Proper Care (Cornwall) Limited

Proper Care is a domiciliary care agency that provides personal care to people in their own homes. The service provides support to predominantly older people who may be living with dementia and/or have a physical disability. At the time of our inspection the service was supporting over 50 people.

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.

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

People told us they felt safe and were complimentary of the care they received. Comments from people and their relatives included, “I feel safe with them and I know I can talk to [the provider] if I need to, I’m very happy with Proper Care”, “I think they are excellent and would use them again and recommend them” and “I would recommend this agency and I have recommended them to people”.

The services recruitment processes were safe and staff had received appropriate training to enable them to meet people support needs. One person told us, “The carers are very good, they know what to do and they do everything I need”.

The service was experiencing some staffing challenges and there was an ongoing recruitment campaign. The registered and deputy managers were regularly completing care visits. Rotas showed the service had enough staff to provide planned care visits and the registered manger told us the service only took on new packages of care when they had sufficient staff available.

People knew when to expect staff to arrive and the service’s rotas were well organised and included some travel time between consecutive care visits. Staff told us, “I never run late, I take my time and have time to chat.” One person commented, “We do have a rota and generally they stick to it and if the carers are going to be very late they do phone”.

People were supported with the medicines safely and staff understood how to protect people from infection control risks.

Risks in relation to people’s care needs and the environment had been appropriately assessed and local safeguarding procedures were well understood.

People’s needs were assessed by managers before the service agreed to provide support and care plans had been updated promptly in response to reported changes in needs.

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.

The service was well-led and the registered manager and management team provided effective leadership and support to care staff. On call arrangements were effective and staff told us they were well supported.

The providers quality assurance systems were effective and action had bene taken to address and resolve issues identified during our previous inspection.

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 requires improvement. (Published 9 October 2021).

Why we inspected

We carried out an announced comprehensive inspection of this service on 10 September 2021. A breach of legal requirements was found in relation to governance. The provider completed an action plan after the last inspection to show what they would do and by when.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Proper care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Proper Care (Cornwall) Limited provides personal care to people living in their own homes in the community. Services are provided to predominantly older people living in and around Helston in south west Cornwall. At the time of our inspection the service was providing support to 70 people. The service generally provides short visits at key times of the day to support people with specific tasks to enable people to continue to live in their own homes.

We carried out this announced inspection between the 6 and 10 September 2021 in response to concerns raised about a drop in staffing levels, the handing back of packages of care to the local authority and the management of the service. At the last inspection, in September 2018, the service was rated good overall. At this inspection we found improvements were required regarding the governance and records held by the service.

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

Several care staff had left the service in the last month. This had led to the provider having to hand back some packages of care to the local authority as they did not have enough staff to carry out the visits. One relative had complained to the Care Quality Commission about this. During the week of this inspection three senior office staff and four further care staff ceased working in the service. The provider was working closely with the local authority to manage packages of care and was actively recruiting to replace staff.

At the last inspection we received mixed feedback from staff, in relation to the amount of time allocated on the rota to travel between care visits. We identified that some staff visit schedules did not include appropriate amounts of travel time. We issued a recommendation in relation to the services visit scheduling systems in the last report. At this inspection we could see that the provider had ensured travel time in some rotas. However, due to the lack of staff recently, many current rotas failed to allocate any travel time between visits. The provider was committed to ensuring staff had sufficient time to travel between visits and assured us this would be added to the rotas as soon as sufficient staff had been recruited.

Any accidents or incidents that occurred had been investigated and action had been taken to help prevent any re-occurrence. However, such events had not always been appropriately recorded.

There were gaps in many medicine records. This meant it was not always possible to establish if people had received their medicines as prescribed.

Audit processes were not effective. For example, medicine records that had been signed off as audited were found to contain gaps where prescribed medicines should have been signed for as given. This had not always been identified and addressed with staff.

The service did not have robust recruitment practices. The provider confirmed that two references were required before staff began working alone. Some staff had commenced working alone in the community without the necessary references required. New staff confirmed they received appropriate training and support before they worked alone with people.

The guidance and process in place for staff to follow when handling people's money for shopping etc., was not robust. This meant it was not always possible to establish how people's money was used.

People and their relatives had not been impacted by the recent staff shortages. They told us the service provided safe care. People told us their care visits were normally provided on time and for the full duration and one person told us, “I feel safe with them. I have not had any cancelled calls. They are very good to me and they stay the time as they should. They wear all the PPE to protect me from Covid-19.”

People told us they received a good service. Some visits had been cancelled recently, due to a lack of staff. People had been advised of this by phone. We spoke to many of these people who confirmed they had access to alternative support and were not wholly dependent on the staff for their support.

Staff had received training in safeguarding adults and knew how to respond if they had any concern in relation to people’s safety.

Risk assessments had been completed and where risks had been identified staff were provided with guidance on how to manage and minimise these risks while providing support.

Staff provided mixed feedback, they told us, “We have had to give some packages back to the Council as we could not cover them. Our rounds are still busy but achievable. My clients have not been affected really,” “Absolutely fine, I really enjoy it, I get good feedback from clients. I have not had any problems” and “We don’t get paid for our travel time between visits, we get paid mileage only. It can be a good bit of our day taken up with travelling between visits.”

Staff told us they were well supported by the provider and commented, “(Provider’s name) is a good boss they are supportive and if we raise an issue with them it gets sorted. I can always get hold of them when I need help with anything” and “I have a lot of respect for (Provider’s name) it has been a good place to work, things are not so great just now but I am confident they will get better.”

Staff knew people they supported well and those people told us they were normally supported by a small group of carers whose company they enjoyed. Information about people’s likes and interests was gathered during the needs assessments process and where possible the service aimed to provide support staff with similar interests.

One person’s relative said, “They have had no cancelled calls at all and my gosh they certainly make her feel safe, they are a Godsend, I don’t know what we would do without them!”

People told us they were asked for their views on the quality of care the services provided as part of the care plans review process and records showed that people’s comments had been complimentary.

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

The last rating for this service was good (published 9 November 2018)

Why we inspected

We carried out this announced inspection as we had received concerns in relation to the management of the service and staffing shortages. This had led to some packages of care being handed back to the local authority. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to governance processes not being robust and records not always being completed as required. Please see the action we have told the provider to take at the end of this report.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Proper Care on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Proper Care (Cornwall) Limited provides personal care to people living in their own homes in the community. Services are provided to predominantly older people living in an around Helston in South West Cornwall. At the time of our inspection the service was providing support to approximately 70 people. The service generally provides short visits at key times of the day to support people with specific tasks to enable people to continue to live in their own homes. These services were funded either privately, through Cornwall Council or NHS funding.

People and their relative told us the service provided safe care. Their comments included, “I feel happy and safe with them [staff]” and “Yes I do [feel safe], they [staff] are very good.” Staff had received training in safeguarding adults and knew how to respond if they had any concern in relation to people’s safety. Staff were confident the registered manager would take any action necessary to ensure people’s safety.

Risk assessments had been completed and where risks had been identified staff were provided with guidance on how to manage and minimise these risks while providing support. Any accidents or incidents that occurred had been appropriately recorded and investigated by the registered manager to reduce the likelihood of similar events reoccurring. The service had purchased a lifting aid and staff had received training on how to assist people who were uninjured up from the floor following a fall. This meant people were protected from the risks associated with spending time on the floor while awaiting assistance from emergency services.

People told us they received a reliable service and no one reported having experienced missed care visits. Staff told us, “There are no missed visits. There is always someone to every visit.” We received mixed feedback from staff, in relation to the amount of time allocated to travel between care visits and identified that some staff visit schedules did not include appropriately amounts of travel time. We discussed these issues with the registered manager who accepted and recognised that travel time had not been consistently included in staff rotas. We have made a recommendation in relation to the services visit scheduling systems and the manager explained that changes were planed to address these issues.

People told us their care visits were normally provided on time and for the full duration and one person’s relative said, “One thing is we have been allocated a reasonable amount of time so we don’t feel under any pressure. The people are very caring and pleasant and they do try to understand my husband. They take the time and trouble to understand what he feels unsafe about.” Staff told us the issues with travel time did not impact on the support they provided and daily records showed staff normally arrived on time. We have made a recommendation in relation to the service’s current visit scheduling system.

Staff were sufficiently skilled to meet people’s needs. Following our previous inspection a new system had been introduced to ensure all training was regularly reviewed and updated. Staff told us, “They are very strict that all our training is up to date.” While health professionals said, “Staff appear to be well trained and are happy and actively striving to improve their education”. There were appropriate staff induction processes in place and all staff new to care received formal induction training in line with the requirements of the care certificate.

The service had robust recruitment practices, which meant staff were suitable to work with vulnerable people. Staff told us they were well supported by their managers and commented, “The managers are [very] nice, easy to talk to” and “They come out and supervise us and they do random spot checks as well.” Records demonstrated all staff received regular formal supervision and annual performance appraisals.

Care plans provided staff with sufficiently detailed direction and guidance on how to meet people’s individual needs and wishes. Peoples’ care plans were regularly reviewed and updated. People and where appropriate their relatives had been involved in these reviews and reported that changes had been made to their care plan in response to suggestions they had made.

Staff knew people they supported well and those people told us they were normally supported by a small group of carers whose company they enjoyed. Information about people’s likes and interests was gathered during the needs assessments process and where possible the service aimed to provide support staff with similar interests. One person’s relative said, “They originally chose a carer who had travelled a lot as we did when we younger.”

People’s care plans included guidance for staff on their individual communication needs and how to support people to make decisions and choices during each care visit. Daily care records showed staff respected people’s wishes when planned care was declined. People said staff respected their dignity at all time and commented, “I never feel judged by her” and “We have a good rapport. They never come in grumpy and they never talk about other clients, never swear and never smell of smoke even though I know some of them do.”

The service acted within the legal framework of the Mental Capacity Act 2005(MCA). Management and staff respected people decisions and choices in relation to how their care was provided.

Staff were motivated and spoke passionately about their role. Team meetings were held regularly and staff were encouraged to visit the office each Friday to collect their rotas and chat informally with managers. Staff told us they were supported and commented, “I like the staff here, we all help each other out”, “[The managers] are brilliant, if you have an issue they sort it out straight away. Little, big, whatever it gets sorted” and “All in all [The registered manager] is a good boss and it is a good place to work.”

People and their relatives were complimentary of the support the service provided and told us, “I think they are very good, no excellent”, “They have a brilliant team and [the registered manager] should be proud of all his girls” and “It takes a great weight off me as I know I can rely on them.”

The service had effective quality assurance systems in place to drive improvements in performance. People told us they were asked for their views on the quality of care the services provided as part of the care plans review process and records showed that people’s comments had been complimentary. Information about the service complaints procedures was included in each person’s care plan and people told us they would not hesitated to raise any concerns with the registered manager who they knew well and visited regularly.

Before the inspection we sent out a survey to a random selection of 50 people who used the service. Everyone who responded to our survey and all of the people who we spoke with during our inspection told us they felt safe with, and were well cared for by their staff from Proper Care. Comments received from people and their relatives included; “I definitely feel safe with my care staff”, “They are absolutely delightful” and, The staff are always lovely. [My relative] gets on really well with them.”

People told us they received a schedule of planned care visits each week which included details of the times of all visits and the names of the staff who would be visiting. People said this information was normally accurate, that staff arrived on time and stayed for the full planned care visit. People’s comments included; “Very, very occasionally they are late”, “They are never late they come when they say they will” and, “They are normally on time and will let me know if they are going to be late. Basically they are on time or I get a call.” We examined staff visit schedules and daily care records. We found staff were provided with appropriate amounts of travel time between consecutive care visits and provided care visits of the planned length. Staff told us, “We do get travel time”, “There is enough time during visits, you do not feel you have to rush people” and, “I definitely have enough time to talk. I can stay and have a cup of tea and a chat with people, I love all the stories people tell you.”

Proper Care had appropriate procedures in place to protect people from abuse and avoidable harm. Staff understood local safeguarding procedures and people’s care plans included detailed risk assessments. These assessments provided staff with detailed guidance on the actions they must take to protect people from each identified risk. The service’s recruitment procedures ware robust and necessary staff pre-employment checks had been completed.

The training needs of the staff team had not been met. Before our inspection the provider’s quality assurance systems had identified this area of concern. As a result the service’s training and induction systems had been reviewed. It was planned that in future all staff would receive appropriate regular training to help ensure they had the skills necessary to meet people’s care needs.

There were sufficient numbers of staff available to meet people’s assessed needs and care staff received regular supervision from managers and senior care staff. The service’s on call management arrangements were effective and staff told us, “I know I can phone up at any time and they will answer, I think they [managers] do an absolutely fantastic job.”

People told us, “I see the same staff regularly, I get on with them” and staff visit schedules showed people regularly received care from a consistent small staff team who they knew well. In addition, office staff knew people well and understood their care needs and individual preferences.

People’s care plans were detailed and informative. They provided staff with sufficient information to enable them to meet people’s care needs. Care plans were based on information gathered during assessment visits completed prior to the initial care visit by one of the service’s managers. All of the care pans we reviewed had been regularly reviewed and updated to ensure they accurately reflected people’s current care and support needs.

Many people told us they would recommend Proper Care to others and commented, “I mean it sincerely, they are very good. I have recommended them to my friends and family”, “I would give them ten out of ten” and, “I have recommended them to other people I know.” Where complaints had been received these were resolved promptly and to the complainants satisfaction.

The staff team were well motivated and supported by the registered manager. Staff comments in relation to the service’s managers included; “They are so approachable and helpful, you never feel silly when you ask questions”, “They have been amazingly supportive” and, “The managers are brilliant, so easy to talk to." Managers valued and respected the staff team and each Friday cakes and other treats were provided for staff when they visited the office to collect their rotas. These visits provided an informal opportunity for care staff to share information with managers and this was highly valued by the registered manager who told us, “the more time staff spend here, the more info we get so we have more of a feel for what is happening out there.”

The size of the service had significantly reduced since our previous inspection as a result of changes to local commissioning practices and difficulties retaining and recruiting staff. These difficult challenges had been well managed and the service had acted appropriately to ensure people’s care needs were met.

Below is a summary of what we found. The summary is based on information gathered during conversations with people who used the service, relatives, staff and management of Proper Care (Cornwall) Ltd.

Is the service safe?

At the time of the inspection we found the service was safe. The 23 people who used the service that we spoke with all told us they felt 'absolutely' safe with their care staff supplied by Proper Care (Cornwall) Ltd.

The Care staff we spoke with understood local safeguarding procedures and had received appropriate safeguarding and Mental Capacity Act training.

We found the providers Safeguarding policy had been updated and new procedures introduced for recording details of shopping trips completed by members of staff.

Is the service effective?

At the time of the inspection we found the service was effective. Everyone we spoke with was complimentary of the care provided by Proper Care (Cornwall) Ltd. People's comments included 'excellent', 'very good', 'absolutely wonderful' and 'I'd give them 100%, I have had no problems with them at all'.

Staff demonstrated during our conversations with them a good understanding of the importance of gaining consent prior to providing care or support and people who used the service told us 'they come in and chat, make sure I am OK then get started' and 'the girls do things the way I ask'.

We saw that people's care needs had been assessed in order to ensure that the service could meet their needs and we saw that detailed risk assessments had been completed.

The four care plans we inspected were up to date, highly detailed and provided staff with comprehensive information about each person's care needs.

Is the service caring?

We found that the service was caring and that people who used the service valued the care and support provided by both office and care staff. People told us 'Proper Care from the manager down are a really lovely group of people' and 'they do listen and the service is always excellent'.

The five staff we spoke with reported that they enjoyed their work, their comments included 'I love it' and 'It's a fabulous place to work'.

The daily records of care we inspected were detailed and included information about the care provided, the individuals mood, any changes to their condition and information about how the person had spent their day.

Is the service responsive?

At the time of the inspection we found the service was responsive, we found the service had appropriate complaints procedures and people who used the service told us told us 'all the details (of how to make a complaint) are in the folder that has been provided by Proper Care' and 'I phoned the office about one of the carers I wasn't happy with and haven't had her since.'

The service regularly received compliments and thank you cards from people who used the service and their relatives. We saw this information and details of any complaints received were shared with staff during informal rota collection meetings each Friday.

An annual survey of people who used the service had been completed in October 2013 when the majority of the 82 people who responded to the survey said the service was 'Excellent' or 'Very Good'.

Is the service well led?

At the time of our inspection Proper Care (Cornwall) Ltd was well lead and it's manager was registered with the Care Quality Commission.

People who used the service told us 'the manager is excellent, you only have to phone him. He listens and makes adjustments where needed. One phone call and it is sorted' while staff told us 'it's a fabulous place to work', 'if I had a problem I would call them (the office) and I am sure something would be done' and 'out of hours, amazing service I always get through and always get the help I need'.

The service had appropriate quality assurance systems in place and accidents and incidents had been investigated appropriately.

We spoke with the registered manager, the deputy manager, the training manager, the community supervisor and four members of staff.

Care plans were detailed and informative. Risk assessments did not contain enough information to guide staff on how to manage identified risks.

We saw people were not protected from the risk of abuse because the provider had not taken steps to ensure staff were able to recognise and respond to potential abuse.

We looked at personnel files for four members of staff. Recruitment systems were robust and staffing levels were satisfactory.

Staff were supported well with regular supervision and meetings. We noted there was an open culture within the organisation.

Proper Care had a suitable quality assurance system in place.

The care plans we looked at directed and informed staff as to how the care was to be provided on each visit and reminded carers to offer choices to people as well as prompting them to be respectful of peoples privacy and dignity during activities of personal care.

Some people told us they had specificially requested carers of one gender or another and this request had been accepted. We also saw examples of this documented in care plans and initial assessments. The agency told us that where there was difficulty accommodating a particular request they did not accept the care package.

The recruitment process was robust and training was both comprehensive and provided frequently.