This inspection took place on the 24&25 May 2016 and was unannounced.We last inspected this service in October 2013. At that inspection we found the service was meeting the legal requirements in place at the time.
New Care Services & Cornerstone [Delta Care] is a privately owned domiciliary care agency. They are situated in Preston near the city centre. The agency provides care staff to support people in their own homes. They provide assistance with tasks such as personal care, food preparation, medication administration and household chores. The service supports people around Preston, South Ribble, and surrounding areas. Services are provided to older adults, adults with physical disabilities, adults with memory loss or dementia, adults with complex needs and adults with specific conditions such as strokes.
At the time of our inspection New Care Services & Cornerstone provided services to two hundred people.
The registered manager of the service was present throughout our inspection. 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.
We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. People’s views on the service’s reliability were mixed.
People’s medication was not effectively managed. We found a significant number of medication errors. However medication training and audits had been undertaken.
The majority of staff we spoke with told us they were given enough time with people, time for travelling and that visits to people did not overlap. However, some staff told us they had to leave some visits early to get to the next visit in time. This was however not widespread.
We looked at care assessments undertaken for six people. Some risk assessments had been carried out. However, risk assessments for people’s personal care needs had not been done. The service followed safeguarding reporting systems as outlined in its policies and procedures. Allegations of unsafe care had been identified and actions had been taken to investigate and safeguard people.
We found the service had promoted staff development but there were significant shortfalls in training. Training records showed some training had been undertaken. However, some essential training had not been undertaken for areas such as, mental capacity, dignity, and nutrition. Significant shortfalls were found in other areas of training such as fire risk awareness, dementia, diabetes, equality and diversity and managing challenging behaviours. Staff told us they felt well supported by management and we saw evidence that regular supervisions had been undertaken.
We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act [MCA]. People's care records had no evidence of mental capacity assessments. This was a breach of regulation.
Feedback about care staff and the care that people received was positive. However, some people raised concerns around reliability of the service due to care staff not turning up, or not following the rota.
We found the way people's needs were being met was not entirely person centred. Some files had no details about people’s likes and dislikes. People told us care staff were not always introduced to them before providing care. There were assessment processes in place, which helped to ensure staff had a good understanding of people's needs before they started to support them. However care plans drawn from the assessments were basic and did not always contain detailed information about people’s identified care needs and the risk assessments around the identified needs. We made a recommendation about this.
Staff and people who used the service told us that the management team were approachable. However, they found office staff [care coordinators] difficult to deal with. We found the registered manager was familiar with people who used the service and their needs. When we discussed people's needs the registered manager showed good knowledge about the people in their care.
We looked at staff meeting minutes; they showed staff were involved in discussions about improving the service. Management encouraged the staff team to provide good standards of care and support. There was a staff incentive and rewards system to encourage staff to improve and stay motivated.
The service had a complaints procedure which was made available to people they supported. People we spoke with told us they knew how to make a complaint if they had any concerns and the service had sent information on how to make a complaint to all people.
The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, audits, spot checks and care reviews. Surveys done showed people were satisfied with the service they received. However when we spoke to people some raised concerns regarding consistency, reliability and punctuality of carers.
We made a recommendation about quality assurance for medication.
The registered manager and the leadership team were receptive to feedback and keen to improve the service. They showed us various pieces of work that they were undertaking to improve the service. These included a new log in system to monitor care visits, a new care plan and new policy documents that they had purchased and were ready to introduce. Management worked with us in a positive manner providing all the information we requested.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included Regulation 12 – Safe care and treatment, Regulation 11 –Consent and Regulation 18- Staffing. You can see what action we have taken at the end of this report.