Peepal Care

Peepal Care is a small domiciliary care agency registered to provide personal care to people in their own homes. The service mainly caters for the Gujarati community. At the time of the inspection, the service provided care to ten people. The Care Quality Commission (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

Feedback from one person who received care from the service and relatives we spoke with indicated that they were satisfied with the care provided by the service. They spoke positively about staff and the service and raised no concerns. They also told us the service was professional and well run.

Systems were in place to help ensure people were protected from the risk of abuse. There were appropriate policies in place.

Risk assessments were carried out to ensure people's needs could be met. Where risks were identified, there was guidance in place for staff to ensure that people were safe.

There were appropriate numbers of suitably skilled staff available to meet people's needs. Feedback indicated that care workers were punctual and stayed for the duration of their visit.

Appropriate infection control practices were in place.

Comprehensive recruitment processes were in place. The service carried out appropriate checks so only staff who were suitable to work with people using the service were employed.

The service had a system in place to obtain feedback from people about the quality of the service they received. This enabled the service to continuously monitor the effectiveness of the service. Quality assurance systems and processes included audits looking at key aspects of the service.

Rating at last inspection

The last rating for this service was Requires Improvement (published 3 September 2019).

Why we inspected

We previously carried out a comprehensive inspection of this service in August 2019. One breach of legal requirement was found. The provider completed an action plan after the last inspection to show what they would do and by when in relation to medicines management.

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 and Well-led.

The ratings from the previous comprehensive inspection for the key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

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

Peepal Care is a small domiciliary care agency registered to provide personal care to people in their own homes. The service mainly caters for the Gujarati community and some of the care workers are live-in carers as well. At the time of the inspection, the service provided care to nine people. 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

There was a lack of oversight of medicines management, and we could not be assured that people were receiving their medicines as prescribed. We found a breach of regulation in respect of this.

Feedback from one person who received care from the service and relatives we spoke with indicated that they were satisfied with the care provided by the agency. They were complimentary about care workers and the service and raised no concerns. They said care workers were caring, patient and respectful.

Systems were in place to help ensure people were protected from the risk of abuse. There were appropriate policies in place. People were protected from abuse by staff who understood how to identify and report any abuse concerns.

Assessments were carried out to ensure people's needs could be met. Where risks were identified, there was guidance in place for staff to ensure that people were safe.

There were appropriate numbers of suitably skilled staff available to meet people's needs. Feedback indicated that care workers were punctual and there were no concerns in respect of this.

People received care and support from the same team of care workers. This maintained consistency and ensured that staff knew people and could build friendly professional relationships with people. People and relatives spoke positively about this aspect of the service.

The provider had systems in place to record and respond to accidents and incidents in a timely manner. Lessons learnt were used as opportunities to improve the quality of service.

Staff followed appropriate infection control practices.

Staff had the knowledge and experience to support people's needs. They were supported through induction, training and supervision to ensure they performed their roles effectively.

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.

The service had clear procedures for receiving, handling and responding to comments and complaints. Feedback obtained from one person who received care and relatives indicated that they had no complaints about the service but knew what to do if they needed to raise a complaint or concern.

There were systems in place to assess and monitor the quality of the service provided. The service had a comprehensive system in place to obtain feedback from people about the quality of the service they received through regular telephone monitoring. This enabled the service to continuously monitor the effectiveness of the service.

The registered manager promoted transparency, communication, honesty and was approachable. This was confirmed by care workers we spoke with.

Rating at last inspection

The last rating for this service was Good (published 17 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the safe management of medicines 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 for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

At the time of the inspection, the service was providing care and supporting nine people. There were eight care workers employed by the service.

There was 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.

At our last inspection on 21 December 2015, the service did not meet Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found risks to people’s needs were not assessed appropriately, care workers performance had not been assessed effectively, care records were not person centred and auditing processes were not robust enough to monitor and improve the quality of the service. This meant the quality rating we awarded was requires improvement.

Following our December 2015 inspection we received an action plan from the service telling us what action they would take. At this inspection the registered manager was able to demonstrate that measures had been put in place since the last inspection to respond to the issues identified and meet regulations. Positive feedback was also received by people using the service and relatives.

Systems and processes were in place to help protect people from the risk of harm and care workers demonstrated that they were aware of these. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risks to people were assessed and identified according to people’s specific needs.

People and relatives told us that they were confident that most care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers spoke positively about their experiences working for the service. Spot checks were in place to assess care worker’s competency.

Staff were informed of changes occurring within the service through regular staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

People received care that was responsive to their needs. People's daily routines were reflected in their care plans and the service encouraged and prompted people's independence. Care plans included information about people's preferences.

There was consistency in the level of care people received. People using the service and relatives told us their care workers turned up on time and they received the same care worker on a regular basis. The service had a system in place to monitor care workers punctuality.

Care workers had a good understanding of the importance of treating people with respect and dignity. Feedback from relatives indicated that positive relationships had developed between people using the service and their care worker and people were treated with dignity and respect.

Arrangements were in place in respect of medicines. Care workers had received medicines training and policies and procedures were in place.

Systems were in place to monitor and improve the quality of the service. We found the service had obtained feedback about the quality of the service people received through review meetings, telephone monitoring and satisfaction surveys. Records showed positive feedback had been provided about the service. The service also undertook audits of the quality of the service and took action to improve the service as a result.

We used a number of different methods to help us understand the experiences of people who used the service. We looked at records. We also spoke with nine people who used the service and their relatives, four care workers and the registered manager.

Below is a summary of what we found. The summary describes what people using the service and staff 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 had detailed support plans and risk assessments which helped to ensure their safety and welfare.

There were enough qualified, skilled and experienced staff to meet people's needs.

Training records showed staff had received training in safeguarding and whistleblowing. However when speaking to staff, they were not able to provide examples of different types of abuse and did not know the relevant external authorities to report allegations or incidents of abuse.

Is the service effective?

We found the service ensured people were included and involved as much as possible in their care and support.

We looked at five care plans and saw that people's needs had been assessed and care and treatment were planned and delivered in line with their individual care plan.

Risk assessments had been carried out. We found these were person-centred, detailed and specific to each person and their needs.

Is the service caring?

We received good feedback about the service. One relative told us 'I think it's a really great service and very reasonably priced. I was recommended to them and I have recommended them to others' and 'They [Peepal Care] are very good, I did a lot of homework before choosing them, they are catering for the Asian market and provide carers who speak my parents' language and understand the cultural stuff which is great.'

People who used the service told us they were treated with respect and dignity. When speaking to care workers they had a good understanding and were able to tell us a variety of ways they respected people's privacy and dignity.

People who used the service were given a choice by staff and asked what they wanted to do. People's wishes were respected and accommodated. Relatives told us 'Yes, they [care worker] listens to what my mother wants, my mother's speech is very poor but [care worker] takes the time to really listen to what my mother wants instead of just doing what she thinks.'

Is the service responsive?

We found the service had a complaints policy and procedures in place. We found people who used the service and their relatives were aware of how to make a complaint and felt comfortable approaching the registered manager with any concerns they had.

We also found regular reviews were being held between people who used the service, their family or representatives and the registered manager where all aspects of their care were discussed and any changes actioned if required.

Is the service well-led?

The service had a registered manager in place.

The service had an effective system to regularly assess and monitor the quality of service that people received. We found quality assurance questionnaires had been sent out to people who used the service and also saw evidence of feedback received via telephone monitoring.

The registered manager showed us their quality assurance checks were done on a quarterly basis and covered areas such as review of peoples' care plans, review meetings, training and performance management of staff such as spot checks and supervisions

There was evidence that people's needs were monitored. We saw care plans and risk assessments had been regularly reviewed and updated when people's needs changed.

We spoke with five members of staff who were aware of the importance of treating people with respect and ensuring that people were always offered a choice.

The care of people had been assessed and care plans prepared. These were signed by people receiving the care which indicated that they agreed and understood their care plans. There was evidence that care plans and risk assessments were reviewed and updated where necessary.

We observed that the provider had an effective system to assess and monitor the quality of service that people receive.

Records we looked at were accurate and fit for purpose.

We looked at various care records and satisfaction survey forms and saw that people gave positive feedback indicating that the service improved the quality of their lives.

We also spoke with two members of staff on the telephone. They told us they were happy with the support and training that was provided by Peepal Care. They also told us they got on well with the people they provided care for.

We found that people were provided with information regarding the service and provided a flexible service to meet individual wishes and needs. We also found that there were appropriate procedures in place to safeguard people from abuse and to monitor the services in order to ensure people's welfare and safety.