We carried out an inspection of Care Connect Wirral on the 11 and 12 December 2018. The visit on both dates were announced.

The last inspection of this service was in March 2018. At that inspection the service was rated as requires improvement overall with well-led rated as inadequate. The service had been found to be in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the registered provider had not applied good governance to the service. As a result, the service was rated as “inadequate” in the well led question we ask.

In response to this we issued the service with a warning notice. A warning notice is designed to highlight to the service that improvements were required within a set timescale or more formal enforcement action would be taken. This visit found that the warning notice had now been complied with.

This service is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to predominantly older adults. The service at present provides support to people predominantly in the Ellesmere Port and Wirral area. Not everyone using Care Connect Wirral receives personal care; 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.

During this visit, the registered provider supported 111 people with their personal care. There was 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.

At this inspection we identified that the required improvements had been made. While no breaches were identified at this visit, we have rated the location as requiring improvement overall. This is because the registered provider needs to demonstrate a period of sustained good practice to achieve a rating of good.

Improvements had been made in the auditing processes within the service. Key documents such as care plans, risk assessments, recruitment records, notifications to CQC, medication and service user surveys were now checked with a view to embedding these within care practice.

Not all care plans person-centred. Some had additional information to present a person-centred approach. This had been recognised by the registered provider and a plan of action in place.

We have made a recommendation about the writing of daily records.

Some people commented that some timings of calls were not always on time but that these delays were not excessive and did not have an impact of their support.

People felt safe with the staff team. Staff were aware of the types of abuse that could occur and systems were in place to report these.

Staff provided support in a way which minimised the spread of infection.

The auditing of systems within the service now enabled lessons to be learned.

Staff received the training and supervision they needed to perform their role. New staff had a structured induction process to enable them to prepare for work.

The registered provider operated within the principles of the Mental Capacity Act 2005. The capacity of people was taken into account during the assessment process.

People consented to the support they received.

People felt cared for and felt that staff treated them in a respectful manner. People’s personal information was kept confidential.

Information was available in alternative formats for those with communication needs.

A robust complaints procedure was in place. People told us that they knew how to make a complaint.

The registered provider co-operated with other agencies. The registered provider was aware of the requir

This comprehensive inspection took place on 21 and 22 March 2018 and was announced. During our last inspection we found a breaches in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the registered provider not ensuring that medicines were managed in a robust manner and Insufficient and ineffective systems being in place to assess, monitor and improve the service that people receive and to protect them from the risk of harm. At this inspection we found that although some improvements have been made, the provider was still in breach of Regulation 17, Good governance.

Care Connect Wirral Limited is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to older adults. Not everyone using Care Connect receives 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.

At the time of our inspection, 116 people were supported with their personal care needs by the service. 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.

Although people felt safe with the care they received in their homes; an adequate system had not been established to investigate allegations or evidence of abuse. Risk assessments and guidance was not always in place to ensure specific issues were identified and managed safely. The registered provider had a recruitment system in place but this was not followed and appropriate pre-employment checks had not been completed on newly recruited staff.

Each person using the service had a care and support plan however not all of the risks identified had an action plan record for staff to follow.

The registered provider did not have any formal systems in place for assessing and monitoring the quality of the service. This included the reviewing of medication administration records (MAR charts). This meant that there was a risk that they would not identify where quality and safety were compromised and to be able to respond appropriately to concerns.

People told us staff were kind and caring and sought their consent before providing care. People told us they were treated with dignity and respect and were involved in how their care was planned. Staff promoted people's independence. Staff supported people to meet their nutritional needs. People knew how to raise concerns and a complaints system was in place. The quality assurance system was not effective at identifying concerns or driving improvement.

An induction programme was in place with refresher training to enable staff to work safely and effectively. Staff had the skills to meet peoples’ needs.

During this inspection we found breaches in 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 this report.

This was an announced inspection, carried out on 29 and 30 June 2016. ‘24 hours’ notice of the inspection was given because the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be available in the office.

Care Connect Wirral Limited is a domiciliary care agency. It offers care and support to 126 people in their own homes including personal care. The agency has offices based within a business park in Ellesmere Port and is registered as a supplier of services to Cheshire and Wirral local authorities. They employ 52 support staff.

This was the first comprehensive inspection of this service.

The service had a registered manager who had been in post since 1993 and is registered with the Care Quality Commission. 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.

At this inspection we found a number of breaches 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.

People’s needs were assessed and risk assessments were in place prior to when the service commenced. The needs and risks were reviewed regularly. People’s histories, wishes and preferences were not consistently reflected within their care plans. This meant that staff may not provide support in line with a person’s wishes particularly when they were new to the person. Care plans demonstrated the specific tasks to be undertaken by staff at each visit and were signed by the person receiving the service. Daily records were maintained for each person that showed they had received their care and support.

The registered provider did not have any formal systems in place for assessing and monitoring the quality of the service. This included the reviewing of medication administration records (MAR charts). This meant that there was a risk that they would not identify where quality and safety were compromised and to be able to respond appropriately to concerns.

Staff received training and support to carry out their job and they were provided with further opportunities to develop within their roles. Staff had access to policies and procedures in relation to safe practice. However, the registered provider failed to ensure that staff were observed carrying out support tasks such as medication administration and therefore could not be assured of their competence.

People had no concerns about their safety and the way they were treated by staff. There were systems in place to protect people from abuse which included training for staff and policies and procedures for staff to follow. Staff spoken with demonstrated a good understanding of what action needed to be taken in the event of a person being at risk from harm. Recruitment practices helped ensure that only people suitable to work with vulnerable people were employed by the service.

People felt that they could be better informed about which staff they could expect or if they were running late. However, people told us that the staff completed all of their required tasks. People told us that they had a core team of staff which was good because they got to know each other well. They told us that most staff met their needs and had the right skills to provide their support. The registered provider employed a sufficient number of staff to meet the needs of the people they supported.

Staff were confident about dealing with emergency situations. Records showed they had details of people and services they could contact if they needed advice, guidance or support at any time of the day or night.

The Care Quality Commission is required by law to monitor the ope

We were able to gain comments relating to the experiences of the support provided by Care Connect from ten individuals. Comments included:

"Carers are wonderful"

"They are lovely"

"They are very efficient"

"They are top notch"

"There is an occasional problem but it is sorted out"

"They are excellent"

"I thank them for the lovely care they give"

One comment we saw related to newer staff not completing tasks as they should. There was evidence that the manager had sought to resolve this and fed this back to the staff team.

This visit found that the health and wellbeing of people was promoted through the regular review of care plans, the inclusion of people in their care plans and the recognition that risks could adversely affect people using the service. We saw that people were protected from harm through the policies and training that the service provided. Where there was a need for safeguarding investigations to be made, we found that the agency sought to co-operate with local authorities and to take decisive action to ensure that people were safe.

We found that the recruitment process was robust with checks being undertaken to ensure that people were suitable for their role. We saw that the service actively sought the views of service users about their care and adopted the services of an external independent agency to ensure that quality assurance systems were effective. We found that when complaints were raised, these were listened to and acted upon.

We visited Care Connect in response to concerns that had been reported from people who use the service and their families. We had received comments prior to our visit such as:

"Carers did not turn up and my relative did not receive her medication"

"No staff turned up and they did not contact us and they had agreed to do"

"We want to go with a new agency"

"Carers did not turn up and as a result my mobility was affected as I need them to help me put on surgical aids to help me move"

"Staff do not seem to be trained in using hoists"

"Carers did not turn up and as a result my relatives medication was not given and she had to go to hospital to get it all sorted"

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from Care Connect Wirral Branch as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We used postal surveys, telephone interviews and home visits to people who used the service and to their main carers (a relative or friends) to gain views about the service.

We were able to contact 25 people. People we spoke with made positive comments about the care and support they received from Care Connect. People we spoke with told us they were given choices as to what they needed care staff to do for them. They said that they were involved in making decisions about their care and support package. Comments included “Staff are kind and helpful”, “The staff help me to shower and don’t make me feel embarrassed”, They are reliable and kindly” ”They generally send the same staff so we get to know each other and get on well”.

People said that staff ask what they wished to be called which they said was nice. Comments included “Staff are friendly and make me feel at ease”, “The staff treat me well and I am totally comfortable with them”.

People told us that they or their designated person was involved in discussion and decisions about their future care and support needs. They said they felt as if their wishes had been listened to and acted upon. They said their individual needs were catered for.

People said that information had been recorded in a care file and this was used to produce a plan of care and risk assessment to ensure the care and support provided was appropriate to need.

We were told that people felt able to express their views and make choices about their care and support, comments included "I like to get to know my carers and enable them to get to know me. We do not always get the same carers but they all know what to do", “Staff always do what I ask some are better than others but they are all fine”.

Comments from people included "I was able to tell them what I wanted", "I felt I was listened to", "My husband and I were

involved with drawing up the plan”.

People spoken with said that they felt safe in their home and they did not feel in any way threatened or concerned when the care workers were around. All the people we spoke with told us that they felt safe receiving care from Care Connect Wirral branch. They said they felt they were respected and listened to and would say if they felt they were not. They knew they could speak with a manager and would have no problem doing so if they had any concerns.

Everybody we spoke with said they felt fully supported by the care staff. One person told us that the service was very accommodating. For example if there was a hospital appointment they could ring up and change the times the carer was to call to fit around the ambulance pick up times.

All of the people we spoke with made positive comments about the care staff who supported them. They felt that staff met their individual needs and knew what they were doing.

Comments from people included "Staff vary in terms of experience ,however they all do a good job”.

We spoke to people who use the service and asked their views about how they and their relatives are involved in making decisions about their care and treatment and how the service is run.

People told us they have information about the service, which they keep in their home. They also told us that they are kept up to date with any new information by the staff that supports them.

They felt the standard of care provided by the staff was very good. People using the service and their relatives/next of kin told us that staff support them well and treat them with respect.

Everybody told us they would ask to talk to somebody in the office if they were not sure about the care and treatment received.

People who use the service made the following comments about the staff who supported them:

"We have the same regular carer…she is very good"

""I have very good carers they are very kind."

"They are very used to me; they talk to me and understand me."

"The staff usually make me a sandwich or a snack that I fancy and a cup of tea."

"One person does my shopping and she always gives me a receipt."

"I have a care file with lots of information in it; I have lots of numbers to contact if need be…"

"We do very well, no problems at all; the girls are just marvellous…."

"I'm very pleased with them; I more or less see the same staff."

"The standard of care is very good."

"I can approach the manager if needed but I’ve not really needed to lately."

We received two complaints prior to our visit and we referred one of these complaints to Wirral Social Services for their review.

We had also contacted the local authority contracts and monitoring team for Cheshire West and Chester and Wirral before we visited the service and we also contacted them after our visit. They were positive about the service and advised that they had dealt with recent complaints and safeguarding referrals but they had been investigated and closed and they had no issues of concern to report about the service.