Archived: Kensington Community Care (Bristol)

When we place services in special measures we expect providers to take action to significantly improve the quality and safety of their service. Services placed in special measures will be inspected within six months and kept under review during this period. The purpose of this inspection is to check the service had improved and to provide a new quality rating. 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.

At the time of this inspection the service was providing support to 36 people who lived in their own homes. The service had previously handed back, to both Bristol City Council and South Gloucestershire Council, funded care packages to enable the service to stabilise and improve. The service was provided to people who lived within the South Gloucestershire and Bristol local authorities. The service employed 23 care staff but were actively recruiting to enable the service to expand again.

There was no registered manager in post, however an application to be registered with CQC had already been submitted and accepted. 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 manager will be registered to carry on the regulated activity at two branches – Bristol and Birmingham. They will be supported by a deputy manager in both branches.

The findings from the inspection have been very positive. Significant improvements have been made. The office had been tidied up and was organised. The atmosphere in the office was good and the staff were working together for the benefit of the people they were providing a service to.

Why we have rated the service Good ?

The service was safe. Care staff had received further training about safeguarding adults and were fully aware of their responsibilities to protect people. They knew what to do if safeguarding concerns were raised. The service followed safe recruitment procedures to ensure unsuitable staff were not employed.

The management of medicines had been significantly improved and care staff had been trained to administer medicines safely with their competence checked. However, we recommend that protocols be put in place to give guidance to care staff where they need to help people with ‘as required’ medicines.

The service was responsive. Significant improvements had been made to ensure that people received a person centred service. People’s care and support needs were assessed so that their care plan could be agreed with them. People were involved in making decisions about how they wanted to be looked after. Risks to people’s health and welfare were assessed and measures put in place to reduce or eliminate the risks. Where people needed support with their meals and drinks, their needs were assessed and detailed in their care plan. Care staff assisted people to make contact with any health care professionals and their GP as necessary. People’s care and support needs were reviewed and their care plans were amended as necessary.

The service was effective. The provider had a four day induction training for new staff to complete and this was in line with the Care Certificate. All other staff had a programme of refresher training to complete and records evidenced the training staff had completed. Staff were supervised and their work performance was spot checked. These measures ensured the staff team had the appropriate skills and knowledge to meet people’s care and support needs.

Care staff asked people for consent before they provided care and support and we found the service was working within the principles of the Mental Capacity Act 2005.

At this inspection, we found that the service was caring. Better work planning meant people were supported by the same care staff or the least number of care staff. This provided people with a consistent service and feedback we received from them was good.

People were encouraged to have a say about the service and could do this during their care plan review meetings, quality assurance surveys and via the provider’s complaints procedure. Those complaints the service had received since the last inspection had been handled correctly.

At the last inspection, we found there was a lack of leadership and management of the service and the culture amongst the staff was poor. This had been due to many management changes and incompatible office staff. The provider has taken appropriate action since the last inspection. The previous registered manager had returned to the branch and there were two new care coordinators in post. The measures to monitor the quality, safety and ‘customer’ satisfaction with service provision had been re-introduced and the provider had set up processes to ensure they kept an overview of how the service was performing. There was a regular programme of auditing and people were being asked to provide feedback regarding their views and opinions of the service.

At the time of this inspection the service was providing support to 55 people who lived in their own homes. However the service had recently handed back, to both Bristol City Council and South Gloucestershire Council, funded care packages the service was no longer able to cover. This was because about 10 home care assistants had left Kensington Community Care (Gloucester). The service was provided to people who lived within the South Gloucestershire and Bristol areas. The service employed 30 care staff (some on a bank staff status). Throughout the report we have referred to the service as Kensington Community Care.

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. The registered manager however, is not present every day in the service because they were now the registered manager for the Birmingham branch. A new manager for this branch has already been appointed and was making application to CQC to be the registered manager (referred to throughout the report as the manager).

The management of medicines was not safe. Home care assistants did not receive adequate training in order to be able to administer medicines safely or understand the reasons why the completion of records was important. The manager had found that medicine records contained a lot of gaps with missing staff signatures. Many of the staff team were not up to date with their safeguarding adults training and a significant number of safeguarding concerns had been raised with the local authority.

People did not receive a person centred service. Care calls were often not scheduled at the time which had been agreed during assessment. Some home care assistants did not stay for the agreed length of time. On occasions relatives had been asked to cover care calls because staff were not available. This had improved recently because a number of care packages had been handed over to other care providers. People and their relatives were concerned that home care assistants often told them of their concerns about their work and difficulties working for Kensington and off-loaded on to them.

New staff to the service had three day induction training to complete and all staff had refresher training to complete. However, many staff had not had any training for a number of years. Compliance with the requirements of the Care Certificate required improvement. Staff were not supervised or their work performance spot checked. No annual appraisals had been completed in 2017.

People’s care and support needs were not reviewed and their care plans were not kept up to date. Some of the care plans we looked at were out of date and did not reflect the service provided. This had the potential to mean people could receive the wrong care and support.

Complaints were not handled correctly despite there being a complaints procedure in place. People and their relatives told us about concerns and complaints they had raised but these had not all been logged. For four complaints there was a record of action taken by the manager however the response had not covered all the issues and had resulted in just a one line apology.

The service did not have measures in place to monitor the quality, safety and ‘customer’ satisfaction with the service provision. People had not been asked to provide feedback regarding their views and opinions of the service.

Risks to peoples health and welfare were assessed and management plans in place to reduce or eliminate that risk. However when care calls are missed or not provided at the agreed time, these risks might not be mitigated. Where people were assessed to see how much support they needed with food and drink, the level of support was detailed in their care plan.

Home care assistants asked people for consent before they provided care and support. Where people were supported by regular home care assistants, the feedback from them was good. They referred to named members of staff who had supported them well and cared for them.

The service follows safe recruitment practices. All pre-employment checks had been completed. This meant that unsuitable staff were not employed.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 (part 4).

The service has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Full information about CQC’s regulatory response to any concerns found during inspection is added to reports after any representations and appeals have been concluded.

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

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe and received the service they expected. People were involved in setting up the care delivery arrangements.

Where people needed support with their medicines, this was carried out safely by staff who had been trained to administer medicines safely. Their ongoing competence was checked.

Staff were appropriately trained and supported to do their jobs well. Their work performance was regularly monitored and people who used the service were asked to give feedback about the staff and the service they received.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, concerns and complaints. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People’s care and support needs were assessed and they were involved in deciding the care delivery arrangements. People’s preferences and individual needs had been recorded and care and support had been provided in accordance with people’s wishes. People were provided with a copy of their care plan and they were kept up to date in order to reflect their current needs.

People were complimentary about the service they received. A copy of the care plans and risk assessments were kept in the care folders in each person’s home. People told us, “I get the help I expect. One carer comes to me for four days and then another comes for four days. It works very well” and “The carers are very competent and respectful”.

Is the service caring?

People were supported by kind and attentive staff. Staff spoke professionally and caringly about the people they supported. People commented, “I look forward to the visits from the girls. I could not manage without their help” and “The carers are so kind and know that XX gets nervous when being hoisted”.

People who used the service had completed an annual satisfaction survey. Where shortfalls or concerns were raised these had been or were in the process of being addressed.

Is the service responsive?

The service was able to adapt service provision where needed. Regular care plan reviews ensured that care delivery arrangements and care plans were amended when peoples care and support needs changed. Staff responded to any incidents and events well.

People knew how to make a complaint if they were unhappy. Copies of the complaints procedure were kept in the service folder in people’s homes. We looked at how previous complaints had been dealt with, and found that the responses had been open, thorough, and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service had an effective quality assurance system in place. The records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

The staff team were clear about their individual roles and responsibilities. A newly registered manager was in place and provided good leadership for the team. The provider representative now had greater input and an overview of the service provided by the agency. This helped to ensure that people received a good quality service at all times.

People told us they were involved in making decisions about the support they received. They said the service had improved recently, they now received help from regular care workers and that time keeping was improved. Some concerns were raised with us about care workers not always reading the care plans and not always having the skills needed to meet certain care needs and we shared these with the operations manager and care coordinators.

The agency followed a safe recruitment process, appropriate checks were undertaken before staff started work. New workers received induction training and worked with experienced carers at first. The provider needs to make improvements with staff training to ensure care workers have the right skills to meet people's needs and to improve supervision of care workers work performance.

The provider had no measures in place to monitor the quality and safety of the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.