About the service:

Vine House Care Ltd is a domiciliary care provider that was providing personal and nursing care to 27 people at the time of the inspection.

People’s experience of using this service:

Although improvements had been made from the previous inspection, we found that records about people were still not up to date with their current care needs.

People with specific health needs did not have robust assessments to inform staff about support needs or signs that they were unwell. Improvements were also needed to documentation where people required support to make decisions about their care.

Although records required improvement, there was limited impact on people because staff knew them and their support needs very well. The manager agreed this was an area for improvement and by the third day of inspection, had already implemented changes to improve.

People told us they felt safe and one person said, “I feel safe in the presence of the carers, they always reassure me.” Staff knew people and risks to their safety very well.

There were enough staff to meet the needs of people and staff were recruited safely. Staff had a good understanding of safeguarding, such as signs that a person could be at risk and who to report to.

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 processes in the service supported this practice.

People, their relatives and a professional were confident that staff had the skills and knowledge to support people. They had received specialised training to meet the needs of people. Staff worked in partnership with health and social care professionals to improve people’s wellbeing.

Everyone we talked to spoke highly of the staff and told us they were, “Kind”, “Caring” and, “Attentive.” Staff worked with the same people each week and had therefore built strong relationships with them. People’s independence, dignity and privacy was continually promoted.

Staff understood people’s communication needs well and used a variety of tools to aid this. Care was personalised to people’s preferences and wishes and regularly reviewed.

Although no-one was receiving end of life care at the time of inspection, we saw thank you cards from relatives who said staff were, “So caring, thoughtful and loving” when they had supported people at this time of their lives.

Although there were areas identified for improvement in documentation, everyone we spoke with was unanimous in their views that the service was well-led. There had been a change of manager but no-one felt that this impacted on the care provided and they spoke highly of the new manager.

Staff felt well supported and part of a strong, passionate team, with an open and honest culture.

Rating at last inspection:

At their last inspection in May 2018, Vine House was rated Requires Improvement. (Report published 15 June 2018)

Why we inspected:

This was a planned inspection based on the rating 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

Vine House Care Ltd is a domiciliary care agency. At the time of our inspection they provided personal care to 28 people living in their own homes. It provided a service to older adults and some younger adults with a physical or learning disability. At the previous inspection, care was only being delivered to people during the night. This included waking nights, staff that slept at people’s homes and live in carer’s. At this inspection, care had been extended to provide support to people during the day as well.

Not everyone using Vine House Care Ltd received the 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.

At our last inspection in July 2017, the service was rated 'Requires Improvement'. During this inspection, we found some areas still required improvement. This is the second inspection where the service has been rated Requires Improvement.

The service had a 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. There were also two day supervisors and two night supervisors, who supported the registered manager to monitor staff and manage office documents.

Staff recruitment practices were not as safe as they could have been. Although Disclosure and Barring (DBS) checks were completed, the provider had not ensured that they had a full employment history for each staff member. This is required to ensure that staff character and skills are suitable to support people.

Staff had knowledge of offering people choices, however did not always demonstrate understanding of gaining consent for people who did not have capacity. Staff were not always clear about who was able to give consent and documentation that recorded people's understanding of specific decisions did not reflect the person's views or those that knew them well.

A number of shortfalls were found within record keeping which demonstrated current auditing processes needed to be developed. Although there was a care plan audit, this had not yet been implemented. Staff had a thorough knowledge of people and their support needs, which meant where shortfalls were identified, there was limited impact to people. However people’s support needs were not consistently identified in their written care plans. There were limited risk assessments with regard to specific support needs, such as diabetes, managing skin integrity and positive behaviour support. Documentation that was missing or incomplete was not always identified. There was a potential risk that if unfamiliar carers were to complete care calls, they would not have all the information they required to support people.

People told us they felt safe and gave positive examples of how staff supported them. Staff demonstrated a good knowledge of how to safeguard people and there were suitable numbers of staff to meet people’s support needs. Medicines were managed in such a way that people received them safely. People were by staff that were trained in administering medicines.

Staff had received a wide variety of training and people and their relatives were confident that staff had the right skills and knowledge to support people effectively. Staff spoke positively about their induction into the service and said regular supervision was given. These and regular spot checks meant they felt positive practise was recognised and areas of improvement identified.

All of the people and relatives we spoke with gave positive feedback about the kind, caring staff team. People's dignity, independence and privacy was promoted and encouraged. Staff knew p

Vine House Care Ltd is a domiciliary care agency registered to provide personal care for older people who are living with dementia, have a physical disability or sensory impairment and younger adults. The agency supported 22 people living in their own homes in East Sussex including Winchelsea, Hastings, Bexhill and Lewes.

The agency provides personal care and support at night from 10pm to 7am. This includes sleeping nights, short visits throughout the night and waking nights with staff available at any time depending on people’s individual needs, such as frailty of age, physical disability following a stroke and supporting people living with dementia.

This inspection took place on the 25 April 2017 and was announced.

A registered manager was present during 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.

The registered manager had a quality assurance and monitoring system in place, however it had not identified the concerns we found during the inspection. The provider had not followed their own recruitment procedures for all staff and the information in some care plans was not clear in terms of guidance for care staff to provide appropriate care and support.

Staff had a good understanding of people’s needs and explained clearly how they supported people to make choices and have as much control over their lives as possible. People were very positive about the care provided. They said staff were friendly and treated them with respect.

Staff had attended safeguarding training and demonstrated a good understanding of supporting vulnerable people. If they had any concerns they reported them immediately to the registered manager or supervisors, who were on call at weekends and out of office hours. Medicines were managed appropriately and staff had attended training before they were able to assist people with medicines.

Staff felt supported by management and there were systems in place to monitor and review the support provided to ensure people’s needs were met.