Curant Care Maidstone

Curant Care Maidstone is a domiciliary care service providing personal care to younger adults with physical disabilities and adults aged 65 and over in the Maidstone area. At the time of our inspection there were 30 people receiving a service.

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

Risk assessments were in place to provide guidance to staff on how to support people. However, risks to people's safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. Medicines management was not always safe. The provider could not be assured that people had received their medicines as prescribed.

The service was not always well-led. The provider had failed to identify issues relating to risk assessments, medicines management and mental capacity. Their quality monitoring processes had not identified issues with records that we found on inspection.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Prior to people receiving a service their needs were thoroughly assessed. However, some assessments were not robust enough to identify the complete picture of people’s needs. Oral health and medicines had not always been included in the assessment.

People and relatives had mainly positive views about the service. Comments included, “The care that my loved receives from the carers is very good”; “They are really good carers, in fact they are very good”; “They listen to what you say and will adapt to suit our needs” and “I am very happy with my care and I recommend the company.”

The provider had an up-to-date infection prevention and control (IPC) policy. Staff had completed IPC training. Staff had access to enough PPE and wore this to keep themselves and people safe.

Enough staff were deployed to keep people safe. People were supported by regular staff who they knew well. Staff were well supported by the management team. Most staff had received training relevant to their roles, however some staff required additional training in catheter care, safeguarding and diabetes to make sure they could meet people’s needs effectively.

Care plans were in place which provided a list of tasks for staff to complete. These were person centred and detailed to show new staff what all the tasks were. People and their relatives told us staff knew their needs and preferences well. They told us they had been involved with the care planning process.

People and relatives knew how to complain. The provider engaged with staff, people and their relatives. People had been contacted by the management team in regular telephone monitoring calls and via feedback surveys.

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 24 August 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been rated requires improvement for the last 2 consecutive inspections.

At this inspection we found some improvements had been made. However, the provider remained in breach of some regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

We have identified breaches in relation to risk management, medicines management, mental capacity and quality monitoring at this inspection. We have made a recommendation about training for staff.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Curant Care Maidstone is a domiciliary care service providing personal care to 43 younger adults with physical disabilities and adults aged 65 and over at the time of the inspection. When we attended the office to inspect, the service was known as Kare Plus Maidstone. Shortly after the inspection the service changed their name to Curant Care Maidstone.

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 and relatives had mixed views about the service. Some relatives shared positive experiences, and some had negative experiences. Comments included, “It’s all brilliant. Without them we would be lost”; “It is all running ok now after those problems in December”; “Very happy with the care and support” and “Carers are very thoughtful, I am so pleased with the care. One improvement though would be to notify me of anything such as if a carer is held up.”

Risks to people's safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. Medicines management was poor. The provider could not be assured that people had received their medicines as prescribed.

Accidents and incidents had not been appropriately recorded, this meant the provider had not taken action when accidents had occurred.

Care plans included people’s individual preferences and interests and personal history. Care plans provided information about what staff should do in each care visit to meet each person’s basic needs but did not provide enough information to meet additional needs such as catheter care, choking and diabetes. The provider was unable to demonstrate that people had received the care they were scheduled to receive.

When people’s needs had changed their assessments and support plans had not always been updated and amended to detail their current assessed needs. Support plans and supporting documentation were not always individualised and person centred. Which meant that people may receive care and support which did not meet their needs.

The service was not always well led. The provider had not carried out the appropriate checks to ensure that the quality of the service was maintained. The provider had failed to identify issues relating to risk assessment, staff recruitment, staff deployment, medicines management, recording and care planning we had identified. The provider had not always notified us of incidents relating to the service. These notifications tell us about any important events that had happened in the service.

People's views and opinions were not always listened to. People had been given opportunities to provide feedback about the service. Surveys and feedback evidenced that people had been surveyed in February 2021. The provider had not made any improvements to the service to act on people’s feedback. People and relatives told us they did not know who was running the service. The provider had not communicated with people and relatives regarding staffing changes.

Staff understood their responsibilities to protect people from abuse. Staff described what abuse meant and told us how they would respond and report if they witnessed anything untoward.

The provider had not maintained complaints records. The provider had not followed their own complaints processes when responding to complaints that had been received.

There were suitable numbers of staff on shift to meet people's needs when we inspected, however there had been issues where in recent weeks where there had been missed and late care visits. The provider had identified this and made some improvements. Staff did not always have enough time allocated to them to travel between care calls. Staff had not always been safely recruited, the provider had not ensured that each staff member had a full employment history. Pre employment checks had been carried out, such as Disclosure and Barring Service (DBS) criminal record checks and reference checks.

The provider ensured people were protected by the prevention and control of infection. Staff had access to enough personal protective equipment (PPE). The provider had not put a robust system in place to ensure all staff were regularly tested to check if they had COVID-19.

The provider and management team have put in place an action plan following the inspection to address the issues found.

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

Rating at last inspection

The last rating for this service was Good (published 17 November 2018).

Why we inspected

We received concerns in relation to staffing levels, missed care visits and moving and handling practice. As a result, we undertook a focused inspection to review Safe, Responsive and Well-led only.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires improvement. 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 Curant Care Maidstone on our website at www.cqc.org.uk.

Please see the action we have told the provider to take at the end of this report.

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.

On the day of our inspection there were 17 people using the service and everyone received the 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 they do we also take into account any wider social care provided.

This was the first inspection of this service as the service was registered with CQC on 26 September 2017. A registered manager was 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.

People were protected from abuse and avoidable harm and the provider had effective systems in place to manage this. Risks to people were identified, risk assessments were completed and kept up to date. There was enough safely recruited and suitably trained staff to meet people’s assessed needs. There was some feedback from people that calls had been late, however, staff had the time to meet people’s needs. The provider had acted on this feedback and was implementing a new electronic care system to improve the monitoring of late or missed calls. People were supported with their medicines safely and protected from the risk of infection. Accidents and incidents had been monitored and analysed; and lessons were learnt from these.

People's needs assessments were kept up to date and reflected in people's care records. There was clear guidance for staff on how to support people with their needs in the way the person wanted. People's individual protected characteristics, such as their sexuality or disability were considered during needs assessments and within peoples care plans. People were supported to live healthily and access healthcare. 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 were treated with kindness and staff were caring and respectful. The service had received positive feedback from other health professionals, relatives, staff and people. There was a person-centred culture and the managers and staff knew the people they cared for well. People and relatives were involved with their care and staff respected people's need for privacy and dignity. Confidential information was kept secure and people’s independence was promoted.

People received personalised care which was responsive to their needs. Care plans and assessments were kept up to date, were detailed and person centred and recorded what was important to the person. People were involved in their reviews, along with their relatives. People could raise any concerns or complaints they had. The complaints procedure was available to people and complaints were managed appropriately. People’s end of life wishes, where known, were recorded and reflected well in people’s care records.

People, relatives and staff were engaged in the service and the registered manager had acted on feedback received from people and their relatives. The provider had systems in place to promote continuous learning and acted to make improvements. The provider had good oversight of the quality and safety of the service and risks. Regulatory requirements were understood and managed. Records were well organised and stored safely. Staff achievements were recognised and rewarded and staff told us they received regular supervision and training. The managers and staff worked in partnership with a range of healthcare professionals to meet people’s needs. The provider and registered manager kept up to date with best practice, maintained partnerships with other local agencies and actively supported their local community.