About the service:

Creative Care and Support Limited is a domiciliary care agency providing personal care to people in their own homes. At the time of this inspection it was providing services to 62 people.

People’s experience of using this service:

During the last inspection we identified the provider’s systems which monitored quality and safety of services provided were insufficient to ensure people consistently received safe care and support. At this inspection, we found people received a good service and support was provided by staff who were safely recruited. The provider ensured care was delivered in a safe way and had introduced a range of systems since the last inspection to ensure care was monitored effectively.

People told us staff were kind and caring. They were positive about how they were treated by staff. People told us they were in control of their day to day routines and staff supported them to remain independent. People were generally happy with their call schedules; however, some mixed feedback about the punctuality of people’s care calls indicated further improvements were required in this area. The management team were aware of this issue and demonstrated they were committed to improving this aspect of the service.

Staff received training which they told us equipped them for their roles, and also told us the induction they received was effective.

People were supported in maintaining good health, and staff liaised with external healthcare providers where appropriate to ensure care was provided in a way that met people’s needs.

Staff told us the management team were supportive and understanding of their own personal circumstances. People and relatives said the management team were very approachable.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service followed clear processes for obtaining consent before care and treatment was provided. The quality of people’s completed consent forms was sometimes inconsistent, which the provider assured would be addressed after the inspection.

Rating at last inspection:

Requires Improvement. The report was published on 27 April 2018.

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

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.

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

Creative Care and Support is a domiciliary care agency, providing personal care to people living in their own houses and flats in the community. We previously carried out an announced comprehensive inspection of this service on 11 and 19 January 2018; we rated the service Good. The service was not in breach of the Health and Social Care Act 2008 regulations at that time. After that inspection we received notification of a serious incident involving a person who used the service. This incident is being reviewed by the Care Quality Commission (CQC) in line with our specific incidents policy. Therefore, this inspection did not examine the circumstances of the specific incident.

The information received by CQC about the incident raised concerns about the way the service managed risk to people. This announced focused inspection of Creative Care and Support on 15 March 2018 included an examination of how those risks were managed. The team inspected the service against two of the five questions we ask about services: is the service safe, is the service well led. No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Creative Care and Support on our website at www.cqc.org.uk.

The service had 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 service had a recently recruited a care co-ordinator and were recruiting a further two senior care staff. The registered manager said they had sufficient care staff employed but when we spoke to care staff they felt there were insufficient staff to cover staff absences. Recruitment processes were not robust. Gaps in employment were not explored and written references and criminal records checks were not always in place prior to staff commencing employment.

Systems were in place to ensure people received their medicines as prescribed. Staff completed medicines training but they had not always received an observational competency assessment prior to administering people’s medicines.

Staff were aware of the different types of abuse and understood their individual responsibility in reporting any concerns to senior staff. Individual risk assessments were in people’s care files; these were reviewed and updated at regular intervals.

We found, since the specific incident, lessons had been learned and improvements made to policies and procedures although at the time of the inspection not all field based staff appeared to be aware of this or the subsequent changes to procedure for office staff.

There had been a recent introduction of management meetings to share relevant information. The business manager had systems in place to enable them to monitor when tasks needed to be completed and by whom. The registered manager told us they completed regular spot checks on the performance of the business manager but no formal record of this was kept.

The management team understood their role but there was no effective governance system to ensure delegated tasks were completed in a timely manner and to the required standard.

This is the first time the service has been rated Requires Improvement.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 in relation to fit and proper person’s employed and good governance. You can see what action we told the provider to take at the back of th

We undertook an announced inspection of Priory Campus on 11 and 19 January 2018. We gave short notice of the inspection in line with our methodology, as it was a domiciliary care agency and we required the appropriate staff to be available.

Priory Campus, Creative Care and Support is a domiciliary care service that provides personal care for people in their own homes.

This was Priory Campus, Creative Care and support’s first inspection since they registered the location with the Care Quality Commission (CQC) in December 2016. However, the provider was in the process of moving to a new office location. They were intending to move the location in February 2018 and register the changes with CQC. There would be no changes to the service provision it is only a change of office location.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Staff we spoke with were knowledgeable regarding signs of potential abuse and how to recognise abuse. They were also aware of the reporting procedures. Assessments in care files identified risks to people and management plans were in pace to reduce risks.

People we spoke with told us they felt safe with the staff who supported them. Staff were knowledgeable and had the right skills to meet their needs. However, the service was short staffed and existing staff were picking up calls to ensure people's needs were met and it did not have a negative impact on people who used the service. The registered provider had a policy and procedure in place for the safe recruitment of staff and they were recruiting at the time of our inspection.

People said they received good quality care and that staff treated them with dignity, respect, kindness and care.

Systems were in place to make sure people received their medicines safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff told us they felt very well supported. They said regular supervisions and appraisals were provided with appropriate frequency and in line with the registered provider's policies. However staff felt at times communication could improve.

People said they predominantly had their own regular care workers who knew them well and cared for them as agreed in their care plans. People's plans were reviewed and updated regularly and changes made where necessary.

The registered provider listened to people and had a complaints procedure in place. People and their relatives told us they felt able to report any concerns and said they were confident these would be dealt with.

There were meetings for staff where they could share ideas and good practice.

The registered provider was implementing a management structure at the time of our inspection and a new care co-ordinator had been recruited and was due to start in February 2018.

Quality assurance audits were carried out to identify how the service could improve and the registered manager had an on-going and effective improvement plan for the service.