Archived: Casa Doncaster

We gave the registered manager short notice that we would be coming because the location provides a domiciliary care service and we wanted the registered manager to assist us in planning visits to people in their homes.

This was Casa Doncaster second inspection since they registered with the Care Quality Commission (CQC) in October 2016. The last inspection was in October 2017 when the service was rated ‘requires improvement.’ At that inspection we found two breaches of the regulations in relation to staffing and good governance. This was because sufficient numbers of suitably qualified, competent, skilled and experienced persons were not deployed to meet the needs of people who used the service. Also, the systems or processes did not operate effectively to assess, monitor and improve the quality and safety of the service and mitigate risks to the health, safety and welfare of people.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good.

At this inspection we found that evidence supported the rating of ‘good.’ This was because the provider had addressed the shortfalls we identified at the last inspection.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Casa Doncaster’ on our website at www.cqc.org.uk.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Overall people told us they felt safe with the support they received from the staff at Casa Doncaster.

People were protected against the risks associated with medicines because the registered provider and registered manager had appropriate arrangements in place to manage medicines safely. We found some small gaps in the information required to be kept in medicine administration records. This was dealt with on the day of the inspection.

The registered provider had a policy and procedure in place for the safe recruitment of staff.

Most staff told us they felt supported by the registered manager and other senior staff. We found staff were provided with a regular programme of training, supervision and appraisal, which assisted them to deliver effective care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care and support was planned by a multi-disciplinary team of people. People told us they were supported to maintain good health and wellbeing, which included being provided with a nutritionally balanced diet and plenty of drinks.

Staff were caring and compassionate and engaged people in friendly interaction, respecting their preferences and individual likes and dislikes. Relatives told us staff respected people's privacy and dignity and staff could describe how they managed this. People's cultural and religious needs were met by staff at this service.

People told us they could talk to their care workers and the office staff at Casa Doncaster. They said if they had any concerns or worries they were confident staff would listen to them and look at ways of resolving their issues.

There were opportunities for people who used the service, their families, staff and healthcare professionals to become involved in developing the service and they were encouraged to provide feedback about the service provided. This was both on an informal basis speaking to the managers' and through a quality assurance survey.

Casa Doncaster is a domiciliary care service that provides personal care for people in their own homes.

This was Casa Doncaster first inspection since they registered with the Care Quality Commission (CQC) in October 2016. The inspection was prompted in part as a consequence of information of concern sent to CQC. The information shared with CQC indicated potential concerns about the management of risk.

There was no registered manager in place for the service. The service had a manager who was in the process of registering with the CQC. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

At this inspection we found two breaches of the regulations in relation to staffing and good governance. This was because sufficient numbers of suitably qualified, competent, skilled and experienced persons were not deployed to meet the needs of people who used the service. Also the systems or processes did not operate effectively to assess, monitor and improve the quality and safety of the service and mitigate risks to the health, safety and welfare of people.

You can see the action we have asked the provider to take at the back of the full version of this report.

People we spoke with had different views about the quality of the service. Many people praised the service and spoke highly of the care and support provided by the staff. Others raised concerns about aspects of the service which they felt were less than satisfactory.

Some people and their relatives had concerns about the reliability and consistency of the service. People told us they had concerns about the lack of organisation and planning around staff rotas. When people had regular care workers they received consistent levels of care by staff who knew how to look after them. However, people told us issues arose when their regular care worker was not available and less experienced staff, who they did not always know were allocated to provide their care.

Staff had completed an induction when they started work and received training relevant to the needs of people using the service. However, parents of some young people who used the service had concerns about the training and competence of some staff who provided care to their children.

Staff were trained to give people their medicines in a safe way. Throughout the inspection people spoken with and surveyed did not raise any concerns in the way they were supported to take their medicines. Following the inspection we received some information of concern regarding the safe administration of medicines for one young person. We referred this information to the local authority safeguarding team and asked them to investigate this. This investigation is still being carried out.

Staff understood the Mental Capacity Act 2005 (MCA) and acted according to this legislation.

People's care records included assessments relating to their dietary needs and there were appropriate arrangements in place to ensure that people were receiving food and fluids.

People had access to a GP and other healthcare professionals when they needed it.

People told us their care workers were, “Kind” and “Lovely.” People had developed positive relationships with their regular care workers and enjoyed the time they spent with them.

People told us that staff respected their privacy and dignity and promoted their independence. There was evidence that personal and cultural requirements were considered when carrying out the assessments and allocating care workers to people who used the service.

People and their relatives knew how to make a complaint but did not always feel able to share their views and opinions about the service they received. This was because they felt they weren’t always listened to and they did not always know who was in charge at the service, due to the high turnover of managers.

The majority of people and their relatives told us they were involved in planning how care and support was provided. An initial assessment was completed from which care plans and risk assessments were developed. Care was reviewed if there were any significant changes, with health and social care professionals being contacted to authorise changes in care received.

There were quality assurance systems in place to monitor the quality of the service provided and understand the experiences of people who used the service. However, these were not fully effective as there were relatives of people who used the service who continued to be dissatisfied with the quality of the service provided.

The lack of robust quality monitoring systems meant that the registered provider could not be sure that people using the service were receiving the care and support they required as was assessed and recorded in their service agreement. Any improvements that might be needed to the quality and safety of the service were not always identified.