fill their time.All the staff are very pleasant and friendly".

People who used the service were potentially at risk of not receiving their medicines as prescribed as we found a lack of appropriate arrangements in place with regard to the management of medicines.

People who used the service were potentially at risk of receiving care from staff who were not considered suitable to work with vulnerable people as effective recruitment procedures and checks had not been undertaken before staff began work.

People who used the service were potentially at risk of receiving poor care as staff did not always receive timely induction and training to enable them to deliver care and treatment safely.

We found that improvements were needed to the quality assurance system to ensure people's health, safety and care was monitored effectively and that appropriate action could be taken where necessary to make changes in the service.

We found that the provider/manager had taken on board the recommendations from the local authority visit in October 2013. We saw some evidence that action had been already taken to improve practices within the service and further action was planned.

Although we had concerns about the service, the people who used the service were very happy with the service they received. We spoke with five people who told us 'The service is marvellous', 'Excellent service', 'I always get someone when I ask for extra care', 'Very good at arranging care when I come out of hospital' and 'The staff go above and beyond my expectations.'

We found that people were consulted about their care and that the service sought people's consent to their care and treatment. We saw that the service assessed people's capacity to make decisions. When people were assessed to lack capacity and where decisions were needed about care and treatment, these made by a multidisciplinary team to ensure they were in the person's best interests.

We saw that the service assessed people's care needs and developed care plans which were reviewed with risk assessments in place. This meant that people received the care they needed.

We saw that people were protected from risk of harm through the correct recruitment practice and appropriate checks.

The service handled medication safely to protect people's health.

The service monitored the quality of its care and support through surveys and internal systems so that improvements could be identified and put in place.