About the service:

Charter Care is a Domiciliary Care Service that is registered to provide care for people within their own homes. People using the service are older people, people with mental health needs, people who misuse drugs and alcohol and those with a physical disability or sensory impairment. 140 people were using the service at the time of the inspection.

People’s experience of using this service:

Staff were not always recruited in a safe way.

People's care plans did not always reflect the needs and preferences of people and were limited in the information they provided.

Audits were not comprehensive enough to provide a consistent overview of people’s care.

People were supported by staff to remain safe. There were enough staff available to people and people’s needs were attended to in a timely manner.

Risk assessments were in place to minimise any potential risk to people’s wellbeing. People received their medicines as expected.

Staff knew people’s needs. Staff received training and had been provided with an induction, and felt able to approach the registered manager with any concerns. People were assisted to receive nutrition and hydration by staff. People were supported to maintain their health.

People were supported to have choice and control over their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff ensured that people’s privacy and dignity was maintained.

Complaints were dealt with appropriately in line with the complaints procedure. People felt able to go to staff who would listen to them.

Rating at last inspection: The rating for the service at our last inspection was ‘Good’ with our last report published on 06 October 2016.

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets. We had also received some information of concern from the local authority regarding a specific incident around medicines not being given where required. We spoke with the registered manager about this and received their perspective on the incident. The registered manager had taken some learning from the incident and the person was no longer using the service.

At the last inspection the key question of Well led was rated ‘requires improvement’. This was due to concerns that there was no effective structure for staff supervisions and audits were not comprehensive. At this inspection we found that whilst staff now received regular supervisions, audits still required some improvements in providing an overview of patterns and trends.

Enforcement:

No enforcement action was required.

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.

Charter Care is registered to provide domiciliary care to older people, people who may have physical disabilities or mental health concerns, sensory impairment or those who may misuse drugs or alcohol. At the time of our inspection 121 people were using the service. Our inspection took place on 18 August 2016 and was announced with 48 hours’ notice to enable staff to be present to speak with us. Telephone calls were made to people to ask for their views on the service on 19th August. The service was last inspected on the 18 September 2014 where it met the standards.

The manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

People were kept safe, with detailed risk assessments in place. Medicines were given appropriately, however the recording of this was not always clear. We found that there was a suitable amount of staff available with the skills, experience and training in order to meet people’s needs. Structures for supervision allowing staff to understand their roles and responsibilities were not always in place, however staff felt well supported by the registered manager and felt that they could speak with them at any time. People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were not carried out on a regular basis, but were updated as and when an event or incident occurred. Quality assurance audits were not always comprehensive and so not all areas of care provided could be analysed for trends and patterns. The provider supported the registered manager and staff well. Notifications were sent to us as is required by law.

People were supported to take sufficient food and drinks and their health needs were met. Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

Relatives and staff spoke positively about the approachable nature and leadership skills of the registered manager. People told us that they were able to raise any concerns they had and felt confident they would be acted upon.

We undertook this inspection to check on actions that we had asked the provider to take following our planned inspection on 10 April 2014. This inspection was undertaken by one inspector. During the inspection we spoke with the person that was managing the service, four care staff, looked at six care records and reviewed policies and procedures that had been developed since our inspection.

At our inspection on 10 April 2014 people spoken with told us that they received their medication when needed. However, we found that the service was not safe. This was because medication procedures and systems for supporting people with their medication were not managed appropriately. We told the provider that they must improve this and they sent us an action plan, which told us what they would do to improve. During this inspection although the provider had not fully implemented their action plan, we found that they had done substantial improvements to ensure that medication systems were safer than they were. This included, new procedures, updating staff training, improved monitoring procedures and staffing structure to ensure effective monitoring of medication records and systems. This would ensure that people receive their medication in a safe way.

At our inspection in April 2014 we also found that the provider was not acting in accordance with the Mental Capacity Act and therefore people’s rights were not protected in line with the legislation. During this inspection we saw that the provider had introduced new procedures and have trained their staff in those procedures to ensure that staff knew how to obtain adequate consent for care where people may lack the capacity to give informed consent.

We held telephone interviews with nine people that used the service; two relatives and we visited two people at home to talk to them about their experience. We spoke with the registered manager, deputy manager and three care workers. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Everyone that we spoke with said that they were safe with the staff that supported them. One person told us, “Yes, I feel safe with them. They always lock the door and make sure I am safe when they leave.”

We saw that people had an assessment of their needs and associated risks. A plan of care was completed to enable staff to offer care and support to people in a safe way. Staff told us that they received training and support to enable them to offer care and support safely.

Staff spoken with told us that they knew how to raise concerns if they felt that people using the service needed to be safeguarded. The provider had policies and procedures in place to safeguard people that use the service and we saw that where issues of safeguarding matters have occurred the provider took appropriate actions to ensure that people using the service were safeguarded.

Whilst people told us that they always received their medication, we found that safe systems were not in place for the recording and administration of medication. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. This is a domiciliary service and therefore this is not applicable.

Is the care effective?

People told us that they were receiving the care that they needed and they were happy with the care. One person told us, “Oh yes I have been with Charter Care for six years, I get morning and evening care. I am happy with the care and can’t do without them.”

Everyone that we spoke with told us that their care worker talked to them about their care and they always give their consent to being supported. One person that we visited told us, “We do things together and they do what I want them to do.” However, we found that staff were making judgments about people’s lack of capacity without showing how they had established this fact. Therefore people’s rights were not adequately protected in line with legislation. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

Everyone that we spoke with told us that the care workers that supported them were caring. One person told us, “They are all caring and friendly.” Another person told us, “They are respectful. I wouldn’t have them otherwise.”

Is the service responsive?

People that we spoke with told us that staff did what they wanted them to do. They told us that if their care workers were going to be late they were kept informed. One person told us, “If carers are going to be late they always let me know.” A relative told us, “The service is good. They are very good with dad. They are regular and pleasant; they talk to him and treat him well.”

Is the service well led?

We saw that the service had a staffing structure that would enable the service to be managed appropriately. This included a manager that we have registered to be responsible for the running of the service. People were consulted about the quality of service they received. Comments and suggestions were analysed to identify where improvements were needed.

During our inspection we spoke with six people that used the service, three care workers and the manager.

People that we spoke with said that they and their relatives were involved in agreeing and planning their care. We found that people’s views and experiences were taken into account in how the service was delivered.

People told us that their needs were being met. One person told us, “They ask you what you want and they do it and always ask if they can do anything else.”

People told us that staff wore personal protective clothing whilst providing personal care. We found that people were not fully protected from the risk of infection because appropriate guidance had not been followed.

People told us that they had no concerns about the staff that visited them. We found that staff were suitably recruited into their role.

People that we spoke with were confident that they could speak to the manager and their concerns would be listened to. One person told us, “No complaints, if I had I would phone the office and they would sort it out.” We found that there were clear systems in place for handling people’s complaints.

We carried out this review to check on the care and welfare of people using this service.

We visited the agency offices as part of this review, and looked at information we have received about this provider since our last visit in August 2011.

We checked the systems for planning care, documentation and paperwork produced by the organisation.

We could see improvements in a number of areas for example in how we are being notified of incidents, the way safeguarding information was being stored, and in how risks are being managed. These improvements now need to be sustained.

The manager has continued to undertake an assessment of the service against the essential standards for quality and safety. They told us that they are going to employ an external consultant to ensure the process remained transparent.

One person who received a service from the agency said they had "no qualms at all". A relative told us how they were “really satisfied” with the care workers who visited their relative.

We spoke with people and relatives over the telephone as part of this review. Overall people were happy with the times of their calls and the staff providing their care. Nobody we spoke with had experienced a missed call in the last 12 months. All staff are reported to wear uniforms and use gloves and aprons. This is to reduce the risk of cross infection.

People told us that they were involved in their care planning and regular review. They told us that their care workers made them feel safe and knew how to provide their support. All of them said that if they had any concerns they would speak to the office. They felt by doing this, there issues would be listened to and resolved.

During our inspection we spoke with four people that used the service, the relatives of 10 other people, the manager, deputy manager and seven care workers.

Most people told us they were happy with the service and felt their needs were being met. One person told us, “Very good care.” We found that care was not planned and delivered in a way that was intended to ensure people's safety and welfare.

Everyone that we spoke with felt they were safe with the staff that visited them. We found that people who used the service were not protected from the risk of abuse, because staff had failed to act in accordance with the provider's procedures.

People using the service had no concerns about infection control and we found that people were protected from the risk of infection because appropriate guidance had been followed.

Everyone that we spoke with felt that the service was reliable. We found that there were enough staff to meet people’s needs.

The majority of the people that we spoke with were satisfied with the standard of service that they received. A relative told us, “No concerns about the care at all, they have been very good with her.” However, we found that the provider did not have an effective system to regularly assess and monitor the quality of service that people received.