Care Concern (NW) is a domiciliary care agency that supplies personal care and support to people in their own homes. Care Concern (NW) is based near Birkdale and provides care for approximately 200 people around the North West. They provide personal care for predominantly elderly people with dementia or stroke.
We undertook an announced inspection of Care Concern (NW) on 11th, 12th, 13th, 16th and 23rd February 2015. We informed the provider two days before our visit that we would be inspecting.
The inspection team consisted of two adult social care inspectors and an ‘expert by experience’. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.
The service had 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.
People who used the services of the agency told us they felt safe when receiving care and support. This included support with personal care, help with meals and also with shopping.
Care staff we spoke with had a good understanding of how to keep people safe in their own home. This included risk assessing practices such as, the use of entry key codes to people’s homes and equipment to transfer people safely.
Within people’s care files we saw a number of assessments to help identify and manage risks for people to ensure their health and safety. The risk assessments included information about action to be taken to minimise the chance of harm occurring.
People told us care staff supported them with their medication at a time when they needed to take it. They said this was in accordance with their wishes and needs. We checked a sample of medicines against the corresponding records and these showed that medicines had been given correctly. Some medicine care plans lacked clarity around the level of support people needed with their medicines. Following the inspection we were informed of the actions taken to improve this.
Effective recruitment practices were in place to ensure staff were suitable to work with vulnerable people.
Staffing levels were determined by the number of people using the service and their individual needs. Two relief care staff covered emergencies, sickness, annual leave and to help provide extra support to people where needed. People told us that generally they received care from a regular team which they felt was very important.
Care staff received regular training and supervision. The manager was aware of the need to commence staff appraisals this year.
People’s care needs were recorded in a plan of care in an individual care file. The manager had identified the need to introduce new care plans to enable staff to record more detail around people’s preferences, choices and level of care and support they required. This was to make the care plans more tailored to individual need.
People were supported at mealtimes in accordance with their plan of care. People told us the care staff prepared the foods they liked and offered regular drinks to them.
With regards to people making their own decisions, people we spoke with informed us they were able to do so and were involved, as much as possible, regarding decisions about their welfare.
Care staff were available to support people’s access to health care appointments. Care records we looked at showed the agency liaised with health and social care professionals involved in people’s care if their health or support needs changed or if their advice was required.
People who used the service said the staff were very caring and kind. Their comments included, “They (the care staff) are angels”, “All the carers are very nice”, “They (the care staff) are just so considerate that I feel they treat me with dignity at all times” and “The staff are excellent, they go above and beyond to help you.” On the whole people said care staff stayed for the agreed length of time of their visit. We did however receive some comments regarding this not always being the case and therefore not in accordance with people’s plan of care. We brought this to the attention of the manager.
People told us the agency responded to their needs in a positive way. They told us the care staff listened to them, acted on what they said, delivered care in a way they liked and a time that suited them.
Speaking with care staff confirmed their knowledge about the people they supported and how they would respond if a person was unwell.
A complaints procedure was in place and details of how to make a complaint had been provided to people who used the service. We saw the complaints’ register and complaints received had been responded to in a timely manner and in accordance with the service’s policy and procedure.
Systems were in place to monitor the quality of the service provided. This included audits (checks) on areas such as, care documents, medicine administration and also meetings with people to ensure they were happy with the care provided. A more in depth medicine audit was carried out following our inspection. This was in light of our findings with regard to a lack of clarity around the level of staff support for medicines. Actions were being taken to improve this practice.
People who used the services of the agency had received feedback surveys in 2013 to gain their views about the agency. The manager told us these were being sent out again this year.
All staff we spoke with were positive in respect of the overall management of the agency and the caring, supportive and efficient leadership of the manager. Their comments included, “Really good”, “You can speak to (manager) about anything” and “We get plenty of support.” Feedback from staff confirmed the agency promoted and open and transparent culture.