About the service:

Caring Direct is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection, 66 people were using the service.

People’s experience of using this service:

People were cared for by a consistent team of staff who were skilled and competent in providing care and support. Staff knew how to keep people safe from harm. There were enough staff and they were appropriately recruited with relevant checks in place.

People’s needs were assessed and monitored and risks to their health and wellbeing were recorded.

However, we recommended that the provider refer to best practice guidance on managing the risks of emollients and smoking.

Safe infection control procedures were in place and people were given their medicines as prescribed.

The service followed good practice guidance and met their legal requirements. The service was meeting the requirements of the Accessible Information Standard. People’s capacity was considered and they or their legal representatives consented to their care.

Staff had effective induction, training and support to carry out their role. Staff were caring, kind and considerate.

Care and support were personalised and met people’s needs. People told us the service enabled them to remain as independent as possible and to live in their own homes.

Staff had access to up to date information about how to support people and communication with health and social care professionals was effective in ensuring people received joined up care.

Complaints had been dealt with appropriately, lessons had been learnt and improvements made.

The service was well led, and management and staff knew their roles and responsibilities. Systems were in place to audit the quality and delivery of care to people.

However, we recommended that the provider focus on how they will sustain good outcomes in the delivery of high quality care for everyone using the service.

Rating at last inspection:

The service was rated as Good in safe and effective and Requires Improvement in caring, responsive and well led with an overall rating of Requires Improvement. The last report was published 22 May 2018.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Well led was given a rating of Requires improvement with an overall rating of Good.

Follow up: We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out an announced comprehensive inspection of this service on 26 March 2018. We reported that the registered provider had made the necessary improvements to the service and they were no longer in breach of Regulation 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, some small improvements were required to Caring in relation to the consistency of staff; Responsive in relation to rota arrangements and in Well-led to continue to monitor the improvements to the quality of the service. The service remains 'Requires improvement'.

Caring Direct is a domiciliary care agency currently providing individual packages of care to people in their own homes. The provider was given prior notice of our visit because they provide a domiciliary care service and we needed to be sure staff would be available at the location to meet with us. At the time of our inspection, 98 people were using the service with 12 management and office staff and 36 care staff supporting them.

The service has 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.

Improvements were needed to the consistency of staff and the rota arrangements in some areas of the county to ensure people had times when they needed them.

The service was not always caring and respectful as the quality of staff varied. People did not always experience person centred care, which met their needs, preferences and choices in relation to the rota arrangements and call times.

The service was not always well-led. Improvements had been made to the quality assurance process but staffing arrangements needed some action to be taken to deliver a high quality service.

People told us they felt safe when receiving care and support and were involved in developing and reviewing their care plans. Systems were in place to protect people from abuse and harm. Risk assessments had been completed so that staff knew how to keep people and themselves safe.

There were sufficient staff with the right knowledge and skills to meet people’s needs. Staff had been recruited safely. Staff had the competence and skills to administer medicines safely and as prescribed. A reminder to staff about protecting people from the risks of infection had been put in place, straight after our inspection, based on what people told us. The provider recorded, reviewed and investigated incidents and accidents and took the necessary action.

People’s needs were holistically assessed and support delivered in line with current guidelines. Staff had induction, training, supervision and appraisals and had the skills and knowledge to carry out their roles.

People’s health needs were met as staff liaised well with health and social care professionals. Improvements had been made to enable people to have their meals as and when they wanted them and which met their nutritional needs.

The service was working within the principles of the Mental Capacity Act 2005. People or their relatives gave their consent to the care and support provided. People were involved in their care arrangements. Their health needs were met in a timely way as staff liaised well with health and social care professionals.

People’s care plans were comprehensive, personalised and detailed so that staff would know about their needs. The feedback and monitoring of complaints had been used to improve the service. Staff were up to date in their knowledge and skills of caring for people at the end of their life.

We carried out an announced comprehensive inspection of this service on 10 February 2016. We reported that the registered provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were also required in relation to the service being Safe, Responsive and Well led.

At this inspection on 24 July 2017, we found that some improvements had been made in relation to training, support and supervision, communication with staff and the management of the service. However, we found that there were still areas where action was needed in all of the key questions.

Caring Direct is a domiciliary care agency currently providing individual packages of care to people in their own homes. The provider was given 48 hours' notice of our visit because they provide a domiciliary care service and we needed to be sure staff would be available at the location to meet with us. At the time of our inspection, 115 people were using the service with 61 care staff supporting them.

The service has 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.

The assessment, monitoring and feedback systems needed improvement in relation to the quality of the service people experienced. Improvements were needed to the allocation of staff across the service. People remained very unhappy with the delivery of the service. Although impact was minor in terms of safe delivery of care, the effects of the ineffective management of people’s views and the deployment of staff meant that the service continued to fail in their delivery of service.

People were supported to have sufficient to eat and drink but not always at a time they chose.

The service was not always caring and respectful as regular staff were not always provided and some staff were not aware of people’s care arrangements.

People did not always experience person centered care which met their needs, preferences and choices

People’s complaints were not always processed appropriately and information was not used to improve the service.

Risks to people’s health and wellbeing and that of the staff had been completed to ensure safe care could be provided. The assessment process was sufficiently detailed to provide an accurate description of people’s care and support needs.

Although there were sufficient numbers of staff available to meet people’s needs, the deployment of staff meant that people remained unhappy with the timing of calls and delivery of the service. Appropriate recruitment checks were in place which helped to protect people and ensure staff were suitable to work at the service.

Staff had a good understanding and knowledge of safeguarding procedures and were clear about the actions they would take to protect the people they supported. Staff had induction, training, supervision and appraisals and had the skills and knowledge to carry out their roles.

People’s medicines were administered to them safely and as prescribed.

The service was working within the principles of the Mental Capacity Act 2005. People or their relatives gave their consent to the care and support provided. People were involved in their care arrangements. Their health needs were met in a timely way as staff liaised well with health and social care professionals.

We have now given this service an overall rating of 'Requires improvement.' You can see what action we told the provider to take at the back of the full version of the report.

A comprehensive, announced inspection of Caring Direct took place on the 10th of February 2016. We gave the provider 48 hours’ notice so that we could be sure that someone from the service would be there to greet us.

Caring Direct is a domiciliary agency currently providing care to around 130 people in Chelmsford and surrounding areas. They currently employ around 71 staff members and provide individual packages of care to support adults within their own homes. Since April 2015, caring direct has also been providing a service to support people to return home from hospital, when they may not have otherwise been able to do.

The service has 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.

This service was rated as requires improvement overall with a good rating in "Caring" and "Effective.”

The service worked with other professionals to ensure that people received the physical health care that they needed. This included supporting people to leave hospital early and return to their own homes with support. Staff were compassionate and caring. However, the service did not objectively listen to people's complaints and people were afraid to report concerns in case their service was terminated. They did not have systems in place to adequately monitor the safety of the service they provided. For example, when missed or late visits had occurred and the impact of these on people, medication audits to identify errors and appropriately recording all complaints, no matter how small.

During this inspection, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with three people who used the service and they told us that they were well looked after by kind and helpful staff.

People told us staff gave them the attention they required.

Staff spoken with demonstrated their understanding of people’s needs and how they provided needs led care and support to the people who used the service.

We looked at people’s care records and these showed us that people's individual needs and preferences had been taken into account and that people had been given a choice in how they wished to be cared for.

The care records also showed that a person's independence was actively supported. Staff were knowledgeable about a person's care and gave examples of how they treated people with respect and dignity and promoted people's independence.