Caresta Limited - Office 8, St Erth Business Park

Caresta Limited (trading as West Cornwall Care), provides people with personal care in their own homes. At the time of the inspection the service provided support for approximately 38 people for people in the Penzance, St Ives, Hayle and St Just in Penwith areas. The service works primarily with elderly people.

The service had a registered manager. 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. However a manager had recently been appointed, and an application had been submitted for the person to be registered with the Care Quality Commission. This was in order to meet its conditions of registration.

The service had satisfactory safeguarding policies and procedures to keep people safe. Staff were trained to recognise abuse, and what to do if they suspected abuse was occurring. Suitable risk assessment procedures were in place, and risk assessments were regularly reviewed. Where appropriate management and staff had submitted safeguarding referrals to the local authority.

Recruitment checks for new staff were satisfactory. For example, the registered provider obtained a Disclosure and Barring Service check and written reference check when the member of staff was recruited. When staff started to work at the agency they were required to complete a staff induction programme, which included relevant training which assisted the member of staff to carry out their job. The registered provider had a suitable system of staff supervision and annual appraisal.

Medicines procedures were safe, and we saw evidence that supported this, including administration records and systems to support people with medicines. Staff were trained in procedures to minimise the risk of infection. People and their relatives said staff were always well presented in thieir individual roles.. Staff said they were provided with disposable gloves and aprons to support them in their roles.

There were satisfactory procedures to assess people to check they were suitable to receive support from the service. Subsequently staff developed comprehensive care plans for people and these were regularly reviewed.

Where people received support to prepare meals. Procedures to monitor food eaten and fluid intake, if and where necessary, were satisfactory.

Where people lacked mental capacity, the agency provided people with the correct support to ensure their rights were protected.

Staff worked with people to maximise their independence. We received positive support about staff attitudes. Comments included; “They are very good,” “They are excellent, “ “I love them they are all very accommodating.”

The service had a complaints procedure. People said they would approach staff or management if they had a concern. People told us where they had raised concerns or complaints these had been managed sensitively and resolved appropriately.

Management were viewed positively by the people who used the service and staff who we contacted.

The staff team told us they worked well together. People and their relatives viewed staff positively and staff were viewed as caring.

Quality assurance processes were satisfactory to monitor the service was working effectively, and pick up and address shortfalls in service provision.

The service provides help with people’s personal care needs in Penzance, Hayle and the surrounding areas. This includes people with physical disabilities and dementia care needs. The service mainly provides personal care for people at key times of the day to help people get up in the morning, go to bed a night and support with meals and domestic tasks.

At the time of our inspection 54 people were receiving a service from Caresta.

We carried out this announced comprehensive inspection on 26 February 2016. We told the provider two days before this inspection that we would be coming. This was to ensure the registered manager and key staff were available when we visited the agency’s office. The service was last inspected in August 2014. The service was meeting the requirements of the regulations at that time.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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. The registered manager was also the provider and owner of the service.

People told us they felt safe using the service and commented; “I am very happy with the service” and “Very good staff.”

Staff had attended training in how to recognise and report abuse. Staff were clear about how to report any concerns within the service and were confident their concerns would be acted upon. Staff were able to access information in the service’s policy and procedure for reporting safeguarding concerns. Information on raising concerns was also present in each person’s service user guide, which was provided to people when they began to use the service.

There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. Staff were regularly allocated the same people to visit. This meant there was a familiarity and consistency in the way people received their care and support. The service was flexible and responded to people’s changing needs. People were very positive about the care provided by Caresta.

People were supported to take their medicines by staff who had been appropriately trained. People received care from staff who knew them well, and had the knowledge and skills to meet their needs. People and their relatives spoke positively of the staff and comments included; “They (staff) could not be more obliging” and “I have been thrilled with how they have cared for (the person).”

Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were kind and compassionate and treated people with dignity and respect.

The management and staff had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

The registered manager was very committed to continuous improvement and feedback from people, whether positive or negative. This was used as an opportunity for improvement. The registered manager demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service. The registered manager demonstrated strong values and a desire to learn about and implement best practice throughout the service.

There was a positive culture in the service, the management team provided strong leadership and led by example. Most staff had worked for the service for many years and they were motivated and clearly passionate about making a difference to people’s lives. Staff told us; “I love my job” and “I have been doing this work for many years and would not do it if I did not enjoy it so much.” The management team and staff told us they never missed a single visit and that people were contacted should their visits run late for any reason.

This inspection was carried by one inspector over one day. During the inspection, the inspector worked to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and staff told us.

Is the service safe?

At the time of our inspection we found the service was safe.

We found there were enough qualified, skilled and experienced staff to meet people's needs. We looked at the homes care rota for the month of July 2014 and found that the number of care staff consistently met the provider's own staffing levels.

The provider had suitable arrangements in place to ensure staff received appropriate training, supervision and appraisal and were encouraged to obtain further qualifications appropriate to the work they performed. This meant people's health and support needs were met by competent staff.

People we spoke with told us they felt safe when being supported by Caresta staff. One person remarked, 'They are a lovely bunch. I always feel well looked after and safe when they are here'.

Care documentation and risk assessments we looked at as part of the inspection demonstrated the provider recognised and documented the needs of each person supported by the agency. Thorough needs assessments had taken place prior to the agency providing support and these were regularly updated to ensure they were an accurate reflection of people's current needs.

The service had suitable arrangements in place which ensured people who used the service were safeguarded against the risk of abuse.

Is the service effective?

At the time of our inspection we found the service to be effective.

People's health and care needs were assessed and individual care plans were in place to guide and direct staff to meet a person's health and social care needs. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

There was a system in place to provide staff with supervision. Supervision is a formal process to help discuss working practices and addresses any improvements or on-going training that may be required.

Is the service caring?

At the time of this inspection we found the service to be caring.

People we spoke with told us they 'liked' staff from Caresta and felt 'genuinely cared for' by staff. Other comments included, 'I don't think I'd be able to stay at home if they didn't come. I'm looked after alright', and 'on the whole very good'.

One person told us the service had 'improved' since they had begun receiving more consistent carers to assist them at home.

Service communication records completed each time support is provided demonstrated staff acted appropriately in the recording of the support provided, were aware of the importance of upholding people's dignity and were respectful in the way they referred to people who were supported.

Is the service responsive?

At the time of our inspection we found the service to be responsive.

We spoke with people about whether staff came consistently when they were scheduled to. People told us, 'They are pretty good. Most of the time they come on time and if they get delayed it's not normally for a long time'.

We saw the service had a quality assurance system in place which aimed to gather timely and specific feedback about aspects of the service to ensure appropriate action could be taken to improve the service where necessary.

The agency arranged team meetings. These were used to raise any issues that needed to be discussed and ensure familiarity with the agency policies and procedures.

Is the service well-led?

At the time of our inspection we found the service to be well-led.

People told us they could always speak with the care manager or another senior member of staff if they needed to. Staff we spoke with confirmed they were satisfied with the quality of the leadership provided by Caresta Ltd.

You can see our judgements on the front page of this report.

People's privacy, dignity and independence were respected and people experienced care, treatment and support that met their needs and protected their rights.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service people received and there was an effective complaints system available.

We spoke with ten members of staff who worked for Caresta. They told us that they were supported by the agency in order to carry out their work. They said that they could ring the office or on call staff at any time for assistance and that this was helpful to them. We were told that there were always care plans in the home of people who used the service to guide them with the care that was needed to be given. Positive comments were received regarding the training provided to them.

We were told that two members of staff had not met with their manager for supervision to discuss their work. We saw from written evidence in the office that a programme of supervision had recently been started for all staff.