Care service description

Kare Plus Guildford is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older and younger people some of whom may be living with dementia or have a learning or physical disability. At the time of our inspection the service provided a regulated activity to 36 people.

Rating at last inspection

At our last inspection we rated the service Good. This latest inspection was partly prompted by an incident which had a serious impact on a person using the service and this indicated potential concerns about the management of risk in the service. While we did not look at the circumstances of the specific incident, which may be subject to criminal investigation, we did look at associated risks. The Local Authority also made us aware of ongoing concerns that related to staff not attending calls to people using the service.

The registered manager was not available on the day of the 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. Instead we were supported by the provider.

People’s medicines were not being managed in a safe way which put people at risk. Staff were not trained or assessed as safe to administer medicines to people. Accidents and incidents were not always reported and actions were not always taken to reduce reoccurrence of them. Good infection control was not always being followed by staff and assessments of the risks associated with people were not always assessed. Where people were at risk of malnutrition or dehydration there were sufficient processes in place to monitor this.

The provider had not ensured that there was sufficient organisation of the staff rotas and we found that staff were at times late for calls of failed to attend calls. The provider, registered manager and staff were not following procedures that related to safeguarding people from the risk of abuse or neglect. The recruitment of staff was not robust which put people at risk.

Staff were not sufficiently trained or supervised to ensure that they were competent to carry out their role. There was a lack of understand of the Mental Capacity Act and its principles. Where people’s capacity was in doubt there was no assessments undertaken by the registered manager. Prior to people receiving care there was a lack of assessments of their needs. Where advice was needed to be obtained to support people, health care professionals were not always being contacted. Appropriate systems were not in place to ensure that staff were communicating changes in people’s needs.

People’s care was not provided in a consistent way. People were not always sure who would be attending their call and told us that this caused them anxiety. People were not always involved in their care planning. Where they asked for staff to attend the call at a particular time this was often not adhered to. Care plans lacked information about people’s backgrounds, interests and things that were important to them. Where people were being cared for at the end of their lives there was no care planning in place around this.

Care plans lacked detailed and guidance for staff. There were times where staff were delivering care without having any information about the person’s needs. Where there was a change to people’s care their care plans were not updated to reflect this. Where people and relatives complained about their care, this was not recorded and insufficient actions were taking place to address their complaints.

People, relatives and staff felt the service was poorly managed. Appropriate steps had not been taken to ensure that staff were attending calls or whether they were staying for

Kare Plus is a domiciliary care agency which is registered to provide personal care to people in their own homes. At the time of our inspection the service was providing personal care to nine people.

This inspection took place on the 6 October 2017 and was announced. We gave 48 hours’ notice of the inspection to ensure that staff would be available in the office, as this is our methodology for inspecting domiciliary care agencies.

A registered manager was 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. The registered manager assisted us with our inspection.

People told us they were cared for by staff who were kind and caring. They said they arrived on time, stayed the full time and carried out care for them in the way they wished it.

People and their relatives told us they felt safe with staff from Kare Plus. Staff had a clear understanding of the different types of abuse and the procedures to be followed if they had witnessed or suspected abuse had taken place. The registered provider had followed safe recruitment processes to ensure they only employed suitable staff.

Risks to people were identified and actions taken to help people stay safe. In the event of an accident the agency followed this up.

If an emergency occurred at the office or there were adverse weather conditions, people’s care would not be interrupted as there were procedures in place. There was an on-call system for assistance outside of normal working hours.

Staff had received training and supervisions that helped them to perform their duties. They also received spot checks from the registered manager whilst they were working with people. The registered manager understood the Mental Capacity Act 2005 (MCA) and we found that people’s consent was sought before the agency provided care to them. People received information on what care the agency could provide to them prior to accepting the care. Staff received induction training when they commenced working at the agency. Mandatory training and other training specific to the roles of staff was also provided.

There were enough staff to ensure that people’s assessed needs could be met and all visits could be undertaken in a timely manner. Management of medicines was undertaken in a safe way and recording of such was completed to show people had received the medicines they required.

Person centred care plans were in place for people and included information about how people preferred their care to be provided. Guidance for staff was detailed and there was evidence people were involved in their care plan.

People’s nutritional needs were met by staff who would cook meals for those who required this type of support. Healthcare professionals were involved in people’s care and staff liaised with them as and when required.

People were supported by staff to remain as independent as they were able. People were encouraged to do things they would normally do such as washing themselves. Where people wished to go to specific events or activities, staff supported them to do this. Such as one person who staff supported to go on holiday.

Quality assurance audits were carried out to help ensure the quality of the care the agency provided met the needs of people. People and staff were involved in the running of the agency and staff told us they felt supported and valued. There was a complaints procedure in place and we found that management responded to complaints promptly. Records were held securely and confidentially. The registered manager was knowledgeable about the service and was able to assist us with the inspection. It was evident they had a good relationship with staff as we saw staff coming in to the office and sp