Greenfield Care is a domiciliary care agency. It provides personal care to people living in their own home in the community. It provides a service to older adults and, at the time of the inspection, was supporting 65 people in the South Suffolk and North Essex areas of Essex.

The inspection was announced and we gave the provider notice as we needed to make sure that someone would be at the office when we visited.

There was a registered manager in post who also was the provider. 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 our last inspection in May 2017, we found improvements were needed. Training was not well developed and staff had not received training in key areas in line with the needs of the people using the service. The arrangements in place to support people with their shopping did not provide people or staff with sufficient safeguards.

At this inspection, we found significant improvements had been made in some areas and there was greater oversight and scrutiny of the arrangements in place for purchasing items on people’s behalf. Regular staff meetings were being held and staff had been provided with training to ensure that they had the skills and knowledge they needed to deliver effective support.

However, we found that they need to strengthen the systems in place to oversee medicines and we made a recommendation about medicine administration. Care plans were in place but needed to be updated to reflect changes in people’s needs. Audits were being undertaken but they were not always identifying issues. The registered manager responded to the issues we raised by strengthening the head office team and appointing a new member of staff to update care plans and conduct audits.

Despite this, people’s day to day experience of the agency was good. There were sufficient staff available to provide the care that people needed. People told us that staff were reliable and they were supported by a consistent team of staff who knew them well. Checks were undertaken on staff suitability prior to their employment.

Risks to people’s welfare were identified and there were management plans in place to reduce the likelihood of harm.

People were supported to eat and drink and maintain a balanced diet. Staff were aware of people's dietary needs and the support they needed to eat their meals. People had good access to health care professionals and staff were alert to changes in people’s wellbeing

Staff sought people’s consent before starting to provide care. 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.

Care staff maintained good relationships with people who used the service and their families. Staff communicated effectively and there were systems in place to handover information. People told us that staff were kind and considerate and they were enabled to express their views and have a say in how they were supported.

Assessments were undertaken before people started to use the service, and people were enabled to make decisions about how they wished their care to be delivered. People’s needs were reviewed and care packages amended to take account of changes in people’s wellbeing. The agency was described as helpful and people told us that that they addressed any concerns promptly.

Staff morale was good and staff told us they were well supported by the registered manager who was visible and approachable. Questionnaires were distributed and analysed at regular intervals to ascertain people's views of their care.

The inspection took place between the 11th, 12th and 16th May 2017 and was announced.

Greenfield Care Limited is a domiciliary care agency, delivering services in the South Suffolk and North Essex Area. At the time of our inspection the agency was supporting 47 people.

The service has a registered manager who is also the provider. 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 in May 2016, we asked the provider to make improvements as we found shortfalls in the management of risk and safeguarding arrangements. Staff had not always received the training they needed and medicines were not managed in a safe way.

At this inspection we found that changes had been made which had led to some improvements however there remained areas where further work was needed. For example safeguarding procedures were clearer and staff could tell us about what to do if they had concerns about people’s welfare however the arrangements in place to safeguard people when staff made purchases on their behalf were not satisfactory. They did not protect the people using the service or staff. Some staff training had been undertaken but there were gaps and there was a need for a more comprehensive training strategy. Medicines were being managed in a safer way but there was a need for greater oversight and we have made a recommendation regarding this.

Peoples experience of this agency was good. They told us that they were supported by a consistent team of care staff who knew them well. The agency communicated with them and they knew in advance what staff would be visiting them. If there was a problem they were advised if the carer was delayed.

People spoke highly of individual staff describing them as caring and considerate. They told us that they were in control of their care and their choices were respected by care staff.

The manager was aware of their responsibilities under the Mental Capacity Act 2015 and the Deprivation of Liberty Safeguards. Staff had not received training in this area.

Staff supported people with meal preparation and helped them maintain a balanced diet. Where concerns were identified, monitoring was increased. Staff were alert to changes in people’s health and wellbeing and supported people to access appropriate health care support. Where necessary they accompanied people to healthcare appointments.

There were care plans in place to inform staff of people’s needs and preferences and people benefited from being supported by a regular team of care staff. Risks were assessed but information was not always presented in a clear way for staff to follow. We have made a recommendation regarding this. Reviews were undertaken when people’s needs changed.

Peoples concerns were listened to and there was a system in place to address complaints. We saw that concerns people had raised had been responded to in a timely way.

There was a quality assurance system in place to identify shortfalls and what the service could do better. This included seeking people’s views through annual surveys. We saw that the service had acted on feedback received and made changes. Audits were also undertaken however they were not well developed or always undertaken in a systematic way. Further work is needed to drive improvement

You can see what action we told the provider to take at the back of the full version of the report.

We carried out an inspection to this service on two separate dates, the 20 May 2016 and the 23 May 2016. During the first day we visited six people using the service in their own homes and on the second date we visited the service’s office. The visit was announced to give the provider time to organise the visits for us where we were accompanied by the compliance manager. The compliance manager was a senior member of staff responsible for the coordination and review of people’s care.

The service provides domiciliary care for people living in their own homes. There is a registered manager in post who is also the registered provider.

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.

We last inspected this service on the 2 November 2015 and found the service was required to make improvements in each area we inspect against: Safe, Effective, Responsive, and Well led. We rated the service as good in caring and inadequate in safe. We made a number of compliance actions in relation to breaches of regulation. We passed our concerns on to the Local Authority who assessed the service to ensure they were meeting their contractual arrangements.

At this inspection we noted improvements had been made since the last inspection and the feedback we received from staff working for the service and people using the service was very positive. However there was still a significant amount of work to do to improve record keeping, auditing and ensuring staff had the necessary skills to meet people’s needs.

There were enough staff rostered to ensure care calls were covered and there were additional staff who could be rostered to work if regular staff went off sick. People using the service were given a timetable so knew who to expect and the time the staff would come to support them as agreed. People were satisfied about their care and most people had regular carers or a small team of carers which meant people had a continuity of care from staff that knew them.

There were systems in place to ensure people were supported correctly with their medicines if required. However staff had not received adequate training to do this and there were no spot checks to ensure staff were sufficiently competent to undertake this task.

Staff had an understanding of how to safeguard people and who to report concerns to, if they suspected a person to be at risk of harm or actual abuse. However none of the staff we spoke with were able to identify any situation where they had concerns and we identified a safeguarding concern which had not been reported and recorded as such. Staff training required updating but was booked this month.

Recruitment of new staff was adequate to ensure only suitable staff were employed.

Risks to people’s safety was documented and records around people’s needs and risks associated with their care had improved since our last inspection. However lack of training for staff could place people at additional risk of unsafe care.

Staff spoken with had skills and experience in care. However the provider was not able to sufficiently demonstrate how they supported their staff through a robust programme of mandatory training or provide staff with the necessary support. There was poor evidence of training other than during the initial induction. Staff supervision and spot checks on their performance were did not sufficiently show how staff were effectively supported.

Staff had limited understanding of legislation relating to the Mental Capacity Act 2015 and the Deprivation of Liberties safeguards. Staff received some basic training to help them know how to lawfully support people.

Staff supported people to eat and drink where required and kept records

This inspection took place on the 2 November 2015.The inspection was announced.

This agency is owned by a sole provider who is also the 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.’

The agency are registered to provide personal care. They currently have fifty one people using the service. Some are funded by the Local Authority, others are privately funded.

The provider/manager had the right level of skills and experiences to manage the business but had not delegated tasks and responsibilities to other members of staff. Neither had he ensured that the staff had the right skills and experiences for their job role. The provider told us they were both planning the service and often delivering the care which meant they did not have adequate time to review the level of service provided to people. This meant that they had poor quality assurance systems and support systems for staff.

We did not feel people always received a safe service because staff did not receive all the training they needed and they were not supervised adequately or their practice assessed. We identified particularly concerns around medication practices and were not assured this was administered safely or correctly. In the absence of accurate records it was difficult to establish a clear picture. We also felt people were particularly vulnerable to financial abuse because there were not robust systems and audits in place to protect people from financial abuse. People were also placed at risk from poor recruitment processes which did not ensure that only suitable staff were employed.

Some staff were working excessive hours and there was not an adequate plan in place should a number of staff be sick at the same time. Some people reported missed calls or late running calls which affected their satisfaction with the service. However complaints were not recorded and missed or late calls were not either so we could not see if actions taken were appropriate.

We could not see if the care and support provided to people was always adequate because people’s care plans often did not give sufficient details about people’s needs, wishes and conditions which might impact on the person’s independence. Reviews were not regular and there was not a clear system to audit records to assess if care was being delivered correctly. We could not see evidence that people consented to the care they received.

We found breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 in multiple regulations. You can see what action we told the provider to take at the back of the full version of this report.

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People who used the service were treated with dignity and respect. Staff were able to provide us with a wide range of examples about how they upheld these principles. A relative told us, “The carers are very kind and patient and always full of smiles.”

We saw that people’s needs were assessed and care was provided in line with their individual care plan. These incorporated an assessment of risks and risk management plans that ensured people’s safety. We saw evidence that these were reviewed regularly.

People who used the service were protected from abuse because they were cared for by a staff team who had appropriate knowledge and training on safeguarding adults. People told us if they had any concerns they would not be afraid to report them to the manager.

Staff received ongoing training and support, which provided them with the skills and knowledge to meet the needs of the people they were supporting. Staff confirmed that they felt very supported to carry out their roles.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires and spot checks. The manager also visited people frequently to oversee the standard of care provided by the staff.

We found that people had an appropriate assessment of their care and support needs and had agreed to their plan of support. Care was provided according to the assessed needs, and the service responded well to people’s changing needs and requests for support. We saw that there was effective communication with other service providers to promote safety and support for people in their homes.

People told us that they had good support for managing of medications and we saw there were accurate records of medication administration. There were checks and processes in place to ensure that appropriate staff were recruited to work with vulnerable people.

The service provided people with clear information about how to contact the manager if they needed to make any comment or complaint. We saw that the service responded effectively to people’s comments or requests for support.

People we spoke with told us that they were very happy with the care and support

that they were receiving from Greenfield Care Limited. They told us that the staff were

always friendly and cheerful and were also always very polite and respectful when

supporting people. One person told us that the staff were absolutely fabulous and they could not fault them.