This was an announced inspection carried out on the 12 October 2016. Key Care and Support was last inspected in July 2013 and was compliant with all regulations inspected at that time.

Key Care and Support is registered to provide personal care to people in their own homes. At the time of the inspection the service was providing personal care support for one person who was supported by one member of staff. The service was not actively seeking to increase the people it supported as it was concentrating on other areas of the business. The main area of work for Key Care and Support is the supply of agency staff to other organisations, for example NHS hospitals, care and residential homes.

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 registered manager was not in the office during our inspection. We spoke with the care co-ordinator who was responsible for managing the one support package the service had.

The relative we spoke with said their loved one was safe supported by Key Care and Support. They currently employed their own personal assistants as well as having support from Key Care and Support. A review meeting was due to take place in the week following our inspection to review the care plans and potentially increase the support provided by the service. The care co-ordinator had plans in place for establishing a trained staff team, with additional staff trained to cover for annual leave and sickness, if this happened.

Staff had received training in safeguarding vulnerable adults and knew the correct action to take if they suspected any abuse had occurred. Staff said the care co-ordinator would listen to any concerns they raised.

Staff administered medicines safely via the percutaneous endoscopic gastrostomy (PEG) feeding tube ‘mickey’ button. Key Care and Support staff recorded all medicines administered and monitored food and fluid intake and used bowel charts. The care co-ordinator checked that the paperwork was correctly completed during the annual review. All paperwork remained at the person who used the service’s home. However the personal assistants did not complete the monitoring charts and daily logs. This was to be discussed at the forthcoming review meeting to agree clear instructions as to what was to be completed by whom so complete records were available if required.

The care plans in place were due to be reviewed. They were written in a person centred way and contained the preferences and choices of the person who used the service. Clearer guidelines were required for some tasks, for example when to support the person to turn over at night and the positioning required for some personal care tasks. Clear agreement of who was to complete what tasks was also to be agreed, for example who was to re-order the medicines.

Where external agencies such as the NHS provided equipment and guidelines for its use, these needed to be dated to clearly show they were current.

Risk assessments had been completed giving guidance to staff on how to mitigate the risks identified. These were updated annually.

Staff received annual refresher training including person centred care, fluids and nutrition, mental health, safeguarding vulnerable adults, basic life support and health and safety. Staff had also been trained in the use of the equipment provided and for PEG feeding. However these were not regularly refreshed unless the equipment changed. Observations of staff competency when using the equipment and administering medicines were not completed. The care co-ordinator said they would arrange for observations to be undertaken.

The person who used the service had capacity to make their

People who used Key Care and Support staff, and those working for the agency had a high regard for the organisation and felt that staff were supported to be effective and safe workers.

We were told:

“The best thing about the service is that there are a lot of different places to work and then we have an appraisal with forms to fill in. The support is ongoing. It’s not just passing the interview.”

And,

“The best thing about the service is that the director is keen on sending out the right person for the right job.”

At the time of the inspection visit we found that Key Care was mainly providing trained nurses and care assistants to care homes and hospitals on a short term basis. They did provide staff directly into people homes but at the time of this inspection this was for a very small number of people.

People we talked with who used Key Care and Support staff agency, had a high regard for the organisation and felt that staff were supported to be effective and safe workers. They told us: “Key Care are very receptive and accommodating to the needs of the clients.”

And:

“From what I’ve experienced I’ve had no problems whatsoever. There is really good communication and they work with us well.”

People who worked for the agency told us: “They have a good reputation amongst workers and the hospitals.”

And:

“We have all the training we need, everything you can think of, first aid, moving and handling, how to give injections or take bloods…everything.”

We found there were effective systems in place to ensure people were involved in planning their care and support.

People were protected because staff understood about infection control and preventing cross infection.

We found that a robust recruitment and selection process was used which meant the employment of good quality staff was promoted.

We found that when staff were supplied directly into people’s homes, systems to check that assessments and care plans were up to date needed to be improved but quality monitoring that took place was effective because the provider listened to people and improvements made in response to what was said.