Clarendon Home Care

Clarendon Home Care is a domiciliary care service and is registered to provide personal care and support to people 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, 82 people were receiving personal care and support.

People’s experience of using this service

There was a continued breach of regulation in relation to staffing. We received mixed feedback about staff punctuality and the amount of time they spent with people when providing care. People and their relatives commented, “Sometimes they are late by half an hour to one hour”; “Other carers are erratic and turn up an hour to two hours late”; “Staff can be abrupt as they are in a hurry.” Other comments included, “Usually the carers are on time”; “Generally, it’s not a problem” and “Our regular carer is on time and stays the whole time.”

Systems were in place to monitor the quality of care people received. However, the electronic system used to monitor staff attendance on their calls did not always work as intended. Despite this, there had not been any missed calls. The registered manager and provider were aware of the problems and told us they were working to resolve the issues.

People felt they were safe with the care and support provided. Comments included, “I feel completely safe and well looked after by them”; “The care is 100% safe”, “I’m OK with the carers” and “[Carers] know me and my needs. I feel safe with them. They hoist me and it’s done safely”.

People’s needs were met. People told us, “I definitely get the care I need”; “Staff have been fantastic” and “They make sure [person] is cared for well”. Staff knew how to identify and report abuse and were trained in safeguarding of vulnerable people. Risk assessments and management plans were in place which enabled staff to provide care safely. Safe recruitment checks were undertaken to ensure suitable staff were employed at the service. People received the support they needed to take their medicines safely. Staff knew how to minimise the risk of infection when providing care.

The majority of relatives, people using the service and staff were happy with the management of the service. People were asked to provide feedback about the service, although they said opportunities to do so were limited at the height of the COVID-19 pandemic. Audits were carried out to monitor and improve the quality of the service.

Accidents were recorded and monitored and discussed with staff to minimise a re-occurrence. The provider worked in partnership with other professionals and agencies to meet people's care needs.

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 the service was requires improvement (published on 22 December 2020) and there was a breach of regulation. The provider also completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the registered manager had increased oversight of staffing and quality assurance processes to ensure people received the care they needed. Despite the improvements made since our last inspection, more work was required to ensure adequate staffing levels and consistency in the delivery of care.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

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.

At this inspection we identified a continued breach in relation to ensuring sufficient suitably qualified staff were deployed to meet the needs of people using 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 work alongside the provider and 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.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

Clarendon Home Care is a domiciliary care service and is registered to provide personal care and support to people 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 the inspection the service supported approximately 112 people.

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

We found people were sometimes placed at risk of avoidable harm. The provider had not always ensured people received safe care. The provider assessed people’s needs prior to supporting them. However, care was not always consistently delivered in a safe manner as indicated in people’s care plans. Some care packages that required two members of staff were delivered by a single person. There were instances of missed and delayed calls. Procedures to ensure staff were adequately deployed had not been robustly followed. Improvements were required to ensure people had support from sufficient numbers of staff and to reduce the risk of missed calls.

The provider had systems and processes in place to support the delivery of care. However, the quality monitoring and assurance processes were not used effectively to provide a consistent standard of care.

Most people and their relatives felt safe with the care and support delivered. People had mixed views about the response to their concerns regarding delayed/missed or shortage of staff on their calls.

Staff understood their responsibility in relation to infection prevention and worked in a safe manner to reduce the risk of spread of infection.

The management team were responsive during the inspection and were working in strengthening the systems to address staffing issues.

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

Rating at last inspection

The service was registered with us on 3 December 2010.

The last rating for the service was good, published on 2 May 2019.

Why we inspected

The inspection was prompted in part due to concerns received about staffing. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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 a breach in relation to insufficient numbers of staff deployed to provide care at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will review the action plan we have requested from the registered provider. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

People’s experience of using this service:

• The service meets the characteristics of a good service and therefore we have rated it ‘Good’ overall and for all five key questions, ‘Is the service safe, effective, caring, responsive and well-led?’

• People told us they were happy with the overall standard of care and support provided.

• People received a home care service from staff who were in the main suitably trained and supported to meet their personal care needs. However, additional training was needed for staff who supported people with specific needs.

• Risks to people had been assessed and were regularly reviewed to ensure people’s needs were safely met. People were protected from avoidable harm, discrimination and abuse.

• Appropriate recruitment checks took place before staff started working for the service.

• The agency had procedures in place to reduce the risk of the spread of infection.

• Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

• Where people needed assistance with taking their prescribed medicines this was monitored and safely managed in line with best practice guidance.

• Staff routinely sought the consent of the people they supported. Managers and staff adhered to the principles of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.

• People were supported to maintain a balanced diet where staff were responsible for this.

• People received the support they needed to stay healthy and to access health care services as and when required.

• We noted in people’s daily records that in some cases care workers did not always stay for the whole of the allotted time. We have made a recommendation to the provider to review this practice.

• People received support from staff who were kind and compassionate. Staff treated people they supported with dignity and respect and ensured people's privacy was always maintained particularly when supporting people with their personal care needs.

• People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives. People, and where appropriate their relatives and professional representatives, were involved in discussions and decisions about the support they would receive.

• People's concerns and complaints were dealt with by the provider in an appropriate and timely manner. The provider had effective systems in place to assess and monitor the quality of the service people received.

• The service was well-led and management support was always available for staff when they needed it. There was an open and transparent and person-centred culture.

• People, their relatives and staff were all asked to share their feedback about the service.

• The provider worked in partnership with other health and social care professionals and agencies to plan and deliver an effective home care service.

Rating at last inspection:

At our last inspection, the service was rated Good overall and Requires Improvement in Safe. Our last report was published on 27 September 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 and to see if the provider had improved Safe to Good.

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

Clarendon Home Care provides a domiciliary care service to over 200 people living in Kingston and the surrounding area. This includes personal care such as assistance with bathing, dressing, eating and medicines, home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties. We only looked at the service for people receiving personal care during this inspection as this is the service that is regulated by the Care Quality Commission.

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.

The provider had arrangements to administer medicines and overall these were safe. In some circumstances staff had not always sign the medicines administration records charts to say they had administered the medicines. There were also no protocols in place where people were prescribed a variable dose of medicines so staff were clear when to administer the relevant dose.

People on the whole received visits according to their care plan. Some people said they did not receive the same care workers consistently and at times the care workers were late and they were not informed. The registered manager had a plan to address these concerns.

People told us they felt safe with the support they received from staff. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place to inform people who used the service and staff how to report potential or suspected abuse.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe. The provider ensured there were safe recruitment procedures in place to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Staff received training in areas of their work identified as essential by the provider. We saw documented evidence of this. This training enabled staff to support people effectively.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. Records showed people were involved in making decisions about their care and support and their consent was sought and documented.

People were involved in planning the support they received and their views were sought when decisions needed to be made about how they were supported. The service involved them in discussions about any changes that needed to be made to keep them safe and promote their wellbeing.

Staff respected people’s privacy and treated them with respect and dignity. Staff supported people according to their personalised care plans.

The provider encouraged people to raise any concerns they had and responded to them in a timely manner.

Staff gave positive feedback about the management of the service. The registered manager was approachable and fully engaged with providing good quality care for people who used the service.

The provider had sent out to staff and people the core company values to “Promote a flexible, service user centred approach to care provision”.

The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions and action plans were developed where required to address areas for improvements.

During this inspection we found improvements had been made to reduce the risks to people who used the service. We saw that a system that highlighted priority visits to people who required time sensitive care had been implemented. A quality assurance team were now responsible for ensuring up-to-date information was kept in people's homes. Appropriate arrangements were in place for the safe administration of medications although we found some gaps in medication record keeping. We saw that medication records were not completed to indicate when a visit had been cancelled.

A structured quality audit process had been implemented and monthly audits were conducted to check that records were being recorded correctly. However we found the new processes required improvement as some audit sheets did not include the outcomes of audit investigation. Changes to record management had been implemented.

Most people told us they were consulted and included in discussions about their care. One person said 'I did get a say in my care plan which was good and was consulted throughout'. People said they were supported in promoting their independence and treated with dignity and respect. 'Absolutely they help me do as much as I can for myself and treat me appropriately for my age'.

We saw completed risk assessment documents and care plans which showed that people had their needs assessed. People commented positively about the care workers who attended to them regularly, "We build up a relationship with people who come in regularly". Late attendance of care workers and not being informed was cited a consistent problem by the majority of people we spoke with.

Staff received induction and annual refresher training in line with the roles they performed, one care worker said, "The training is pretty good". The provider had systems in place to assess the quality of service provided, although we found gaps in the quality of audits they conducted. The quality of manual care records we reviewed were inconsistent.