Croft Care Services

The inspection of Croft Care Services took place on 17 July 2018 at their offices and was followed by telephone calls to people using the service and care staff between 19 and 24 July 2018.The provider was given short notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies to make sure the registered manager would be available.

At our previous inspection in April 2017 we rated the service as ‘Requires Improvement’. We identified two regulatory breaches which related to safe care and treatment and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions – safe, effective, responsive and well led, to at least good. This inspection was to check improvements had been made and to review the ratings.

There was a registered manager in post and available at the time of the inspection. 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.

We found improvements had been made in regard to risk management and medicines. Risk management plans were person-centred and contained information in relation to equipment and method, including pictorial guidance for staff to follow. Risk reduction measures were reflective of individual need. Medicines management was safe as staff were able to explain the process in detail and audits ensured effective oversight was in place.

People told us they felt safe with care staff, and we were confident staff knew how to recognise safeguarding concerns and what action to take in the event of having such a concern.

However, we did find some issues with call times from both the recipient and staff perspective. This was not across the whole service but some people felt staff were often late and problems only usually arose in the absence of their regular care assistant. This showed much of the care delivery was consistent but covering absence needed further consideration. Staff had a mixed experience where some felt their workload was appropriate but others felt rushed, with little time to travel between calls. Most staff told us they stayed the full duration of the call and analysis of call times confirmed this. We recommend the registered manager reviews the rotas to ensure staff have sufficient time to complete the required tasks and travel between calls.

The registered manager displayed a sound knowledge of current practice based on a number of sources and was keen to maintain this. This was enhanced by the provider who also took a pro-active approach to ensuring knowledge and policies were current.

Staff received an induction, supervision and training and people felt staff were confident in their duties. Staff felt their colleagues were supportive of each other.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had appropriate nutritional support and were supported to access other services as required if their needs changed. We saw some pro-active involvement by the service when one person’s mobility changed.

We found people spoke positively of the care staff, describing them as kind and friendly. There was evidence of some strong relationships between people and care assistants, and compliments we read reinforced this view.

People felt and were engaged in the process of designing and agreeing their support plans, and these were regularly reviewed to ensure they reflected current need. People told us their preferences were obtained and these were respected, such as with the gender of care staff.

Everyone told us their privacy and dignity were promoted.

Care records were accurate and reflected people’s needs, providing staff with an overview of the person’s needs. Daily records showed sufficient detail to evidence appropriate care delivery.

Complaints were handled with an apology, and full investigation of which the outcome was shared with the complainant. People knew who to approach if they had any issues and were confident they would be resolved.

The service had a registered manager who had developed the service and addressed the issues we found at the last inspection. The quality assurance systems meant records and people’s experiences were regularly evaluated and practice checked. The issue with call times was agreed for further consideration by the registered manager and provider to ensure service delivery was as robust as possible.

Croft Care Services is registered to provide personal care. Care and support is provided to people who live in their own homes within the Wakefield area and the locality of south west Huddersfield. On the day of our inspection 225 people were receiving support with personal care.

The service had a manager in place but they were not yet registered with the Care Quality Commission (CQC). 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.

People told us they felt safe and staff knew what action to take if they were concerned a person was at risk of harm or abuse.

Improvements had been made to people’s moving and handling records but four of the records we reviewed did not contain either sufficient or consistent information to enable staff to provide safe care.

Staff were recruited safely however, there were a number of staff vacancies that the registered provider was recruiting for. People we spoke with did not raise concerns regarding missed calls but said staff were sometimes late. Staff were unhappy that they would often only receive their rotas the evening prior to their shift.

Improvements had been made to the management of medicines. Staff had completed relevant training and a system was being implemented to ensure staff had a regular assessment of their competency to administer people’s medicines. An external audit had been recently carried out to review the organisations regulatory compliance. However, not all the records regarding medicines were robust, we saw a number of unexplained gaps on the MAR for one person and the MAR for another person did not record the maximum dose staff could administer.

The registered provider had an induction programme to support new staff. There was also a system in place to ensure staff were up to date with their training requirements although there was a lack of documentary evidence in regard to staffs practical moving and handling training.

Not all staff had received a recent supervision or field based assessment of their performance but the manager had implemented a spread sheet so they were aware of which staff still needed this to be competed. This would also enable the manager to ensure regular management of staff performance was maintained in the future.

The manager had begun to audit people’s care records to ascertain who needed a mental capacity assessment; however, at the time of the inspection people’s records did not evidence compliance with the Mental Capacity Act 2005.

People told us and records evidenced, staff supported them to access meals and drinks.

People and their relatives told us staff were caring, kind and treated them with dignity and respect. The staff we spoke with were knowledgeable about people’s support needs. Staff were able to tell us how they enabled people to make choices and the steps they took to maintain people’s privacy and dignity.

People told us they had a care plan at their home. Staff told us a number of care plans were being reviewed and updated. We found updated care plans were detailed and person centred. The manager had begun to take action to identify shortfalls in people’s care plans and related documentation.

We found the manager had begun to take a pro-active approach to identifying complaints, reviewing the issues raised and taking appropriate action to address concerns.

A system had been developed to audit a number of records on a monthly basis but at the time of the inspection further development was needed, for example, to check the daily logs were reflective of the care described in each care plan. Work had been undertaken to improve the timeliness of audits and there was evidence the registered provider was also auditing the service.

Staff meetings were being held on a regular basis, and information was passed on to staff who were unable to attend. A recent survey of people who used the service had also been completed.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, we identified continuing breaches in regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Croft Care Services is registered to provide personal care. Care and support is provided to people who live in their own homes within the Wakefield area and the locality of south west Huddersfield. On the day of our inspection 217 people were receiving support with personal care.

The service had a registered manager in place. 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 we spoke with were able to tell us what action they would take if they were concerned a person was at risk of harm or abuse however, not all staff had completed refresher training in this topic. When we spoke with a relative they told us about a potential safeguarding incident which had not been reported to either the local authority safeguarding team or to the Care Quality Commission (CQC).

Not all staff had completed training in medicines, there was no evidence staff’s competency to administer medicines was assessed and no audits were completed on medicine administration records. We looked at the medicine records for eleven people and found they did not provide a clear and accurate record of the medicines staff had administered to people. The risk assessment for one person had not been updated since 2005. This demonstrates a continuing breach of Regulation 12 (1) (2)(a)(b)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 201.

People who used the service said staff did not miss their calls and the regular staff turned up on time. Staff told us they usually provided care to a regular group of people although staff said they often did not receive their rota until Sunday, to commence on Monday morning. We saw systems were in place to ensure pre-employment checks were completed on potential employees.

There was a system in place to support new staff. Where staff required refresher training the time frames specified by the organisation where not adhered to. The provision of ongoing supervision and performance management for staff was not consistent. This demonstrates a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 18 (2)(a)

Where people were living with dementia, there was no evidence of either mental capacity assessments or best interest’s decision making. Where family members had signed to consent to the care and support of their relative, the reason for this was not evident.

People who used the service told us staff were caring and kind. Staff took steps to maintain their privacy and dignity, such as closing doors and curtains. Staff also offered people choices, for example what they a wanted to eat and drink. We saw evidence people were encouraged to maintain their independence where possible.

People told us their needs were assessed by Croft Care services prior to any care being provided. People said they had care plans but not all the staff we spoke with said peoples care plans were up to date. The office manager confirmed the service was behind with reviewing care plans but a plan was in place to address the shortfall.

There was a system in place to manage complaints however; we saw two issues which had not been logged as complaints due the registered manager not being aware of them.

When we reviewed care plans and people’s daily records we found inconsistencies and we were not always able to ascertain the exact care and support someone needed from the records. Daily logs and MAR sheets were not returned to the office in a timely manner.

During our inspection we found evidence regulatory breaches identified at our inspection on 12 November 2015 had not been addressed. We were unable to evidence a robust system of governance was in place and the registered manager had not been provided with a record of the assessment and feedback from the registered provider. Despite an audit being completed by an external consultant and enforcement action taken by CQC following our last inspection the registered manager said there was no action plan in place to monitor the organisations performance in addressing the issues identified. This evidences a continuing breach of Regulation 17 (1) (2)(a)(b)(c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our findings at this inspection and a failure to ensure previous failings had been addressed evidenced the registered manager had failed to ensure people received safe and effective care.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

We were told by staff that one person who used the service had their cigarette intake monitored by staff. We could not see detailed information about this in the person's care plan; we were therefore unable to assure ourselves this was what the person wanted. We were told by a member of staff the person was at risk of falling asleep with their cigarette and therefore the fire service had been contacted and a special blanket had been supplied to try and reduce the risk of a falling cigarette causing a fire. This was not documented in the person's care plan and we could not see a risk assessment on this subject.

People who used the service and some of their relatives told us they had no concerns about their safety. One person said, "Don't worry if they ever did anything wrong I would report them."

We spoke with staff about their understanding of safeguarding. Staff confidently spoke about the types of abuse and what they would do should they have any concerns.

Is the service effective?

We visited a person who used the service in their home. It stated in their care plan that care staff should administer the person's eye drops. We watched the member of care staff administer the person's medication; however, they did not administer any eye drops. We asked why this was and we were told the person no longer required them.

We visited another person who used the service and saw in their care plan that their hearing was good. We noted this person wore a hearing aid and the person was having difficulty hearing the member of staff. There was no mention of the hearing aid in the person's care plan.

We saw a person who used the service had a catheter and a stoma bag, the recording of the assistance to the person was very good. We could see when the bags had been changed and details about the stoma site and how often the site was cleaned. Staff we spoke with told us they had received specialist training and were confident in their abilities to manage the catheter and stoma safely.

Is the service caring?

Throughout our visits to people's homes we saw staff were friendly and supportive in their approach to people. They treated people with respect and it was clear they knew people well. Most people who used the service told us they were happy with service provided by Croft Care Services. One person said, "I couldn't wish for anything better." Another person said, "They do everything for me." and "If I need it they spend more time with me than they should."

Is the service responsive?

We saw the results of the most recent survey and found the results were mostly positive. For example one person had said, "Both carers should be commended on how they do their job and that is brilliantly." Another person had said, "I am very happy with my regular carers but when they are off others are not as prompt." Other comments included, "They were so late I'd gone to bed", "A more regular review would be helpful" and "One carer comes when she wants to come, anytime up to 9.10 a.m." We could not see evidence of what had been done with regard to negative comments.

Is the service well led?

We asked people who used the service to tell us about their experience of the management team at Croft Care Services, one person said, "The staff are lovely. The only problem is the management. They don't know where the places they send the staff are." Another person said, "If you phone the office you don't seem to get anywhere.

All the staff we spoke with were very complimentary about the service and the management team. One person said, 'I wouldn't change anything.' Another person said, 'I feel very supported by the managers.' Someone else said, 'They are a really good company to work for' and 'People are asked for their opinions and the managers listen.'

At this inspection, we reviewed the care record documentation and spoke with staff and the manager.

We reviewed six people's care records and found these provided more detail and were personalised. We saw moving and handling risk assessments had been put into place for people who were immobile or had restricted mobility. The assessments showed how people should be moved safely and what equipment was required.

We spoke with two members of staff who told us they found people's care plans were detailed and easy to follow. One staff member said of the care plans: 'They're very good. You know from them what people like and how things should be done'.

Overall, we found people were protected from the risks of unsafe or inappropriate care and treatment.

People who used the service told us they were happy with the support they received. They said they usually had the same care workers which was important to them. They told us they would raise any concerns they had with the manager. One person said, 'If I wasn't happy I'd tell them, I have done in the past and they sorted it out.' Another said, 'The carers I have are both great. They know what I like and do it my way.'

Staff told us people were involved in planning their care. This was not confirmed in the care records we reviewed which lacked detail, were not personalised or up-to-date.

Staff had a good knowledge and understanding of safeguarding procedures. We found systems were in place and were being used to report any allegations of abuse.

We found satisfactory staff recruitment processes were in place.

Staff told us they had a comprehensive induction and shadowing programme before they started working on their own. There was a programme of staff training and staff were updated to ensure their skills and practice were up-to-date.

We found that the quality of service was being assessed and monitored.