Archived: Just Care (North West) Limited

Just Care is a domiciliary care agency. It provides care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection the registered provider was providing support to 77 people.

Not everyone being supported by Just Care received personal care. A small proportion of people were supported with domestic duties, accessing the community and social needs. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks relating to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was no registered manager in post at the time of the inspection. A ‘registered manager’ is a person who has registered with CQC 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 registered provider had appointed a manager in January 2017 but they had not submitted the relevant documentation to CQC.

At the last inspection in March 2016 the registered provider was awarded an overall rating of ‘Good’. However, we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe Care and Treatment). Following the inspection, we asked the registered provider to complete an action plan to tell us what changes they would make and by when. An action plan was submitted and we looked to see if the registered provider had made the necessary improvements.

During this inspection we found a number of improvements still needed to be made as the registered provider was found to be in breach of ‘Good Governance’. We are taking appropriate action to protect the people who are being supported by Just Care.

At the last inspection we found that medicine management processes in place were not safe. Recording procedures and the administration of medicines were not safely managed. During this inspection we checked to see if medicine management processes had improved. Whilst improvements had been made and the registered provider was no longer in breach of regulation in relation to ‘Safe Care and Treatment’ we found further developments were needed to this area of care provided.

Care plans and generic risk assessments were in place for each person supported. However, the risk assessments we reviewed were not tailored to the individual and records did not always contain the most up to date information. Quality assurance systems were not always effective in identifying areas of improvement which were required in relation to the quality and standard of care provided.

You can see what action we told the provider to take at the back of the full version of the report.

Staff were familiar with ‘Accident and Incident’ reporting procedures. There was an up to date ‘Accident Reporting’ policy in place although we identified that incidents involving medication were not routinely monitored. New documentation was implemented by the end of the inspection to ensure that all incidents involving medication were recorded and risk was mitigated.

Staff and managers expressed that they had recently experienced some problems with staffing levels. However, staff and people we spoke with expressed that staffing levels were well managed and people received a safe level of support they required.

Recruitment processes were safe. All staff had suitable references, the relevant applications had been completed, previous employment history had been established and disclosure and barring system checks (DBS) were in place.

Staff were knowledgeable in the area of safeguarding and whistleblowing procedures; staff knew how to report any concerns and who to report their concerns to. Staff had also received the necessary safeguarding training which meant that people were protected from harm and abuse.

Health and safety policies and procedures were in place. Staff were provided with personal protective equipment (PPE) and they were aware of the different infection prevention control procedures which needed to be complied with.

During the inspection we checked to see if the registered provider was complying with the principles of the Mental Capacity Act, (MCA) 2005. People’s ability to make decisions about the care they received was considered in line with principles of the MCA. However, we did identify that ‘consent’ to care documentation needed to be reviewed and updated.

Staff were supported and encouraged to develop their skills and abilities. Staff received regular supervisions and annual appraisals. There was also a robust induction package in place and staff received regular training and annual re-fresher training accordingly.

The day to day support needs of people was safely and effectively managed. We saw evidence of support provided by external healthcare professionals such as GP, district nurses, occupational therapists and dieticians. People received a holistic level of care which supported their overall health and well-being.

People’s nutrition and hydration support needs were effectively supported, measures were in place to mitigate risk and appropriate referrals were made to external healthcare professionals.

People expressed that they were treated with dignified and respectful care. People said that staff were compassionate, kind and provided warm and considerate care. Relatives also expressed that they always observed staff providing a high standard of care.

A person-centred approach to care was evident. Care records contained specific information about the people who were supported and staff expressed that they were able to familiarise themselves with the person’s preferences, likes/dislikes and daily routines.

There was a complaints policy and procedure in place. Complaints were responded to in line with the registered providers policy. People knew how to raise any concerns and were provided with the complaints process from the outset. People explained that if they did have any complaints or concerns they could confidently speak to staff or managers.

The registered provider had systems in place to gather feedback regarding the provision of care provided. People and relatives were encouraged to share their views regarding the quality and standard of care. This was done through annual questionnaires, care reviews and staff observations.

The registered provider had a variety of different policies and procedures in place. Policies were up to date and contained relevant information. Staff explained where polices could be accessed and the importance of following the guidance provided. Some of the policies we reviewed included medication administration, infection prevention control, safeguarding adults, equal opportunities and confidentiality.

There was a culture of warmth, kindness and compassion. Staff expressed that they felt supported by the managers and believed there was always an ‘open door’ policy operated. Staff explained that the managers and staff worked together as a team for the benefit of the people they were providing care for.

The registered provider was aware of their regulatory responsibilities and understood that CQC needed to be notified of events and incidents that occurred in accordance with the CQC’s statutory notifications procedures.

Just Care is a domiciliary care agency situated in Runcorn Old Town that provides care and support to a range of people in their own homes. The range of support includes assistance with personal care, domestic duties, shopping and meal preparation.

At our previous inspection in November 2013 we found that the provider was meeting the regulations in relation to the outcomes we inspected.

At the time of our inspection there were 61 people using the service, with a variety of care needs, including people living with dementia.

The service has a registered manager. 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.

During this inspection we found one breach of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were ineffective systems in place for the safe management of medicines. You can see that action we told the provider to take at the back of the full version of this report.

The manager was available throughout the inspection and engaged positively with the inspection process. The manager was friendly and approachable; she operated an open door policy for people using the service and staff.

Throughout the inspection we consulted people who used the service. We also spoke with staff from the service and obtained the views of four health and social care professionals who had contact with the service. Feedback was positive and people said they had no concerns about the care they received or the staff who provided it. People told us that staff were caring and treated people with dignity and respect. They told us that the service provided was excellent. They said they had complete trust in the staff and felt safe when they were around.

Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe whilst allowing people to develop and maintain their independence.

People were supported by a stable and consistent staff team who knew people well and had received training specific to their needs.

People had support plans in place but they did not identify clear details of medicines required and the medicine administration records (MAR) contained conflicting information.

Staff told us they enjoyed their work and were well supported through supervision, appraisals and training.

The registered manager spoke highly of the staff describing them as committed and enthusiastic in their approach to their work.

Staff had high expectations for people and were positive in their attitude to supporting them. They were respectful of the fact that they were working in people’s homes. The service offered flexible support to people in order to meet their needs.

The management team had a clear set of values which were apparent throughout our visit. People who used the service told us that the service was excellent, well organised and effective. Staff told us they felt valued and empowered. They said the management team were supportive and the service was very well managed.

We found that care was provided by sufficient staff, however we noted that the agency was carrying out a recruitment drive to add to the current staffing numbers so they could have a more flexible approach to staff working hours

The relationships we saw between staff and people who used the service were most positive. Staff members had developed good relationships with people who used the service and care plans clearly identified people’s needs, which ensured people received the care they wanted in the way they preferred.

Staff knew about the need to safeguard people and were provided with the right information they needed to do this. They knew what to do if they had a concern.

We met with the registered manager and examined nine staff files which held details of staff recruitment and training.

We were able to identify that Just Care had provided staff with robust training and support and we found that the appropriate checks had been made to ensure that staff were suitable to work with vulnerable adults.

We spoke with the provider, registered manager, care co-ordinator, four care staff, service commissioners and eleven people who used the service. We encouraged people to communicate their thoughts about the service using their preferred methods of communication.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, agency staff, service commissioners and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Training events had been arranged by the registered provider to include the provision of guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

The provider had developed guidance on recruitment and selection to provide information to staff on the procedures for recruiting new employees. We looked at a sample of recruitment records for three staff. Examination of records and / or discussion with staff confirmed staff had undergone a comprehensive recruitment process prior to commencing work with the provider. This process ensured that staff had undergone relevant health and safety checks and had been provided with induction training prior to them undertaking any care practices within the community. Staff said this enabled them to carry out their role safely, effectively and competently.

Records also showed that the provider had developed clear polices and procedures to provide staff with supervision and support. We looked at a sample of personnel records for three staff. These confirmed that staff had been provided with training, guidance and support to enable them to carry out safe care practices.

Is the service effective?

We spoke to eleven people who used the service. Comments received included; "I couldn't do without them really. They are brilliant. Excellent service, lovely people, always on time. They provide services which are over and beyond my expectations. X is the most important person in my life and they provide such excellent, appropriate needs led care for him, I cannot thank them enough". One relative spoken with said: "We were very careful about choosing the right service for Y. We did our research and are so glad to have chosen them. They treat Y really well and are responsive to any of our requirements. Staff came out to see us just before the package started to make sure everything was in place and have made sure Y has the personalised care and support required."

Records highlighted that people were encouraged to give feedback about the service and any complaints had been listened to and acted upon. No complaints or allegations were received from people using the service or their representatives during our inspection.

Is the service caring?

As part of our inspection we asked people if they were happy with the care they received and were in agreement with their care package. One person told us; "Yes I agree with the care I get. If I wasn't I would say something. I am very appreciative of my care. I remember signing a form to confirm it was what I wanted".

The eleven people spoken with who were supported by the service told us they were more than happy with the way they or their loved ones were looked after. All feedback received was positive and confirmed the service was responsive and caring to the needs of the people using the service.

We received comments such as: "Staff are good reliable people who treat us well". A relative of a person who used the service told us that staff were "Kind and most helpful and their input certainly enhanced the life of the person they supported."

Is the service responsive?

Records viewed highlighted that the provider is committed to the inclusion of people in the development and operation of the service. For example, the provider had responded to peoples changing needs and had updated care plans and updated call monitoring systems to ensure that all care and support provided was centred around the needs and wishes of the person who used the service.

Is the service well- led?

The provider has worked well with the Care Quality Commission and was aware of the need to keep us updated on any significant events via statutory notifications.

The service continued to utilise a comprehensive internal quality assurance system and had developed systems to involve and obtain feedback from people using the service and / or their representatives.

Comments received from a service commissioning team were positive about the leadership and effective management of the service.

Their comments were mainly very positive and they used words to describe the service such as ''the staff are very good and I am happy with them'', ''the staff are respectful'' and ''I can't fault them at all''.

Everyone spoken with knew how to access staff and the manager. There was a client information pack provided to people who used the service. However, not all of the people we spoke to had received one and the document was needing to be updated to include the contact details of the local authority and the Care Quality Commission.

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