About the service:

Care Never Sleeps is a domiciliary care service providing personal care to people living in their own homes. On the day of inspection, the agency was providing care to seven people. There was a registered manager in post.

People’s experience of using this service:

People told us they felt safe with the staff who supported them. People told us that staff were kind and considerate. Relatives spoken with told us that the staff were respectful. There were enough staff available to support people and calls were completed on time. People reported no missed calls, so people’s care needs were met.

The registered provider told us that people were not supported with their medication. We found that the medication administration records did not always reflect how staff supported people. Staff had completed training in the medication management that enable them to support people if required.

Risks associated with people’s care had been assessed to protect people from the risk of avoidable harm but were not updated with current risks when peoples needs changed..

Staff were aware of how to protect people from the risk of abuse and confirmed who they would report any concerns to, including external agencies if required. The registered manager ensured only suitable people worked at the agency. Recruitment checks were completed and included references and checks with the Disclosure and Barring Service. (DBS)

People confirmed the care they received met their individual preferences and choices. Care records although reviewed were not updated to ensure that accurate information was available.

There was a complaints procedure to enable people to make complaints and people spoken with were aware of these procedures. People told us they felt that the registered manager and staff would address any concerns they had.

People and their relatives told us that staff were very kind and caring and treated them with dignity and respect.

Rating at last inspection: The last inspection was completed on 28 February 2018 and was rated as requires improvement.

Why we inspected: This was a planned inspection.

Enforcement.

The evidence above showed that the provider was in breach of Regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014.

Following a local authority contracts monitoring visit in April 2019 the commissioners set out an action plan for the provider with specific areas for improvements. Because of their findings they stopped new referrals to the service of people funded by the local authority while the provider worked with them on an action plan to improve the service. This will be reassessed by the commissioning authority at their next visit as part of their service level agreement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community it provides a service to older adults.

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 received safe care and were supported by staff who knew how to protect them from harm. Staff understood who to report concerns to and the registered manager understood how to share concerns with relevant stakeholders. Learning from incidents and accidents was shared with staff to ensure people were always safe. Although people received support with their medicines, the competency of staff supporting people’s medicines was not robustly checked. Some people had on occasion received a missed call and the registered manager had introduced a call monitoring system although this was not yet across the whole service.

The service was managed by the registered manager who also owned the service. Systems to monitor the quality of care people received were inconsistent and some people experienced late calls. The registered manager’s system for checking people’s care did not identify anomalies in how people’s care was being recorded. People’s views on the service provided were sought and changes made. Some although not all staff enjoyed their work and felt supported.

Further information is in the detailed findings below.

This inspection took place on 09 June 2017 and was announced. We gave the provider 48 hours’ notice that we would be visiting. This was because the provider offers a supported service to people living in their own homes and we wanted to make sure that people and staff would be available to speak with us.

Care Never Sleeps Limited is a community based adult social care service, registered to provide personal care for persons within their own home. They currently provide a service for nine people.

There was a registered manager in post at the time of our 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.

Care Never Sleeps Limited was last inspected in June 2015 and was rated as a ‘Good’ service,

People were kept safe. Staff had received training and understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm. Staff were provided with sufficient guidance on how to support people’s medical needs. People were kept safe by staff who were able to recognise the signs of abuse and raise concerns if needed.

People were supported by staff that had been safely recruited. People felt that they were being supported by staff with the appropriate skills and knowledge to care and support them.

Staff were trained and supported so that they had the knowledge and skills to enable them to care for people in a way that met their individual needs and preferences. People were supported to make choices and were involved in the care and support they received. Staff had an awareness of the Mental Capacity Act and Deprivation of Liberty Safeguarding (DoLS).

Staff were caring and treated people with dignity and respect. People’s choices and independence was respected and promoted and staff responded to people’s care and support needs.

People and staff felt they could speak with the provider about their worries or concerns and felt they would be listened to and have their concerns addressed.

The provider ensured that all policies and procedures were kept up to date with current guidance and legislation. There were quality assurance and auditing systems in place to ensure continual development of the service.

This inspection took place on 18 June 2015 and was announced. We gave the provider 48 hours notice that we would be visiting the service. This was because the service provides domiciliary care and we wanted to make sure staff would be available.

Care Never Sleeps Limited is a domiciliary care agency registered to provide personal care to people living in their own homes. The service currently provides care and support for 7 people, ranging in age, gender, ethnicity and disability. 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.

Following our last inspection on 23 April 2014, we found the provider was not fully compliant with the regulations we inspected. We had concerns about the provider’s complaints policy and quality assurance systems. Staff had not received sufficient supervision and training to support them in their role. The provider sent us an action plan outlining how they would make the improvements and we considered this when carrying out this inspection visit. We found that the provider had addressed these concerns.

Staff knew how to reduce the risk of harm to people from abuse and unsafe practice. The risk of harm to people receiving the service was assessed. Where people required support with taking their medicine, there were procedures in place.

People felt there were sufficient numbers of staff available to meet people’s needs. Some of the staff felt there was a requirement for additional staff. There were procedures in place to recruit staff safely.

People and relatives felt safe and secure with staff coming into their homes. They felt staff had the skills and knowledge to care and support people in their homes. Staff were trained and supported to care for people. Where appropriate, people were supported by staff to access other health and social care professionals when needed. The provider was taking the appropriate action to protect people’s rights.

The staff was caring and treated people with dignity and respect. People’s independence was respected and promoted and staff responded to people’s support needs.

People felt they could speak with staff about their worries or concerns and they would be listened to and have their concerns addressed.

Everyone felt the quality of the service was good. The provider had improved the internal quality assurance systems to monitor the care and support people received.

On the day of our visit the agency Care Never Sleeps was providing domiciliary care services for six people. It employed six part time staff, three of whom were temporary workers. The summary is based on our observations during the inspection, three people’s care plans we looked at and the agency records, speaking to three members of staff which included the manager, and visiting one person who used the service.

Below is a summary of what we found but if you want to see the evidence supporting our summary please read our full report

Is the service safe?

The care plans we examined contained risk assessments to ensure the safety of the people who used the service. A new member of staff told us they had received supervision by an experienced carer after an induction programme and before working alone.

We saw that staff had been recruited with health and social care qualifications so that they could safely meet people’s needs. This was also confirmed by staff we spoke to and when asked they understood safeguarding, consent and risk issues. However we were concerned that they wore inappropriate footwear for manual handling and nail polish which reduces the effectiveness of hand hygiene.

We also had concerns that staff did not have regular staff meetings and had not received any supervision or appraisals.

Is the service effective?

Although there was no staff rota available to examine, we judged that there was sufficient staff employed on a temporary and part time basis to deliver the level of services that the agency currently provided.

We looked at three people’s care plans. We saw that they were personalised with the details of people’s daily routines and individual goals so that staff had a clear understanding of what services they needed to provide in accordance with peoples wishes. People’s health and care needs were assessed with them so staff had the information they needed to plan and meet people’s individual needs. The three people who had completed satisfaction questionnaires reported being “happy" with the service and rated the staff highly.

Is the service caring?

We visited two people’s homes but only met with one person. This was because the other person had decided to go out with their carer before we arrived. Although we met with one person at their home, they too did not wish to engage with us. However we observed that the manager and the member of staff caring for this person had a friendly and warm relationship with them.

The member of staff could explain the level of personal care and social support they were providing for the person whose home we visited. They had recently been employed and told us they understood the issues around mental capacity and consent in relation to the vulnerable person they were supporting.

Is the service responsive?

We saw that the care packages were agreed and signed by people or their relatives meaning that the plans were approved by them. There was evidence of cooperation between the manager and other professionals in the interest of people using the service. We saw that one person had used an advocacy service to resolve a family dispute and that the service was available to other people if required.

A complaints policy and procedure was in place but we noted that the policy had not been followed in relation to a complaint we looked at. If systems to deal with complaints are not followed then people who use the service cannot be confident that their concerns had been addressed and consequently there is no opportunity for the management to learn from mistakes.

Is the service well led?

We saw evidence that the manager was registered with the CQC. Whilst the manager was well intentioned and keen to deliver personal services to a small group of people, there was no business plan, quality assurance system and monitoring of the service in place. Staff were recruited with National Vocational Qualifications in care, but we had concerns related to the lack of any on-going supervision, planned appraisals and training.

On the day of our inspection we were told that Care Never Sleeps was providing support to two people. During our inspection, we looked at two care records and spoke with the manager and three care staff. We later spoke with two people that used the service.

People were involved in their care and were encouraged to do things for themselves as far as possible.One person told us, "I am happy with the service, staff help me to do things."

Care plans were personalised and risk assessments were in place so that staff had the information they needed to meet people's identified needs. One staff member told us, "The care plans give me enough information to meet people's needs."

Arrangements were in place to ensure that people were safeguarded against harm.

We found pre-employment checks had not been completed before staff started to work with people. The manager told us that this had been identified by the Local Authority and action had been taken. We found that improvement had been made and appropriate checks were completed.

We saw systems were in place to audit and monitor the quality of the service being provided so that improvement could be made where needed.