About the service:

Olive Homecare & Support is a domiciliary care service providing personal care to 17 people living in their own homes. People using the service were older adults with a range of care and support needs. These included dementia and physical disabilities.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

¿Improvements to the service and quality of care people received had significantly improved since the last inspection and introduction of a new management team.

¿Quality assurance processes were not fully imbedded in practice to drive consistent improvements in service delivery.

¿Issues identified from audits were not always acted on in a timely way to improve staff practice.

¿People were protected from the risk of abuse. Risks to people were identified and lessened where possible.

¿Recruitment processes ensured staff were safe to work with people before they started

working at the service.

¿People were supported to access healthcare services and with their dietary needs.

¿Staff had access to training opportunities that supported them to care for people's specific needs.

¿People told us staff gained their consent before carrying out any care or support. People's care plans directed staff to offer people choices.

¿People and their relatives all told us staff were kind and compassionate.

¿A relative told us, "They are very kind and caring. They are very good and know their role.”

¿People and their relatives, if appropriate, were fully involved in discussions about their care.

¿Staff supported people to maintain their independence.

¿People's care was person centred and their care plans contained information about their life history, preferences and the way in which they like to be supported.

¿People told us they would feel comfortable making a complaint but hadn’t needed to.

¿People, their relatives and staff were all complimentary of the new management team and improved communication.

¿People, staff and relatives were engaged and involved in the service provided.

¿Staff worked in partnership with other organisations to ensure people's needs were met.

Rating at last inspection:

Requires Improvement (The report was published on 26 February 2019). The overall rating has improved since the last inspection.

Why we inspected:

The was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good.

The inspection took place on the 17 and 20 August 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service. We wanted to be sure that someone would be in to speak with us and that we could meet with people using the service.

Olive Home Care and Support is a domiciliary care agency registered to provide personal care and support services to a range of people living with physical disabilities, mental health needs and people living with dementia. The service provides personal care to people living in their own houses and flats in the community. At the time of our inspection the service was supporting 20 people.

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.

At the last inspection on 1 August 2017, the service was rated Requires Improvement. This is the second time the service has been rated ‘Requires Improvement.’ This was because the provider had not fully ensured staff were suitably trained and deployed to meet people’s needs in a way that met their needs.

At this inspection we identified further areas of practice that required improvement, including breaches of regulation in relation to safe recruitment, safeguarding, safe care and treatment and quality assurance and governance.

Practice around the administration of medicines was not consistently safe. Staff were trained and assessed as competent to administer medicines. However, practice around the administration and recording was not consistently safe. There was a lack of guidance for staff on how daily and ‘as required’ medicines should be given. People’s prescribed medicines were not always given in the way the prescriber intended and the governance of medicines was not robust enough to ensure that shortfalls were addressed without delay.

People and their relatives had made a number of ongoing complaints in relation to delayed and missed calls since the last inspection. Social care professionals and two local authority professionals had worked closely with the provider to reduce the levels of missed calls. During this time people were at an increased risk of not having their care needs and preferences met including, access to their medicines, food, personal care needs and feeling secure. One person noted in a complaint to the provider that a delay of two hours in their night time call had left them feeling unsafe. Records demonstrated that although some improvements had been made, that not all calls were being made in a timely way that promoted people’s needs being met.

Recruitment procedures had not ensured that staff were safe to work with vulnerable people, as the registered manager and provider had not always robustly carried out their own recruitment and safeguarding policies.

People were not always protected from the risk of harm, abuse or potential abuse. Staff could tell us about different types of abuse and were confident the registered manager would take concerns seriously. However, on at least two occasions, peoples’ wellbeing was not promoted as the registered manager did not effectively identify, or act on, evidence that abuse may have occurred. They also failed to notify the CQC of these incidents and the local safeguarding bodies, or do so in a timely way. Where accident and incidents had been identified and records completed, action were not always fully documented to reduce the risk of reoccurrence and effectively mitigate the risk of further injuries.

Quality assurance systems failed to monitor the overall quality of the service and to identify short falls. The registered manager and provider recorded information relating to quality assurance areas, howeve

The inspection took place on the 1 August 2017 and was announced. The provider was given 48 hour’s notice because the location provides a domiciliary care service. We wanted to be sure that someone would be in to speak with us.

Olive Homecare and Support provides domiciliary care and support for people in their own home. The service provides personal care, help, and support to people with a variety of needs in Burgess Hill and surrounding areas. At the time of our inspection 37 people were receiving a care service with an age range between 34 - 97 years old. This included older people, people living with dementia and people with a physical disability.

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.

Most staff were able to identify the correct safeguarding and whistleblowing procedures should they suspect abuse had taken place, in line with the provider’s policy. However some staff demonstrated an unclear understanding of the types of abuse that could occur.

We identified rota issues with the provision of care and support particularly with the travelling time for staff between calls, which was also confirmed by relatives and people. One person told us “They never arrive on time. 10am to 11am is our slot but sometimes they arrive at 9.30am and once they arrived at 11.30am and never phoned but mostly they do let us know if they’re going to be late”.

Not all care staff had received full training on the requirements of the Mental Capacity Act 2005 (MCA) although the registered manager had ensured policies and procedures relating to the MCA 2005 were in place and readily available to staff. This meant that staff would not be aware of the correct procedure to follow should there be concerns relating to someone's mental capacity.

People and relatives commented that on occasions they found it hard to talk to and understand staff when English was not their first language. One person told us “Carers are very good but language is a problem. They don’t all speak fluent English”.

Care staff received essential training to equip them with the skills and confidence in providing effective care. However when examining the training plan staff had undertaken many online training courses on the same day. For example one member of staff had completed six courses in one day on the computer. This could impact on the member of staff’s ability to retain all the information they had learned and to provide effective care to people.

The registered manager monitored the quality of the service by the use of checks and internal quality audits. We found audits to be inconsistent in quality and not always recorded when they had been carried out. The absence of detailed auditing also meant that the registered manager could not be assured of the quality of the service delivered.

Assessments were undertaken to identify people’s support needs and care plans were developed outlining how these needs were to be met. We found that care plans enabled staff to provide the individual care people needed. People told us they were involved in the care plans and were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

The provider had arrangements in place for the safe administration of medicines. People were supported to receive their medicine when they needed it. People were supported to maintain good health and had assistance to access health care services when required.

People and relatives thought that staff were kind and caring. One person told us “Lovely staff, all of them. Yes they are caring”. Another p