Selective Care

• Selective Care is a home care service. At the time of the inspection the service was supporting 76 people in their own home. People supported included older people, people with a learning disability and people living with dementia.

• For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk.

People’s experience of using this service:

• People and their families gave us positive feedback about all aspects of the service they received.

• Comments included “quite happy with the service” and, “They give me all that I need. They are top rate.”

• Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well-led to at least good.

• At this inspection we found the provider had made the required improvements to people’s care records and to their processes for notifying us of certain events. There were no longer any breaches of regulations.

• People received a service that was safe. The provider had processes to manage medicines safely and protect people from risks.

• People received care and support from staff whose training made sure they had the right skills and knowledge. People’s care and support led to good outcomes.

• Care workers had developed good relationships with people they supported. They respected people’s dignity and privacy, and promoted their independence.

• People’s care and support met their needs and reflected their preferences.

• Management processes were in place to monitor and improve the quality of the service. There was a positive, open and empowering culture.

Rating at last inspection:

• At our last inspection (published 1 February 2018) we rated the service requires improvement.

Why we inspected:

• This was a planned inspection based on the date of and rating at the last inspection. At the last inspection we found breaches of three regulations. The provider sent us an action plan with dates when they planned to be compliant with those regulations. At this inspection we checked that they had made and sustained those improvements.

Follow up:

• We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.

Selective Care provides personal care services for people living in their own homes. At the time of our inspection there were 53 people receiving personal care and support. These included people with complex needs.

This was the first time Selective Care has been rated requires improvement.

There was a registered manager 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.

The provider’s arrangements to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse, were not always recorded completely and care plans did not always contain information about how to manage and reduce risks. Care plans were not kept up to date and did not contain all the information needed to ensure people were supported in line with their needs and preferences.

The provider had not always notified us about safeguarding concerns or changes to the management of the service. Actions identified in quality assurance processes were not always followed up in a robust manner. There was insufficient adult social care expertise in the provider's organisation to support the registered manager.

Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. There were arrangements in place to manage medicines safely.

Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. The registered manager was aware of the legal protections in place to protect people who lacked mental capacity to make decisions about their care and support. Where required, people were supported to eat and drink enough to maintain their health and welfare, and had access healthcare services, such as GPs and specialist nurses.

Care workers had developed caring relationships with the people they supported. People were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s independence, privacy, and dignity.

People who used the service were satisfied they received care and support according to their needs and preferences. There had been no recent formal complaints.

The service had an open, empowering culture for both staff and people who used the service. Systems were in place to make sure the service was managed efficiently and to monitor, assess and improve the quality of service provided, but these were not always operated effectively.

We identified three breaches of regulations. You can see what action we told the provider to take at the end of the full version of this report.

We considered all the evidence we had gathered under the outcomes we inspected. We spoke with 20 people who use the service, eight staff, the manager and two directors from the company. This was a responsive inspection as we had received some concerns about the care and welfare of people and staffing. During this inspection we looked at outcomes relating to the care and welfare of people, safeguarding, medicines, staffing and the quality assurance processes.

This is a summary of what we found-.

Is the service safe?

We found prior to people receiving care, an assessment of their needs was completed. As part of their initial assessment, risk pertaining to people's homes was also considered. People we spoke with were satisfied with the care and support they were receiving. Comments included 'I have complete confidence that I'm safe with my carers and yes they are respectful of my home and things I have too.'

Staff were supported and had received training to enable them to carry out their role. Staff told us they had adequate time to provide care. People told us they 'usually' had the same care staff to help them.

People were supported to receive some of their medicines in a safe way. Risk assessments were in place and records were maintained following medicines administration. However, the management of topical medicines were not adequate and may pose risks to people.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to medicines management.

Is the service effective?

The service was effective. People told us staff had the training they needed and were well informed of their care and support. We saw care plans included completed risk assessments. These were relevant to the person and identified action that was required to manage risks. A person told us when staff used the hoist this was done with 'expertise, dignity and gentleness.'

Is the service caring?

People told us they were cared for in a caring and compassionate way. Staff were aware of people's diverse needs and the support they needed. We received positive comments from people and their relatives. They were treated with care and compassion and staff respected their privacy and dignity. Other people said the staff were professional in their attitude and treated them as individuals.

Is the service responsive?

The service is responsive and took into account people's changing needs. People told us they been involved in their own or their relative's assessments and care planning. This meant their views and preferences were taken into account when providing care. Arrangements were in place to support people out of hours. People were confident that any concerns raised would be dealt with and responded to as needed. There was a process to support the staff in responding to people's needs.

Is the service well-led?

We found there was a lack of an effective system to analyse incidents, accidents and missed calls which may have a potential to cause harm. Staff told us they felt supported and could contact the office or out of hours service for advice. They said they could raise their concerns with the manager or senior staff, and they felt these would be dealt with appropriately. Systems were in place to regularly assess and monitor the quality of service provided.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to identify, assess and manage risks relating to the health, welfare and safety of service users and others.

We found that people were involved in their assessments and the way that support was provided. The care delivered was based on agreed plans, and risk assessments were in place to ensure people's safety and welfare. People using the service were protected from the risk of abuse. The service had effective recruitment procedures and the required checks were made before staff started work. There were systems to review and monitor the quality of the service provided, and complaints and comments were responded to appropriately.