Candlelight Homecare Services Wimborne Area Office

Candlelight Homecare Services Wimborne Area Office is a domiciliary care agency providing person care and support to people in their own homes and flats. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 32 people receiving personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group. This was considered throughout the inspection.

People’s experience of using this service and what we found

Improvements were needed as governance processes and oversight were either not in place or operating effectively within the service. Systems had not been established to monitor, safety, quality, and ensure the service continually sought to improve. The provider had not identified the shortfalls found within this inspection but had been responsive since the inspection to address the improvements needed.

Risks to people’s safety and wellbeing had been identified. However, guidance was not always in place to ensure staff worked to reduce risks and in safe ways. We have made a recommendation about the assessment and management of risk.

People received their medicines as prescribed. However, oversight of medicines was not robust. Medicines care plans were not in place. Guidance had not been created to ensure medicines taken as required were offered consistently. We have made a recommendation about medicines and safe practices.

Accidents and incidents were reported, recorded, and reviewed. However, learning from incidents was not always shared within the service and providers locations. The service actively sought feedback on the service it provided, this was not shared with people, this was an area for development.

Recruitment procedures were in place and robust, ensuring staff had the necessary values and skills to support people who needed care services. People and their relatives told us they were satisfied with the service they received. There were enough staff to meet the needs of people, the service worked continually to provide regular staff to promote continuity of care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Infection prevention and control procedures were robust, and staff had enough supplies of personal protective equipment (PPE).

Staff felt appreciated and told us they were proud to work for Candlelight Homecare Services Wimborne Area Office. We received positive feedback about the management team and the registered manager was approachable and contactable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 28 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified a breach of regulation in relation to the management and oversight of the service. We have made recommendations about risk and medicines management at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Candlelight Homecare Services Wimborne area office is a domiciliary care agency. It provides personal care to people living in their own homes in the community. Not everyone using the service receives a regulated activity; the CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

The service was providing personal care to 35 people living in their own homes.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and who to report this to if abuse was suspected.

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 avoidable 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, occupational therapists 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 using the service especially within the community.

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 and the company.

People, their relatives and professionals described the staff as caring, kind, and compassionate. People were able to 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 how 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.

Relatives and professionals had confidence in the service. 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.

The service understood their legal responsibilities for reporting and sharing information with other services.

Our last inspection on 29 January 2015 found that people were at risk of harm as risk assessments were not completed to identify how risks could be minimised. We found that appropriate systems were not in place to gain and review consent from people who used the service in line with the Mental Capacity Act 2005. During this inspection we found that improvements had been made.

The service provided personal care to 33 people in their own home. There was a central office which had three separate offices, a training room, toilet and small kitchenette.

The service had a registered manager in place. 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, relatives, staff and health professionals told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding adults.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they choose to live their lives. Each person had a care file which also included individual assessments and guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored in people’s homes, correctly recorded and only administered by staff that were trained to give medicines.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example nutrition, catheter care and stroke and Parkinson’s. We noted that the majority of staff were due a refresher in manual handling. The registered manager told us a session had been arranged and that staff due for refresher were booked onto this.

Staff told us they received regular supervisions and appraisals which were mostly carried out by the registered manager. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions; I find them useful and two way. Good opportunity to give and receive feedback”.

People had a capacity assessment in place and care files we reviewed showed evidence of best interest meetings taking place. Staff were aware of the Mental Capacity Act and training records showed that they had received training in this.

Some people are supported with cooking and preparation of meals in their home. We saw that peoples food and fluid intake was recorded in the files where appropriate. The training matrix showed that staff had attended food hygiene training.

People were supported to access healthcare appointments as and when required and staff worked followed GP and District Nurses advice when supporting people with on going care needs.

People and relatives told us that staff were caring. During home visits we observed positive interactions between staff and people.

A health professional said, “Staff are caring and mostly involve the person in decision making. They explain and talk to the person. There is an element of just getting to know the people first”. Another health professional fed back that Peoples choices and wishes were respected. They gave us an example where a carer had visited a person in their home who was not feeling well and did not want a bath that day. They said that the carer had listened to the person and respected their wishes and dignity.

Staff we observed treated people in a dignified manner throughout the course of their visit. Staff had a good understanding of people’s likes, dislikes, interests and communication needs.

People had their care and support needs assessed before using the service and care packages reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals when available. People and relatives told us that they were involved in reviews.

People, staff and relatives were encouraged to feedback. We reviewed the staff and client satisfaction survey report for 2015 which contained mainly positive feedback. This report reflected results from feedback questionnaires sent to people and staff. The quality assurance manager had analysed the feedback and actions were set for the registered manager to follow up. We saw that the two actions identified from this had been addressed.

There was a system in place for recording complaints which captured the detail and evidenced steps taken to address it. We saw that there were no outstanding complaints in place. Compliments were also recorded as part of the compliments, comments, feedback and complaints policy. One compliment said, ‘Carers are always efficient and cheerful. They bring a little of the outside world inside to brighten the day’.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

People, staff, relatives and health professionals all felt that the service was well led. The manager encouraged an open working environment. A staff member told us, “The registered manager does a really good job, they are hardworking, personable and a very good leader”.

The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.

Spot checks were completed by the registered manager and community team managers. The registered manager logged data from critical incident reports monthly which included medication errors, incidents, complaints or falls to name a few. This data was then passed to the quality assurance manager who carried out an overall analysis and looked for trends and learning which was then shared. The manager also carried out regular medication audits.

The service had recently received a bronze award in the Investors In People (IIP) programme.

We found records were maintained about people's care and improvements had been made to ensure that care provided to people was always recorded effectively.

Below is a summary of what we found. The summary describes what people told us, what we observed and the records we looked at.

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

Is the service safe?

People who used the service told us they felt safe receiving care from the agency. For example, one person commented, 'I always feel very safe with them. There is no situation where I don't feel safe.'

Staff were able to describe how they provided people's care in a way that ensured their safety. For example, they told us that they were aware of risks to people's welfare and knew what to do in the event of an emergency. There was regular communication between the agency and people's relatives to ensure people were safe in their own home.

Is the service effective?

The agency provided effective support to people who used the service. They did this by ensuring people received reliable care that, on the whole, met their needs and preferences.

People who used the service had confidence that care workers knew what they were doing and had the right skills, knowledge and experience to meet their individual needs. For example, one person told us, "They are all very good", while another person described how staff understood their preferred routine and followed this each day. This helped ensure they received care the way they wanted.

Staff told us they received enough information about people's needs and how to meet them. They told us that any changes in people's needs were communicated to them promptly which meant they were able to provide effective support.

Although records were maintained about people's care, we identified that some improvements were needed to ensure that care provided to people was always recorded effectively.

Is the service caring?

People who used the service spoke highly about their care workers. They told us that staff were kind, cheerful, helpful and considerate. They also told us that staff would always offer to do more for them, if required.

The staff we spoke with during our inspection clearly enjoyed their work and spoke with great affection about the people they visited. They were able to tell us about people's needs and preferences and how they ensured care was tailored to each person.

Is the service responsive?

The agency responded to changes in people's needs. We saw that the agency communicated with people's relatives about their welfare and contacted their GPs or the emergency services when they were unwell. This helped ensure that changes in people's health were identified and met.

We found that the agency was responsive to people's requests for changes in their visit times and schedules. For example, if people had asked not to receive their care from a particular care worker we found there were systems in place to ensure this was followed through. If people wanted a change in visit times we saw that the agency had tried to accommodate this. This helped ensure that people's preferences were taken into account in the provision of their care.

Is the service well-led?

We found that improvements had been made to the running of the agency since our last inspection. Staff had been recruited into management and care worker positions and their responsibilities were clearly defined. The changes made had resulted in people receiving a more reliable service that met their needs. People who used the service and staff commented positively on these improvements and told us that things were running more smoothly now.

There was a clear management structure at the agency. Although, at the time of our inspection, the agency did not have a manager who was registered with the Commission, an application had been submitted and was being processed. People who used the service were aware who to contact if they had concerns and told us that there was always someone available for them to speak to about any issues that arose. Staff also told us that managers were approachable and were always available on the telephone for advice and support. This helped ensure that people who used the service, and staff, received the support they needed.

The agency had systems in place to ensure that action was taken in response to incidents or complaints. We saw that incidents and complaints were recorded and followed up by the manager to ensure people were safe and improvements were made. There were also systems in place to cascade information to care workers to ensure that they were aware of any changes to the service and were able to provide appropriate care.

There were some procedures in place to obtain feedback from people who used the service and staff about their experience. We saw examples of how the agency had listened to people's views and taken action to improve. The company's quality assurance manager told us that a formal survey to obtain the views of people who used the service would be carried out in the autumn. This would help ensure that the company had a clear overview of the agency's performance and could use people's feedback to plan its development.

People were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to ensure that all medicines were administered safely. All of the representatives that we spoke with were happy with how staff supported people with their medicines.

There were not enough qualified, skilled and experienced staff to meet people's needs. One member of staff told us, 'There are lots of packages (agreements to provide care) and not enough staff.'

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Incidents such as missed calls were recorded in a file but there were no measures put in place to prevent future missed calls. We saw that there were ongoing issues with the times of care visits due to staff shortages. One person told us, 'Someone comes eventually.'

People's care plan and risk assessments were not always accurate and fit for purpose. A member of staff told us about one person's care plan that, 'The current risks are not captured.'

During this inspection we found that improvements had been made.

People told us that they thought staff were well trained and staff told us that they received sufficient support.

Staff received supervision, spot checks and appraisals. The majority of staff were up to date with training.

People told us that they saw a lot of different members of staff and we read visit plans which identified that people saw a number of different members of staff in a week. The agency told us that they were making improvements to ensure that there was continuity for people.

The agency had employed a system whereby staff logged in and out of people's homes when they visited. This enabled office staff to keep people informed of any delays or alterations to the scheduled visit.

People told us there had not been any missed visits recently. We reviewed the records and there was no evidence of missed visits for the three people we reviewed.

People told us that improvements had been made and staff were keeping to the times they said they would visit.

One person told us that they had no concerns. We saw that verbal complaints were logged in the complaints folder and action was taken to address the complaints.