South Western Care Services

South Western Care Services is a care agency which provides short visits to support people living in their own homes. At the time of our inspection the service was supporting approximately 40 older people. 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

The service ‘s recruitment practices were safe and there were enough staff available to provide all planned care visits. Since our last inspection managers had introduced a new weekend rota to enable people’s needs to be met by a reduced number of staff. People were informed of these arrangements before they joined the service. We have recommended the service reviews these arrangements with the aim of improving the consistency of people’s planned visit times.

Staff used a digital call monitoring system to record their arrival and departure times from each planned care visit. This data was monitored by office staff to ensure all planned visit were provided. No-one reported having recently experienced a missed care visit and staff told us, “There have not been any missed visits that I know of.”

Call monitoring records showed most people received their visits on time and people told us the service’s performance in this area had improved. Comments from people and staff in relation to visit times included, “They are always on time", "The timing has got better" and “The rotas are fine, I don’t have to rush.” We found the service’s rotas were well organised and included appropriate amounts of travel time between care visit.

Staff had received safeguarding training and understood how to protect people from all forms of abuse or discrimination. Risks were assessed and the service had made timely, appropriate referral to professionals for additional support where issues of possible self-neglect had been identified.

Staff had the skills necessary to meet people’s needs and there were appropriate procedures in place for the induction of new members of staff. Staff told us there were well supported and records showed they received regular supervision, spot checks and annual performance appraisals. In addition, team meetings were held regularly and included on staff rotas.

Staff supported people to maintain their independence and respected people’s decisions and choices. Manager and staff understood the requirements of the Mental Capacity Act and worked with relatives to ensure any decisions made on behalf of people who lacked capacity were made in their best interest.

People described their support staff as jovial, caring and friendly; and professionals told us staff went, “the extra mile” to ensure people needs were met. Comments from people and in relation to the staff team included, “They show lots of patience", "They are all very friendly" and "They chat with me and the staff listen to me."

People’s care plans were accurate and informative. They provided staff with enough guidance to meet people’s needs. This included information about the person’s background and life history and details of the tasks people were normally able to do for themselves. This helped staff to get to know people and recognise any changes in their individual needs.

The service had appropriate quality assurance systems in place and records showed all complaints received had been investigated and resolved. Feedback questionnaires were completed regularly and people’s comments on the service’s current performance were positive.

A registered manager had been appointed since our last inspection and the provider was no longer leading the service. Staff told us the service’s leadership team were effective and professionals were also complimentary of the service’s management.

Rating at the last inspection

The last rating for this service was Requires improvement. (Report published 21 March 2019) and there was a breach of the regulations in relation to staff recruitment checks. That responsive inspection was carried out to follow up on actions we told the provider to take following previous comprehensive inspection report published on 19 October 2018. Improvements identified in March 2019 inspection report have been sustained and the service has now been rated good in all areas.

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 focused inspection took place on the 1 and 2 November 2018. This inspection was done to check the provider had taken the action necessary to achieve compliance with the warning notice issued following our comprehensive inspection of June 2018. The team inspected the service against two of the five questions we ask about services: Is the service well led? and Is the service safe? The inspection was announced because we wanted to speak with people about the quality of support they received before completing the site visit.

Not everyone using South Western Care Services receives a regulated activity; 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.

The service is led directly by the provider who is based in the service offices full time and is not required to have a registered manager. The provider is legally responsible for ensuring the service is meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

In response to the findings of our previous inspection the provider had returned care packages, in outlying areas, to commissioners for allocation to other service providers. This had allowed the service visit schedules to be redesigned and a new digital visit scheduling system had been introduced. This system used on-line route planning software to calculate the distance and time necessary to travel between consecutive care visits. At this inspection staff told us their rotas were now achievable and their comments included, “I feel the rotas have changed a lot. They have really looked in to sorting out the rounds”, “It does feel like it has improved. We used to have to rush. It now has about the right amount of travel time on the rota” and “Travel time is fine. No issues there, that has been sorted. Visit times have got better as well as you don’t have to rush around.” We reviewed the service visit schedules and individual staff rotas and found they now included appropriate travel time between care visits.

Most people we spoke with said they now received their visits on time and for the planned duration. They told us, "They are always on time, they are very good" and "The timing is good and we get to see the same carers." We completed a detailed analysis of 961 care visits completed in October 2018. We found that over 72% had been provided on time and that visits were normally of the planned duration.

Staff said the inclusion of travel time on their rotas meant they were now able to meet people’s needs and to provide their visits on time. Staff comments included, “You can get to visits on time and you don’t feel that pressure to do visits quickly. I think people are happy about the change” and “I feel it is a lot better out there. I have enough time with clients and you know you have the time you need to get to the next person.”

The provider had introduced a bonus pay system to encourage staff to accurately record details of each visit they provided using the call monitoring system. This had led to significant improvements in the use of this system and managers now monitored the system in real time to ensure staff safety and check that all planned visits were provided. We found no evidence that care visits had been missed since our last inspection and staff told us, “Missed visits do not happen often.”

The service’s quality assurance system had been reviewed following our previous inspection. A manager now phoned each person each month to gather their feedback directly. Records showed action had been taken to address and resolve any issues raised and people recognised there had been an improvement in the quality of support the service provided. Recently received feedback comments included, “Finds the earlier evening visits a lot better. Really happy" and “Happy with everything. Issues brought up in last QA have been resolved.” The service’s systems for the recording and investigation of complaints had also improved.

These improvements meant the provider had taken the action necessary to comply with the warning notice issued following our previous inspection. In addition, systems and processes in relation to the management of medicines and infection control risk had been updated following recommendations made in our previous report. Staff recognised the service had improved significantly since our last inspection and told us, “There is nothing for you to be worried about at the moment.”

People and their relatives told us South Western Care Services staff were kind and caring. Their comments included, "The care is very good", "The care is marvellous and it’s the lovely contact they have with my relative" and "They have very caring staff."

Since our last inspection the provider had notified the commission appropriately of all significant incidents that had occurred.

The service’s recruitment practices were not safe as necessary Disclosure and Barring Service checks had not been completed before new staff were permitted to provided support.

The inspection took place between the 04 and 06 June 2018 and was announced. This was because we needed to ensure staff would be available in the office during the inspection visit. Not everyone using South Western Care Services receives a regulated activity; 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.

The service is not required to have a registered manager as the register provider had direct oversite of the service’s performance and is based in the service’s office on a full-time basis. The provider was legally responsible for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider was supported by a team of office based managers and staff who had well defined roles and responsibilities.

This was the first time the service had been inspected at its current address following changes to its registration. The service had previously operated from a different address where it was registered as Southwestern Care Services Ltd. We had previously completed a responsive inspection of Southwestern Care Services Ltd in March 2017 and found the service to be good in both key questions inspected. A comprehensive inspection of Southwestern Care Services Ltd had been completed in August 2016 and had found the service to be good over all but requires improvement in relation to our question ‘Is the service responsive’.

Prior to this inspection we received information of concern that indicated people’s needs were not being met as care visits were not being provided on time and for the full duration. We looked at the concerns raised as part of our inspection.

The service’s visit schedules, call monitoring data and people’s daily care records confirmed visits were regularly not provided on time or for the correct duration. For example, one person was due to receive an evening visits at 9:30pm. However in one week this visit had only twice been provided within 30 minutes of the planned start time. The earliest visit had started at 8:40pm while staff did not arrive until 10:25pm for the latest visit. Eighteen of the 20 people we spoke with raised concerns about the variability of the timing of care visits, with some people reporting this made them feel unsafe. Comments received from people and their relative’s included, “No [I don’t feel safe] because I never know when they are coming”, don’t know when they are coming. I have to wait for them to help me get up and go to the toilet. It can be any time between 7am and 9am and sometimes I am bursting (for the toilet). It’s awful, waiting” and “No they are never on time. Sometimes they don’t come to put [My relative] to bed until 11.30pm, it’s too late, I am exhausted by then.”

Our analysis also found that care visits were regularly shorter than planned. For example, one person who was scheduled to receive 15 hours of support during three weeks was only provided with eight hours and fifteen minutes of care. People confirmed that care visits were regularly shorter than planned and told us, “They are meant to be here for half an hour but I get 20 minutes at most” and “Sometimes I just get about 10 minutes. They have barely got the chance to say hello.” Staff said, “I don’t think people are always getting the service they are paying for. That is mainly down to staff rushing and not staying for the time they should.”

The service operated in a rural area and staff regularly had to travel significant distances between consecutive care visits. The service’s visits schedules did not include reasonable amounts of travel time between visits. Staff, were generally allocated five minutes travelling time between each care visit but we found numerous examples where journeys of more than 15 minutes were required between calls. Staff told us, “Travel time means some visits are shorter than they should be but it is only normally tablet (medicines) visit that are short” and “There’s not enough travel time, the shortage of travel time has a knock-on effect on the time spent with people providing care.”

The service had quality assurance systems in place which included analysis of staff arrival time and visits duration. These systems had identified people were not receiving the care as planned and this issue had been repeatedly raised during staff meetings. However, the provider had failed to take effective action to address and resolve these issues.

People and their relatives told us that they had regularly made complaints about the services performance, but that these complaints had not been appropriately dealt with and resolved. Their comments included, “I spoke to them (Managers) and they said they would try to sort it out but they didn’t really, so I didn’t ask again”, “I have had to draw a few things to their attention but they don’t really do anything about it” and “I have mentioned things to carers to give them a chance to buck their ideas up before complaining. That usually does the trick because they won’t listen in the office.”

There was a system in place to record details of all complaints received by the service. However, these records had not been accurately maintained and during our inspection we identified complaints that had not been formally recorded. In addition, there was a lack of evidence to demonstrate complaints had been investigated and of responses to complainants explaining what action had been taken to prevent similar issues from reoccurring.

The provider had also failed to notify the commission of significant incidents that had occurred and following the inspection four additional notifications were submitted.

The service’s recruitment practices were safe and there were enough staff available to meet people’s care needs. The service had appropriate induction procedures in place and all staff new to the care sector were supported to complete the care certificate. Staff training had been regularly updated and supervision provided.

Staff supported people to make decision and choices. However, we have recommended that senior staff completed additional training in relation to the Mental Capacity Act 2005 and a new system be introduced to accurately record details for any powers of attorney people had appointed.

Care plans included sufficient information and guidance to ensure people’s care needs were met, however information available to staff on the support people needed with medicines was not always sufficiently detailed. We have recommended the service reviews its systems for supporting people with medicines to ensure they are in line with the recently issued national guidance.

People told us staff did not always wear personal protective equipment during care visits and the service had received a complaint in relation to the inappropriate disposal of used gloves. As a result we have recommended that staff infection control training be refreshed.

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.

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.