C & S Homecare Limited

About the service

C & S Homecare Limited is a domiciliary care agency which provides personal care at home services. The service mainly provides support to older people but can also support people who have learning disabilities and autistic people. At the time of our inspection there were 41 people receiving a personal care service from C & S Homecare Limited.

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

Right Support

Staff focused on people’s strengths and promoted what they could do, so people could maintain their independence as far as possible. Staff communicated with people in ways which met their needs. Staff supported people with their medicines in a safe way and supported people to access community health services when necessary.

People were supported to have maximum choice and control over the care they received from the provider 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.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply their knowledge. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People’s risk assessments and care plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life.

Right Culture

People received good quality care, support, and treatment because trained staff could meet their needs and wishes. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff placed people’s wishes, needs, and rights at the heart of everything they did. People, and those important to them, were involved in planning their care.

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 21 August 2018).

Why we inspected

We undertook this focused inspection to check whether the previous rating was still accurate, given the length of time since the last inspection. We reviewed the key questions of Safe and Well-led only. 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 remained Good, based on the findings of this inspection

Follow up

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

The inspection took place on 26 July and 1 August 2018 and was announced. At the last inspection we rated the service overall as ‘Requires improvement’ at this inspection we saw the required improvements had been made.

This service provides care at home to older adults and younger adults living with a range of health conditions and needs to live independently in the community within the Alfreton area. 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. At the time of our inspection, thirty people were receiving personal care as part of their care package.

C and S Homecare had a registered manager in post, who was also the owner and provider in partnership with their husband. 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 received a service which was safe. We saw that staff understood how to keep people safe and knew how to report any concerns. Risk assessments had been completed to cover all aspects for people’s care, including any equipment they required to support them when transferring. People received consistent staff who had received the appropriate recruitment checks. Staff knew how to handle medicine safety and to reduce the risks of infection.

The latest guidance was available to support staff to understand specific conditions. Staff had received induction and ongoing training for their role. When people received support with meals this was done through choice and dietary needs. People’s health care was monitored supported in this area when required. 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 told us they had established positive relationships and this made all the difference to the care they received. Respect and dignity had been maintained along with supporting people to remain as independent as they were able to be.

There was a responsive approach to people’s needs. The hours of support were flexible to meet people’s needs on a week by week basis. The care plans were detailed and included information in relation to people’s equality needs and information access. When complaints to the service had been received they were investigated and responded to formally with an apology and an outcome.

The service was supported by a registered manager who understand the regulations and ensured we received notifications and information in relation to these. People’s views had been obtained through a questionnaire and when they received a review of their care.

A range of audits had been used in relation to care plans and medicines management. Staff felt supported and enjoyed working for this provider. Partnerships had been established to support the needs of people’s making the links with health and social care professionals.

The service was last inspected on 6 and 7 January 2016, when we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have systems in place to assess, monitor and improve the quality and safety of the service. The provider sent us their action plan, and on this inspection, we found improvements had been made.

The service had a registered manager in post at the time of our inspection, who was present during 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.

People were not consistently protected from the risk of avoidable harm. Risks associated with people’s health needs were not always identified to enable appropriate measures to be taken to minimise risk of avoidable harm. The provider’s auditing systems did not identify this shortfall to enable action to be taken. On this inspection, the registered manager took immediate action to address this.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. However, the systems had not identified several issues in relation to the quality of record-keeping. Again, the registered manager took immediate action to address this.

People were happy with staff who provided their personal care. They felt safe and were confident staff had the skills to provide care appropriately. People were cared for by staff who understood how to meet their individual needs, and were supported to access health and social care services when necessary. People were supported by staff in a caring way, which ensured they received personal care with dignity and respect.

The provider took action to ensure that potential staff were suitable to work with people needing personal care. Staff received supervision and had checks on their knowledge and skills. They also received training in a range of skills the provider felt necessary to meet the needs of people at the service. The provider did spot-checks on staff providing personal care to ensure care was of the quality the provider expected.

People received their medicines safely, and staff worked with health and social care professionals to ensure that people received appropriate healthcare and treatment in a timely manner.

People’s rights were upheld in relation to consent to personal care. Appropriate arrangements were in place to check whether people were able to consent to their care. The provider met the legal requirements of the Mental Capacity Act 2005 (MCA).

People were involved in their care planning and delivery. The support people received was tailored to their individual needs and wishes. People and their relatives felt confident to raise concerns in relation to the quality of care. The provider had a complaints procedure to ensure issues with quality of care were addressed.

C & S Homecare provides personal care to people in their own homes. Care and support is provided to older people, some of whom have dementia, and also people with physical and other disabilities. As part of the inspection we spoke with the registered manager and administrator working at the service and examined records relating to the service provided.

Below is a summary of what we found.

Is the service safe?

The provider was not fully ensuring risks to peoples' welfare and safety were identified and managed. Risks were not always identified promptly and appropriate action taken for the planning and delivering safe care.

Systems in place for responding to emergencies that could affect the delivery of peoples' care were not fully sufficient.

The provider was not using appropriate procedures to ensure suitable staff were recruited to provide people with safe and appropriate care.

Is the service effective?

Care plans were in place at the service. Records about people's care needs did not contain information about any diagnosed health conditions or disabilities.

Some risks that could affect people had not been adequately assessed and managed as part of the care planning process. This meant that care had not fully met people's individual needs. The way care was planned and delivered did not ensure people were appropriately supported with their medication.

Is the service caring?

Care plans were brief and focussed on care tasks the would be completed by staff. Care planning did not always take account of people's wishes, preferences and routines relating to their care to ensure they received personalised care that met their needs.

Is the service responsive?

The service has a complaints policy that was made available to people receiving care.

Some systems were in place for obtaining people's views about the service provided.

Surveys about the quality of their care were sent to people every year but information was not collated and results produced.

The registered manager told us staff were consulted about practice at the service in team meetings but no records were available at the office to confirm this.

We saw systems were not in place to ensure action was taken in response to any incidents or risks that occurred.

Is the service well-led?

The registered manager did not have an effective system for identifying and managing risks or provide an overview of current concerns or areas of development at the service.

Care planning was not adequately detailed to ensure people receiving personalised care that met their needs.

Systems were not adequate for analysing incidents that could cause harm.