Care at Home Services (South East) Limited – Bexhill, Hastings and Rother

Care at Home Services (South East) Limited – Bexhill, referred to as Care at Home in this report, is a domiciliary care agency providing personal care to approximately 183 people at the time of our inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks relating 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

Care at Home had strong person-centred values and placed people at the heart of their work. People had access to staff who knew them well and achieved positive outcomes and strong relationships.

People were supported by kind and caring staff who worked hard to promote their independence and sense of wellbeing. People told us they enjoyed the company of staff with comments including; “They give me lots of company; we have a lot of laughs. I look forward to them coming”, “I adore my carer” and “It’s like having friends arrive, they are all very kind, I can’t fault the carers.”

Most people and relatives spoke highly of the overall service they received from Care at Home. People made comments including; “I would recommend the service. They are all really helpful; can’t fault them. Nothing is any trouble” and “I would recommend the company to others; they are very good. I would and do trust them.” A small number of people we spoke with were not as complimentary and raised concerns with us relating to rota changes and the responsiveness of the office. These concerns were shared with the registered manager who provided us with assurances and told us they would look into these people’s complaints further.

People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable to abuse and avoidable harm.

Risks to people’s health, safety and wellbeing were assessed and action was taken to minimise the risks. During our inspection we identified some shortfalls in the detail available within people’s risk assessments and management plans. We also identified staff lacked clear accessible guidance relating to ‘as required’ medicines. However, immediate action was taken to improve in these areas, staff were knowledgeable about people’s needs and people were confident staff were competent when managing their medicines.

People were fully involved in their care and their wishes were respected. People’s views were sought and their consent was always gained before any care took place. 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.

There was strong leadership at the service and people, relatives and staff spoke highly of the registered manager. There was a positive culture at Care at Home and staff felt their voices were listened to.

Care at Home’s management team were passionate about improving the service and had plans for future projects to benefit people. There were quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided.

We have made a recommendation about comprehensive risk assessments being in place.

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 14 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The agency provided 200 people with a domiciliary service, which was for approximately 1,870 hours a week. Most people were older people or people who lived with long-term medical conditions. People received a range of different support in their own homes. Some people received occasional visits, for example weekly support to enable them to have a bath. Other people needed more frequent visits, including daily visits, and visits several times a day, to support them with their personal care. This could include two care workers and the use of aids to support their mobility. Some people needed support with medicines and meal preparation. The agency also provided some people with care workers at night, including for sleeping-in duties and care workers who remained awake for some or all of the night.

Care at Home – Bexhill, supplies a service to people in the Sussex town of Bexhill, and surrounding rural areas. The provider is Care at Home Services (South East) Limited who provide domiciliary care services to people from different offices in the South East of England.

Care at Home – Bexhill had 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.

Care at Home - Bexhill was last inspected from 23 November to 21 December 2015. At that inspection, it was rated as requires improvement. The service was in breach of Regulations 12, 17 and 19 of the HSCA Regulations 2014 which relate to safe care, quality of care and recruitment of staff. Following the inspection, the provider sent us an action plan to outline how they would address these areas. At this inspection, we found the provider and registered manager had been successful in making the necessary improvements.

The provider had ensured the safety of people and others by developing its risk assessment and care planning processes. Staff we spoke with were aware of people’s risks and how they were to be reduced. This included, among other areas, supporting people with moving safely and reducing their risk of pressure damage.

People’s safety when taking medicines had also been ensured. Care workers now had clear information on people’s medicines and accurately completed records when they had supported people in taking them.

The provider had audited its recruitment processes and ensured new staff were safely recruited, to reduce risk to people as much as possible.

The provider’s systems for reviewing quality of care had been improved, to include regular audit of a wide range of areas of service provision. The opinions of both people and staff were sought, using a variety of means, and action had been taken when relevant following comments made by people and staff. Any complaints and concerns raised by people were documented and actions taken where needed.

People and staff said there were no issues about missed calls due to staff shortages. The visit rotas showed the provider had successfully reduced the number of very late or very early visits to people during the past year. The provider had also introduced systems to ensure people received improved continuity of care from the same team of care workers.

People said they were fully involved in developing their own care plans. Staff told us people’s care plans gave them the information they needed to meet people’s needs. Where a person’s needs changed, their care plans were up-dated to reflect their current needs.

People said staff respected their wishes and supported their independence. People spoke warmly about the supportive nature of staff and how they respected their privacy and dignity. People said staff knew how to support them if they became unwell. Where people needed support with eating and drinking, they said staff were supportive and flexible.

We carried out an inspection at Care at Home, Bexhill on 3 February 2014 and found the provider did not have an effective system to regularly assess and monitor the quality of service that people received. We also found people had not been protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had not been maintained.

Following our inspection we met with the provider on 13 May 2014 to discuss our concerns. The provider sent us an action plan that informed us they were making changes to ensure these issues had been addressed. We carried out a further inspection on 15 September 2014 and found that the provider had not achieved compliance. We met with the provider on 30 September 2014 and we issued a warning notice, which stated that the Care Quality Commission required the provider to have achieved compliance with the warning notice by 6 November 2014.

From the information gathered during the inspection 21 November 2014 we found the provider had met the requirements of the warning notices, although some of the processes required time to be fully embedded into practice.

We saw that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. The provider did not have an effective system to regularly assess and monitor the quality of service that people received. We also found that people had not been protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had not been maintained.

We looked at people's care files and saw that their consent had been gained when they started to use the service.

We saw that care plans did not always reflect the current needs of people who used the service.

Staff were aware of their responsibilities in relation to safeguarding people.

We looked at medication records and saw that the provider did not have appropriate arrangements in place to manage medicines safely.

We looked at staff files and saw that appropriate checks were undertaken before staff commenced work.

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.