Caterham Domiciliary Care Agency

About the service

Caterham DCA is a domiciliary care agency providing personal care to people living in their own homes and supported living settings. The service provides support to people with a variety of health needs. At the time of our inspection there were 31 people using the service. 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. There were 14 people being supported by staff with personal care.

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

Right Support: Some areas of concern were identified with the assessment and management of risks and the effectiveness of the safeguarding policy which left people at risk of abuse. 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.

Right Care: People were receiving care and support in a person-centred way. The care promoted people’s dignity, privacy and human rights. People’s care was provided in line with their preferences and choices.

Right Culture: Some of the management oversight was not completely effective, however, other areas were. For example, we found audits including accidents and incidents and safeguarding concerns had not been effective. Whereas staff competencies were checked regularly and the registered manager had oversight of this. Staff were aware of the values of the provider and ensured people led confident and inclusive lives. Staff treated people with kindness and were caring when offering support.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 July 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The provider was also issued a warning notice in relation to good governance. At this inspection we found some improvements had been made, however, some concerns were found which meant they remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The second day of an inspection visit was prompted in part due to concerns received about safeguarding service users from the risk of abuse. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding service users from the risk of abuse and good governance at this inspection. Since the last inspection we recognised that the provider had failed to keep people safe from risks and the risk of abuse. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Caterham Domiciliary Care Agency provides personal care and support to older people and people with mental health support needs living in their own homes. 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. At the time of our inspection the service was supporting 14 people living in two supported living settings, three of whom received the regulated activity. In addition, a further 19 people living in the community received support with their personal care.

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

Systems to monitor the quality of the service provided were not always robust and effective. The provider had not ensured audits and quality assurance systems were completed consistently in order to assure themselves people were receiving a safe and effective service. Staff competence was not regularly reviewed to monitor the care people received.

Safe infection control systems were not always followed. Guidance in relation to the completion of risk assessments and social distancing within the office environment had not been robustly implemented. This put people at an increased risk when office staff visited people in their homes.

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. However, a consistent approach to the recording of how decisions were reached was required. We have made a recommendation in relation to this.

In other areas we found improvements had been made to the quality of service people received. Safeguarding reporting systems had been implemented and staff were aware of their responsibilities to report concerns. Staff recruitment checks were in place to help ensure safer recruitment decisions. People told us that staff arrived for their visits at the scheduled time and stayed for the duration of the call. Risks to people’s safety were assessed and accidents and incidents acted upon to reduce the risk of the happening again.

Staff training in key areas including person centred care and safeguarding had been updated. Staff told us they felt supported in their roles and could ask for support from the provider at any time. Staff meetings took place regularly and action plans developed for staff to follow.

People told us staff were kind and supported them in line with their needs. Assessments were completed prior to people receiving support to ensure their needs could be met and care plans contained personalised information. Where people required support with nutrition and hydration this was clearly documented and known to staff. Positive links had been established with healthcare professionals involved in people’s care.

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

Rating at last inspection and update The last rating for this service was requires improvement (published 8 April 2019) and there were multiple breaches of regulation. We completed a targeted inspection of the service (published 26 October 2020) to look at specific concerns in relation to people’s care and there were continued breaches of multiple regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found that although improvements had been made in a number of areas, there were three continued breaches of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 27 February 2019. Breaches of legal requirements were found. We carried out a targeted inspection on 18 June 2020 due to concerns we received relating to incidents of alleged abuse and to review the progress made by the service to become compliant with the multiple breaches. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, fit and proper persons employed and good governance. In addition, the provider sent monthly updates to CQC highlighting the improvements they had implemented.

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 which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains Requires Improvement. 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 for Caterham Domiciliary Care Agency on our website at www.cqc.org.uk.

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 continued breaches in relation to safe infection control practices, the monitoring of staff performance and the management of the service at this inspection. Please see the action we have told the registered provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Caterham Domiciliary Care Agency provides personal care and support to people living in their own homes. This includes three people in supported living accommodation owned by the provider. Services are provided to older people, those with a mental health diagnosis, physical and learning disabilities and sensory impairment. 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. At this inspection we focused on the people that lived in the property owned by the provider who were in receipt of the regulated activity ‘personal care’.

People’s experience of using this service:

People were not being protected from the risk of abuse. There had been instances of abuse from staff where the provider and registered manager had doubts about their suitability to work in the supported living home. Risk assessments were not always detailed around the needs of people with a mental illness or those that had a behaviour that challenged. Incident forms were not being completed in relation to incidents of behaviours. There were other risk assessments present that gave guidance to staff for example on moving and handling and people’s skin integrity.

The recruitment of staff was not robust and training and supervision for staff was not always effective in ensuring good care. The registered manager was not following good practice in relation to infection control particularly around COVID 19. Consent was not always being obtained from people where necessary and where people lacked capacity the principles of Mental Capacity Act 2005 were not being followed.

Pre-admission assessments did not always take place and care plans did not always contain accurate information about people. The leadership at the service was not robust and appropriate quality assurance was not taking place.

Rating at last inspection:

The last rating for this service was requires improvement (published 8 April 2019) and there were multiple breaches of regulation. At that inspection we identified breaches in relation to the lack of choices around the care provision, the lack of detailed care planning, the quality and safety of people’s care, training and supervision of staff, the principles of the Mental Capacity Act not being followed, and the lack of quality assurance undertaken at the service.

Why we inspected:

We undertook a targeted inspection due to concerns we received relating to incidents of alleged abuse and to review the progress made by the service to become compliant with the multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report only covers findings in relation to care which people received, safe care and treatment, safeguarding people from abuse, consent to care, staffing and quality assurance. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement:

We have identified continued breaches in relation to the safety of care provided and the quality assurance of the service.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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. We will continue to work with the local authority to monitor progress.

People’s experience of using this service:

Staff were not always ensuring that the risks to people were assessed. Care plans did not always have guidance on how to reduce the risks to people. The management of medicines was not always undertaken in a safe way and there was no evidence that staff were competently assessed in relation to medicines administration. There was no formal recording of accidents and incidents and no evidence that they were being analysed for trends.

People’s rights were not always being protected as staff were not working within the principles of MCA. Staff required more detailed training and supervisions to ensure that they were providing the most appropriate care.

People and their representatives were not always informed of the choices around the care delivery. There was not always detailed guidance for staff around the specific needs of people. Daily notes were task focused and did not provide detail on the person’s care. Quality assurance systems were not robust and the provider and registered manager lacked understanding of the requirements of the regulations.

People and their relatives were complimentary about the caring nature of staff. People were supported to access health care when they needed. Staff always turned up to the call and stayed for the duration of the call. People said that staff treated them with dignity and respect. Staff said they felt supported and valued by the management team. People fed back positively about the leadership of the service.

Rating at last inspection: Good. The last report was published on the 12 August 2016.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: Action we told provider to take (refer to end of full report)

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

The inspection took place on 29 and 30 June 2016. The provider was given twenty-four hours’ notice of the first inspection day.

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.

Staff had a positive and caring attitude about their jobs. People told us that they were happy with the care and support they received. When asked about the service one person said it was, “First class, I am well looked after.” Another person said, “The service is everything I expected it to be, everything I need they do.” All the staff we spoke with were extremely happy in their work and proud of the job they do.

People received a safe service from the Caterham Domiciliary Care Agency. There were sufficient numbers of staff who were appropriately trained to meet the needs of the people who used the service. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding board or the police.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

Staff recruitment procedures were robust to ensure staff were suitable to support people. The provider had carried out appropriate recruitment checks before staff commenced employment. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

People were supported to have enough to eat and drink. They received support from staff where a need had been identified. People’s dietary support needs were recorded and met by the staff.

People were supported to maintain good health. When people’s health deteriorated staff responded quickly and made sure they received appropriate treatment.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout our inspection. When people visited the office staff talked with them and showing interest in what they were doing. When we visited a supported living home, the same positive interactions were seen. The staff knew the people they cared for as individuals, and had a good rapport with relatives, giving a family feel to the service.

People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical, psychological and emotional needs. They gave a good level of detail for staff to reference if they needed to know what support was required.

People knew how to make a complaint. When complaints had been received these had been dealt with quickly and to the satisfaction of the person who made the complaint. Staff knew how to respond to a complaint should one be received.

The provider had effective systems in place to monitor the quality of care and support that people received. Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the service. The registered manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained.

Records for checks on health and safety, and medicines audits were all up to date. Accident and incident records were kept, and were analysed and used to improve the care provided to people. The senior management from the provider regularly visited the home to give people and staff an opportunity to talk to them, and to ensure a good standard of care was being provided to people. One person said, “Everybody that has come here has always been very nice and friendly.” A staff member said, “I can honestly say I have been happiest working here, it has a family feeling and it’s not all about the money for the management, they truly care for the people.”

At our last inspection we found that people who used the service had not been involved in the development of their care plans and that the provider had not assessed whether people had the mental capacity to make decisions for themselves. There was no evidence that the provider had not developed contingency plans to ensure that people would continue to receive care in the event of an emergency. We found that the provider not obtained appropriate references for all staff employed. We also found that, although the provider had distributed satisfaction surveys to people, there was no system in place to collate the results of the surveys, record the action taken as a result and to feed back to people who used the service.

At this inspection we found that the provider had increased the involvement of people in the development of their care plans and had introduced mental capacity assessments. The provider was able to demonstrate that appropriate references had been obtained for all staff and that contingency plans for use in an emergency had been developed.

Almost all the people who used the homecare service and their relatives provided positive feedback about the service they received from the agency. They said that they received their care from regular care workers, which was important to them, and that their care workers almost always arrived on time. People gave positive feedback about the care workers who provided their support. One person said of their care worker, 'She looks after me very well. I'm very lucky to have her.' Relatives also spoke highly of the homecare service. One relative told us, 'The care has been fantastic. I'd recommend them to anyone' and another said, 'I'm confident in the staff. They're very proficient in what they do and they listen to the client, which is the most important thing.' One relative told us that they had raised a concern with the provider about their family member's care. The relative said that they were dissatisfied with the provider's initial response but that the service was now 'improving.'

People who lived in properties owned by the provider told us that they felt safe and secure where they lived. They said that they knew and liked the care workers who supported them. One person told us, 'I feel settled here' and another said, 'I'm happy, I've got nothing to complain about.'

We checked a sample of care records in each of the properties owned by the provider and found that each person had an individual care plan. However we found that some people's care records did not contain all the information required to ensure that people received safe and appropriate care. We also found that some care staff were not aware of the content of people's care plans, which meant that people were potentially at risk of receiving inappropriate care because staff were unaware of how people needed and preferred their care to be provided.

We found that there were systems in place to obtain the views of people who used the service. However we found that the provider had not developed a system to assess and monitor the quality of service that people received. This meant that the provider could not assure themselves that key aspects of the service were functioning effectively and that people who used the service were receiving the care and support they required.

We spoke with the provider, registered manager, assistant manager, administrative staff , five care staff, three relatives of people who used the service and seven people who received care from the service.

People we spoke with all made very positive comments about the staff and care they provided and said the staff were caring and treated them well. People also said that they were usually supported on time and by staff familiar to them. They had no complaints but knew how to make one if they needed to.

One relative of a person who used the service told us they had tried other agencies before and they had cut time short, but this one never does. They said the staff never made their relative feel rushed and would even stay longer if there is a need.

All of the relatives and people receiving a service we spoke to told us they had received quality questionnaires but had not yet seen any feedback from the agency as to what quality issues had arisen from the questionnaires and what the organisation was going to do about them to improve quality.

Staff told us that travelling time between visits, being able to stay longer if needed, reliable company cars being provided for staff, as well as the way staff felt highly supported, all contributed to timekeeping, meeting call times and general reliability of visits.

We found that before people received any care or treatment they were asked for their consent but where people did not have capacity the provider did not act in accordance within legal requirements.

We saw people experienced care, treatment and support that met their needs and protected their rights but there were no written procedures in place to plan for any foreseeable emergencies. This meant that if an emergency situation did occur there would be no procedures known to staff to mitigate the risks that may arise and facilitate continuation of safe appropriate care.

We noted that people who used the service were not cared for and supported by staff who had appropriate checks undertaken before they began work, to ensure they were suitable to work with the people the service supports.

We found that although the health and safety of people was reviewed and audited, there was no quality assurance system in place to record the findings of quality questionnaires, analyse the results, identify and record action to improve quality and feed back to the people who use the service, and the provider did not always protect people as they did not complete follow up action required following disciplinary hearings.

The people we spoke with said they received the care and support they needed in a timely way. One person said, 'I get the care and support I need when I need it." They said they were supported with their health care needs (where appropriate) by staff.

The people we spoke with had some support to make sure they took their medication on time and as their doctor prescribed. They were happy with this arrangement and said their medicines were given out safely. One person said, 'I have tablets which the staff look after for me. They bring them to me when I need them and a glass of water. The staff make sure I have taken them.'

We found staff were recruited safely and people were protected against staff who were not suitable to work with them.

Complaints were recorded and thoroughly investigated to make sure people were safe and protected. People had confidence concerns would be responded to. One relative said, 'The staff are all very nice, I have never been worried. They care for (my relative) so well. If I complained I know they would sort it out, but I don't need to (my relative) is looked after so well.'