About the service:

Care Concern is a home care provider which offers domiciliary care services and personal support. The service provides care and support for people of all ages within their own homes. Support provided includes assistance with personal care, medication, nutrition and hydration, pressure area care and accessing the community. At the time of our inspection the service provided support to around 300 people.

The service provides services to rural parishes in Southport and Lancashire, its office is based in Birkdale village.

People’s experience of using this service:

Medicines were not always managed safely. We looked at a sample of medication administration records (MARs). Some people had been prescribed medication which required a minimum amount of time to have elapsed between doses, we found that staff had not recorded the time of administration, meaning it was not possible to identify whether the correct amount of time had passed before the next dose. This meant that people were at risk of not receiving their medication as prescribed.

People’s care records did not always contain adequate information about the management of risks. Although risks had been identified there was no record of action taken to address and mitigate risks.

People's care records were not always person centred, meaning their life history, preferences and preferred routines had not always been documented.

Regular checks and audits were carried out to determine the quality of the care and to achieve compliance with regulations. However, audits were not always effective and had not highlighted the concerns we identified during our inspection.

Staff received adequate training, induction, supervision and support so they could effectively perform their roles.

The service recorded the investigation and analysis of incidents and accidents.

Both people being supported and their relatives told us staff were kind, caring and dedicated and knew people's needs and preferences well.

The registered manager worked in partnership with health and care professionals and the local community.

The service had displayed the latest rating both at its office and on its website. When required, notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

More information is included our full report.

Rating at last inspection:

At our last inspection, the service was rated overall as "Good.’’ Our last report was published in April 2017.

At this inspection, the service did not meet the characteristics for a rating of "Good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "Requires Improvement.''

Why we inspected:

Services rated as "Good" are re-inspected within 30 months of prior inspections. Our scheduled inspection was brought forward based on feedback we had received from the Local Authority. We needed to check the safety and quality of care people received and that people were not at risk.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care and act on information received. Further inspections will be planned for future dates.

We inspected Care Concern (NW) on 20 February 2017. This inspection was announced.

Care Concern is a large domiciliary care agency supporting over 250 people in their own homes. Care Concern (NW) is based near Birkdale and provides care for people around the North West. They provide personal care for predominantly elderly people living with dementia or who have had a stroke.

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.

People we spoke with said they liked the staff. There were some points raised about staff timekeeping, particularly at the weekend and how this was communicated. People told us how this affected their care. We saw there was a plan in place to address these concerns, however we have made a recommendation about this.

Staff knew how to protect people from harm or abuse and had received the necessary training.

There were processes in place to ensure that staff were recruited safely. This included a satisfactory DBS check and two references.

Medicines were well managed and were administered by staff who were trained to do so.

People were largely positive about the staff and said they had a consistent staff team and liked the staff who supported them. One person said that the staff can sometimes be abrupt, however they were mostly happy with the service. Staff we spoke with described how they provided dignified care.

Staff were trained in all mandatory subjects and had regular supervision and an annual appraisal.

Information was person centred and we saw information recorded about people’s backgrounds, hobbies and interests. A breakdown of each person’s call time stipulated how they wanted to be supported.

Complaints were well managed; there was a process in place if people wanted to raise a complaint. We checked recent complaints as part of our inspection and saw that they were investigated and responded to.

The registered manager had been in post for a long time and was continuously developing and improving the service. This was evident as there had been some issues within service provision in the last few weeks; the registered manager had identified this through their own quality assurance systems and were striving to improve.

The inspection was carried out by a pharmacist inspector. We set out to answer three key questions; Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with the manager and other staff and looking at records.

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

Is the service safe?

We found that the service was safe because people were protected against the risks associated with use and management of medicines.

People received their medicines at the times they needed them and in a safe way. Medicines were administered appropriately and, where necessary were kept safely in people’s homes.

Is the service effective?

We found that care plans for managing medicines were up to date and care workers had clear information to follow to ensure that people were supported to take their medicines safely and in a way that met their individual needs and preferences.

Is the service well led?

We saw that audits (checks) of medicines were carried out regularly to assess the way medicines were managed and to ensure that people continued to receive the support they needed.

We visited four people who used the service during our inspection. Each person had a copy of their care plan and a daily record completed by the staff member who visited them. We checked the daily records and found they reflected the person’s plan of care.

Communication sheets were in place in people’s records so that information could be shared between care workers, people and their families and other professionals and agencies. We saw examples in care records of when care workers had responded to a decline in people's health and had contacted the district nurses or their GP.

We looked at the arrangements in place for managing medicines. We looked in detail at medication and other care records for two people that the agency provided care for. Overall, we found that appropriate arrangements for recording, safely administering and monitoring medicines were not in place.

People we spoke with told us they generally had the same care workers supporting them. One person told us; “Occasionally one of the two girls is new but the other one knows where everything is. New staff soon get to know me and how I like things done.”

People we spoke with told us they felt confident about raising any concerns with the manager or their care worker. There had been one complaint received in last twelve months and we saw this was managed in accordance with the service’s complaints procedure. Action taken as a result was also evident.

Staff we spoke with were knowledgeable about seeking people’s consent and supporting their choices. We spoke with people using the service who said that the staff communicated well with them when they gave personal care. One person we spoke with told us they were fully involved in deciding what level of care they required and how it was delivered. A relative told us that the service kept him informed of any changes in care needs and staff were approachable and responsive if he had any concerns.

We visited three people who used the service. People spoke positively about the care they received. One person told us, “I don’t know how I would live here without them [carers].” Other comments included, “I couldn’t manage without their help.” and "The staff are reliable and very caring.”

People we spoke with said they felt confident that any concerns they might have would be listened to and acted upon. Staff we spoke with told us they had good access to training to help them carry out their work. Supervisions were part of the service’s regular spot checks of care, which were carried out in people’s homes.

The service had systems in place to record, and securely retain, information regarding the care delivered to people and the safe running of the service.

We spoke to several people and their relatives. People told us they were happy overall with the care provided and that they were involved in deciding the level of personal care and support needed. They told us that their respect and dignity was maintained. We were informed that when they had any concerns they would speak to the manager or care worker and their concerns were promptly addressed.

Some people expressed concerns that carers were often late or did not attend as long as necessary. They realised the reasons why there were sometimes delays and said that their care had not necessarily been compromised as a result of this.

Care Concern (NW) is a domiciliary care agency that supplies personal care and support to people in their own homes. Care Concern (NW) is based near Birkdale and provides care for approximately 200 people around the North West. They provide personal care for predominantly elderly people with dementia or stroke.

We undertook an announced inspection of Care Concern (NW) on 11th, 12th, 13th, 16th and 23rd February 2015. We informed the provider two days before our visit that we would be inspecting.

The inspection team consisted of two adult social care inspectors and an ‘expert by experience’. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The service had 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.

People who used the services of the agency told us they felt safe when receiving care and support. This included support with personal care, help with meals and also with shopping.

Care staff we spoke with had a good understanding of how to keep people safe in their own home. This included risk assessing practices such as, the use of entry key codes to people’s homes and equipment to transfer people safely.

Within people’s care files we saw a number of assessments to help identify and manage risks for people to ensure their health and safety. The risk assessments included information about action to be taken to minimise the chance of harm occurring.

People told us care staff supported them with their medication at a time when they needed to take it. They said this was in accordance with their wishes and needs. We checked a sample of medicines against the corresponding records and these showed that medicines had been given correctly. Some medicine care plans lacked clarity around the level of support people needed with their medicines. Following the inspection we were informed of the actions taken to improve this.

Effective recruitment practices were in place to ensure staff were suitable to work with vulnerable people.

Staffing levels were determined by the number of people using the service and their individual needs. Two relief care staff covered emergencies, sickness, annual leave and to help provide extra support to people where needed. People told us that generally they received care from a regular team which they felt was very important.

Care staff received regular training and supervision. The manager was aware of the need to commence staff appraisals this year.

People’s care needs were recorded in a plan of care in an individual care file. The manager had identified the need to introduce new care plans to enable staff to record more detail around people’s preferences, choices and level of care and support they required. This was to make the care plans more tailored to individual need.

People were supported at mealtimes in accordance with their plan of care. People told us the care staff prepared the foods they liked and offered regular drinks to them.

With regards to people making their own decisions, people we spoke with informed us they were able to do so and were involved, as much as possible, regarding decisions about their welfare.

Care staff were available to support people’s access to health care appointments. Care records we looked at showed the agency liaised with health and social care professionals involved in people’s care if their health or support needs changed or if their advice was required.

People who used the service said the staff were very caring and kind. Their comments included, “They (the care staff) are angels”, “All the carers are very nice”, “They (the care staff) are just so considerate that I feel they treat me with dignity at all times” and “The staff are excellent, they go above and beyond to help you.” On the whole people said care staff stayed for the agreed length of time of their visit. We did however receive some comments regarding this not always being the case and therefore not in accordance with people’s plan of care. We brought this to the attention of the manager.

People told us the agency responded to their needs in a positive way. They told us the care staff listened to them, acted on what they said, delivered care in a way they liked and a time that suited them.

Speaking with care staff confirmed their knowledge about the people they supported and how they would respond if a person was unwell.

A complaints procedure was in place and details of how to make a complaint had been provided to people who used the service. We saw the complaints’ register and complaints received had been responded to in a timely manner and in accordance with the service’s policy and procedure.

Systems were in place to monitor the quality of the service provided. This included audits (checks) on areas such as, care documents, medicine administration and also meetings with people to ensure they were happy with the care provided. A more in depth medicine audit was carried out following our inspection. This was in light of our findings with regard to a lack of clarity around the level of staff support for medicines. Actions were being taken to improve this practice.

People who used the services of the agency had received feedback surveys in 2013 to gain their views about the agency. The manager told us these were being sent out again this year.

All staff we spoke with were positive in respect of the overall management of the agency and the caring, supportive and efficient leadership of the manager. Their comments included, “Really good”, “You can speak to (manager) about anything” and “We get plenty of support.” Feedback from staff confirmed the agency promoted and open and transparent culture.