This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. Not everyone using KarVonEttes receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

KarVonEttes provides personal care and support to people in Mansfield, Ashfield and the surrounding areas of North Nottinghamshire. On the day of our inspection, 57 people were using the service.

We carried out this inspection on 7 June 2018. It was an announced inspection, which meant the provider knew we would be visiting. This was because we wanted to make sure that the registered manager, or someone who could act on their behalf, would be available to talk with us.

At our last inspection on 24 November 2016, there was no registered manager in post, medicines were not always managed safely and the service was rated as ‘Requires Improvement’.

At this inspection, we saw improvements had been made regarding the safe management of medicines and there was a registered manager 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.

There was a strong ethos of delivering person centred care and this was a culture which was embedded with the staff team. There were systems in place for staff which enabled them to feel supported, valued and motivated.

People and their relatives spoke positively about the management of the service and felt that the registered manager was professional, readily accessible, approachable and helpful.

Oversight of the service and staff, both formal and informal, enabled the management team to regularly monitor the service provided and ensure all care and support was consistent, responsive and reflected people's ongoing and changing needs.

People, relatives and professionals told us that staff were kind, caring and compassionate.

Staff were appropriately recruited, trained and supported. They had undergone a comprehensive induction programme and, where necessary, had received additional training specific to the needs of the people they were supporting. Communication was effective and regular meetings were held to discuss issues and share best practice. Staff understood their roles and responsibilities and spoke enthusiastically about the work they did and the people they cared for and supported.

The provider had detailed policies and procedures relating to medicines management. Staff understanding and competency regarding the management of medicines was subject to regular monitoring checks and medicines training was updated appropriately. Staff understood what support people needed to manage their medicines safely and these were given as prescribed. There were processes in place to audit the accuracy of recording medicines.

Staff knew the people they were supporting and provided a personalised service and used effective systems for gaining consent. Individual care plans, based on a full assessment of need, were in place detailing how people wished to be supported. This helped ensure that personal care was provided in a structured and consistent manner. Risk assessments were also in place to effectively identify and manage potential risks.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. Staff we spoke with were able to explain how they considered capacity and consent when they supported people.

People received support, where appropriate,

This announced inspection of KarVonEttes was carried out on 24 November 2016.

KarVonEttes provides personal care and support to people in their own homes in Mansfield, Ashfield and the surrounding areas of North Nottinghamshire. On the day of our inspection, 118 people were using the service.

The service did not have a registered manager in place at the time of our visit. The previous registered manager left the service in May 2016. Although a manager was in place at the service, the provider had not submitted an application for them to be registered with CQC at the time of our 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.

People told us they felt safe receiving care in their homes form staff of KarVonEttes and did not have any concerns about the care they received. S we spoke with knew how to protect people from harm. However referrals were made to the appropriate authority when concerns were raised.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm; for example in relation to falls or environmental risks.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff employed. Appropriate pre-employment checks were carried out before staff began work at KarVonEttes.

People who required support to do so received assistance from staff to take their prescribed medicines safely. However, safe recording of medicines administered was not always consistent.

People were supported by staff who received training and support to ensure they could meet people’s needs. Ongoing training and assessment for care staff was scheduled to help maintain their knowledge.

People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

People were supported by staff to maintain healthy nutrition and hydration. People had access to healthcare professionals when required and staff followed their guidance to ensure people maintained good health.

People were treated with dignity and respect and their privacy was protected. People told us they had positive, caring relationships with staff. Where possible people were involved in making decisions about their care and support.

Staff understood people’s support needs and ensured they received personalised responsive care. People knew how to raise a complaint and were confident these would be listened to and acted on.

There was an open and transparent management culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on. Quality monitoring systems were in place to identify areas for improvement however these were not implemented consistently across the service.

The inspection team who carried out this inspection consisted of one inspector to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people who used the agency. We held telephone conversations with people who used the agency and one person’s relative. We spoke with four representatives from the management team and two support staff. We also looked at some of the records held at the agency which included support plans and staff recruitment records.

Is the service safe?

People told us they felt they received their care and support in a safe and considerate manner. Comments included, “I feel safe with all the staff,” and, “As far as I’m concerned I am very safe. All the staff are very friendly and cheerful.” People also told us the support staff attended their appointments in a timely manner and stayed for the contracted length of time.

We found that an on call system was in operation to ensure a member of the management team would be available at all times should an emergency situation arise.

We found that an effective recruitment system was in place to ensure that staff employed to work at the agency were suitable. We also established that staff were able, from time to time, to obtain further relevant qualifications pertinent to their roles and responsibilities at the agency.

Is the service effective?

Systems were in place to ensure that people’s individual support needs could be identified and met. People told us that their support package was delivered in such a way as to meet their individual needs. They also told us they felt that staff had a good understanding of their individual preferences.

Is the service caring?

People told us that staff were respectful and caring at all times. One person told us, “I am always satisfied with the support the girls provide, and I think it’s an excellent service”. Another said, “I really look forward to them (support staff) coming. They are all very helpful and I view them all as my friends now.”

A relative of a person using the service also told us they felt involved in their son’s care package and felt confident that a good quality and caring service was being provided.

Is the service responsive?

We found that systems were in place to ensure that effective needs assessments could be performed when people expressed a desire to use the agency. The manager told us that they would utilise information from people’s relatives and professionals, such as social workers when available, so as to build a comprehensive picture of people’s individual support needs.

We found the reviewing procedures at the agency had been amended since our previous inspection to ensure that support plans were up to date and reflected people’s individual needs.

Is the service well-led?

We found that since our last inspection the roles and responsibilities of the management team had been re-examined to ensure they were fully aware of what was expected of them. One member of the team told us, “We all work as a team now and it’s improved the service. We fit into our job descriptions and we all know our roles and responsibilities. That’s why we have improved.”

Staff told us they received appropriate support and direction from the management team. We saw that formal staff supervision sessions were in place to ensure staff could express their views and discuss any developments at the agency. We also found that staff performance reviews, in the form of spot checks in people’s homes, were undertaken to ensure that staff were maintaining appropriate standards of support.

Records showed that people had been supplied with a satisfaction survey in 2014 so they could make comments about the quality of the service they received. A member of the management team told us, and records showed, that an analysis of the consultation process had been undertaken to develop the quality of the service whilst recognising where improvement could be made.

As part of our inspection process we spoke with twenty people who were receiving interventions from the domiciliary care agency to determine their views of the quality of service provision.

People told us they were very satisfied with the service they received with one hundred per cent of the respondents describing the service as either good or excellent.

The majority of people spoken with told us they felt the agency was well run and flexible in meeting their individual needs. They felt the care staff were confident and competent in performing their duties but also felt comfortable in discussing any areas of concern with the registered manager. One person told us, “I definitely feel comfortable in discussing any issues with the management team they are approachable and caring.”

Further developments were required to ensure that a robust staff recruitment process was followed.

We found that whilst a staff training programme was provided further developments were required to ensure that all staff attained appropriate training pertinent to their roles and responsibilities at the agency.

We found that information within people’s records was not accurate in all instances. The management team required further guidance to ensure they were clear about their roles and responsibilities in this area.