Everycare Midsussex

At our last inspection we rated the service good. The key question for well-led was requires improvement. The provider was required to review how they monitored and analysed information around accidents and incidents, to determine any trends or concerns, to create learning and to make changes or improvements to the service. At this inspection we found sufficient improvements had been made. We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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 harm. Staff received training and understood how to recognise signs of abuse and who to report this to. Staffing levels were sufficient to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk, staff had access to assessments and understood the actions needed to minimise harm. The service was responsive when things went wrong, were open and reviewed practices and had a robust system in place to manage incidents. Medicines were administered and managed safely by trained and competent staff. The registered manager carried out monthly audits of Medicine Administration Records (MAR).

People and their relatives had been involved in assessments of care needs and had their choices and wishes respected, including access to healthcare when required. The service worked well with professionals such as nurses, doctors and social workers. People were supported to have maximum choice and control of their lives and the policies and systems in the service together with staff understanding, supported this practice. The registered manager actively sought to work in partnership with other organisations to improve and nurture positive outcomes for people. Care and support was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. Staff felt supported by the registered manager.

People and their relatives described the staff as caring, kind, and compassionate. People could express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected and staff understood their responsibilities in relation to this.

People had their care needs met by staff who were knowledgeable about their individual preferences. The service had an effective complaints process and people were aware of it and knew how to make a complaint. People and their relatives told us they felt confident their concerns would be addressed. The service actively encouraged feedback from people.

The service had an open and positive culture. Leadership was visible in the service and promoted inclusion. Staff spoke positively about the management team and felt supported by them. There were quality assurance and auditing processes in place and they contributed to service improvements. Action plans were carried out and those responsible kept things up to date.

Further information is in the detailed findings below.

The inspection team was made up of a single inspector and an expert by experience. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is it safe?

Without exception everyone we spoke with told us they felt safe when receiving support from the agency. The provider had systems in place to support staff how to prevent, identify and report abuse. All staff knew these systems and had received training. Staff were clear they would report concerns to the manager and these would be actioned. There was a system in place for recording of incidents and accidents and staff could describe to us how this information was used to improve the service for people.

The provider ensured all appropriate recruitment checks were undertaken before staff could start working with people.

Prior to using the service the provider carried out an assessment of people's needs. This was undertaken with the person and/or their representative. Care plans had been developed for people based on an assessment of needs, however these did not always reflect the person's current needs. Where there were identified risks associated with people's care and treatment these actions to reduce these risks or manage them if they arose had not been identified or planned for. This meant people received care which was not planned and delivered in a way that was intended to ensure people's safety and welfare.

Records held for people at the time of our visit did not always reflect their current needs. Some records could not be found at the time of our inspection visit and therefore staff could not locate these promptly. Records were not always stored securely. This meant that people may be at risk of receiving care and support that was unsafe or inappropriate to their needs.

We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by law in relation to care planning, care delivery and records.

Is it caring?

All people we spoke with expressed their satisfaction with the care they received from staff. People told us they were treated kindly and with dignity and respect by staff.

Is it responsive?

Care reviews were undertaken and where concerns were raised these were recorded. However we could not see what actions had been taken to resolve the concerns for people. People gave us mixed views about the office. One person we spoke with said when they had a problem, they had raised this and it was "soon sorted". Whereas another person told us of their concerns and said 'I have been in touch with the office but they haven't returned my call'. Staff told us they were confident issues of concern would be acted upon.

Is it effective?

The provider ensured all staff received an effective induction prior to working with people. This included a period of shadowing experienced staff as well as appropriate training.

Is it well led?

The agency had some systems in place to monitor and assess the quality of service. This included staff spot checks, supervisions and staff meetings. Five people we spoke with told us the provider often visited people to keep their skills up to date but also to ensure people were happy with their care.

We could not be assured that learning from incidents and accidents took place to make improvements to the service. Incident records reflected the immediate action taken by the care staff, however there was no evidence of an analysis, learning or appropriate actions having been implemented to reduce the risk of recurrence.

The provider did not have an emergency contingency plan. They told us they had thought about this but did not have one in place. This meant arrangements were not in place to deal with foreseeable emergencies.

We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by law in relation to assessing and monitoring the quality of the service provided.