About the service:

Radis Community Care (Reading) is a domiciliary care agency based in Reading, providing personal care support to 48 people living in their own homes.

Overview of findings:

Staff were not always trained or regularly assessed as competent to administer medicines in line with the provider’s policy, clinical guidance and best practice.

Where people were prescribed ‘as required’ (PRN) medication, the service did not always have protocols or guidance in place to ensure that staff knew when to administer PRN medicine.

Audits had not always been undertaken. Those that had, did not always identify gaps or highlight trends, themes or lessons learnt.

Care records did not always clearly reflect how staff were meeting people’s specific health conditions.

Care records did not always reflect what decision people could make for themselves when they lacked capacity.

Where others signed consent to care forms on behalf of people who received support, it was not always clear they had the legal authority to do so.

Where lessons learnt had been identified following complaints, concerns, accidents and incidents, the registered person had not always implemented the required changes to improve the service.

Recruitment processes were in place to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

People told us they felt safe with the staff who supported them.

People's right to confidentiality was protected and their diversity needs were identified and incorporated into their care plans, where applicable.

People and their relatives said staff were caring and respected their privacy and dignity.

People felt the service they received helped to maintain their independence where possible.

People knew how to complain and knew the process to follow if they had concerns.

Staff felt the management was supportive and approachable. Staff were happy in their role which had a positive effect on people's wellbeing.

Rating at last inspection:

The service was inspected on 15 July 2016 (published 27 August 2016). We found the provider was in breach of Regulation 11 of the Health and Social Care Act, (Regulated Activity) Regulations 2014, (Need for consent). We conducted a focussed inspection to follow up this breach on the 6 February 2017 (published 4 April 2017). We found the provider was compliant at the time of that inspection.

Why we inspected:

This was a planned comprehensive inspection.

Enforcement:

Full information about CQC’s regulatory response can be found in the full report which can be found on our website at www.cqc.org.uk.

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.

This was a focused inspection, carried out on 6 February 2017 to follow up on a previous regulatory breach and a recommendation made following a comprehensive inspection on 15 July 2016. The inspection was announced. The provider was given 48 hours’ notice of this inspection because the location provides a domiciliary care service and we needed to be sure the registered manager would be available to assist the inspection.

At the previous inspection we identified a breach of Regulation 11 of the Health and Social Care Act, (Regulated Activity) Regulations 2014, (Need for consent). People’s rights may not always have been protected because it was not always clear care and treatment was provided with the consent of the relevant person. We also made a recommendation the registered manager referred to relevant guidance to develop systematic and demonstrable monitoring systems for the service.

At this focused inspection we found the registered manager had taken, or was in the process of taking, action to address the areas identified. The service was now compliant with Regulation11.

Radis Community Care (Reading) is a domiciliary care agency based in Reading, providing personal care support to 84 people living in their own homes. 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.

We found staff understood the need to obtain day to day consent from people before providing their support and people confirmed they did this. People and their representatives had been involved in planning the care and had consented to care plans. Where others had the legal authority to make care decisions on behalf of people, this was documented. Where the involvement of others had otherwise been authorised by the person supported, this was also documented.

The registered manager had put new systems in place to monitor the operation of the service and had an effective management audit process in place. Team meetings had been held regularly and there were plans to further improve team working.

People’s views about the quality of the service were sought systematically and any issues identified were acted upon and resolved.

This inspection took place on 15 July 2016. We gave the registered manager short notice as we needed to be sure she would be there to assist us with the inspection. The service required improvement in a number of areas at our last inspection in January 2015 although no breaches of regulations were raised.

Radis Community Care (Reading) is a domiciliary care agency that provides personal care and other support to 101 people in their own homes. The service is operated by GP Homecare Limited.

The service had a registered manager as required to manage its day to day operation. 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 and relatives felt staff were caring and kind and worked in ways that supported people’s dignity and privacy. They felt staff involved them in their care and encouraged them to do what they could for themselves. People told us staff asked how they liked things done and respected their wishes. People felt consulted about their care needs which were regularly reviewed.

Complaints were responded to and addressed appropriately by the registered manager and records described the action taken to resolve them. The views of people and their relatives about the agency’s operation had been sought by means of a detailed survey. The feedback was mostly positive and where issues had been raised they were included in an action plan and addressed.

Medicines recording and management systems had improved since the previous inspection to reduce the risk of potential errors. However further work was needed to ensure that all staff had their competency assessed periodically with regard to medicines management and also moving and handling.

Staff knew how to keep people safe and were aware of the signs of possible abuse and how to report it. They felt the registered manager would respond appropriately to any concerns raised.

Where others gave consent on behalf of people who received support, it was not always clear they had the legal authority to do so. This was a breach of Regulation 11 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. (Consent). This meant people’s rights might not always be safeguarded.

Staff training had improved and there was a rolling programme of induction and training to ensure staff remained up to date with their skills and knowledge. However, there was a need to improve the induction process. This was reported to be about to be addressed by the adoption of the Care Certificate induction process.

The level of detail in risk assessments had been improved. People were safer because these documents included information for staff on how to address identified risks. The level of detail in care plans had also improved and they provided the information staff needed to provide people’s care in a person-centred way, respecting their wishes.

A robust staff recruitment process helped ensure that staff had the necessary skills and approach to care for vulnerable people. People usually received support from a regular team of staff who mostly arrived on or around the time they were due and provided the required care according to people’s wishes and their care plan. People’s consent was sought with regard to the day to day care support provided.

Staff received regular support through supervision meetings and annual appraisals; and were kept in touch with changes and other information via regular newsletters. However, team meetings were infrequent, so opportunities to discuss care practice with colleagues were limited.

The service had an overall development plan which identified goals and how they would be measured. However, the views of the staff team had not been sought recently to monit

We did not speak with people who used the service on this occasion.

Our inspection of the 20 May 2014 found major concerns. This was because the provider had not taken steps to protect people against the risks of receiving care that was inappropriate or unsafe. We issued the provider with a warning notice which required the service to be compliant with regulation 9 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 by 25 July 2014.

At this inspection there was evidence that the service was making continual improvements to ensure all of the people who used the service had a plan of care. However, we found further actions by the provider were needed to be fully compliant.

We looked at six plans of care. We saw that comprehensive initial assessments had been completed and person centred plans had been developed from them. These had been put into place in June 2014 and July 2014. We found that risks had been identified, assessed and that risk action plans were available. However, we noted that some of the risk action plans did not always contain enough detail to identify and minimise risks to people and care staff.

The provider had suitable arrangements in place to ensure that staff were properly supported to meet people’s health and welfare needs. This was because staff were receiving appropriate training and appraisal.

The provider was reporting applicable incidents to us as required by the regulations.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register.

Most of the staff we spoke with confirmed the frequency of supervision sessions had increased since our last inspection and they had a recent supervision session. We looked at the personal files for 10 members of staff. All of them showed evidence of a recent supervision session. However, the manager confirmed they had not undertaken any appraisals with staff and none were scheduled.

Some mandatory training had been completed including moving and handling. However, most of the staff had not received training updates for safeguarding of vulnerable adults, infection prevention and control or medication since they began employment with the provider. There was a risk that people who use the service would not have their health and welfare needs met by staff who were competent.

We spoke with the manager who told us they had implemented new processes for quality checks. These included contacting people who use the service by telephone on a regular basis, to see if people were happy with the quality of the service they provided, and spot checks for members of staff when they were providing care to people. Most of the people we spoke with confirmed these quality checks were taking place. One person told us they were “happy with the service” and another said “the carers are really lovely”.

The provider had not reported applicable incidents to us which concerned the provision of care and welfare to people who use the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register. The person currently managing the location was in the process of registering.

People we spoke with told us they felt safe and cared for. One person told us “they do things just how I like them”. A relative told us “staff are excellent”. People were able to access their care plans and ask for changes if they needed them.

People using the service told us staff were respectful of their dignity and privacy. Staff respected people’s choices and treated people as individuals.

We found that the provider had not ensured that all of the essential staff training, supervision and appraisals were being done, or being scheduled for the future.

The provider was not regularly assessing and monitoring the quality of the service they provided.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

This inspection took place on 20 and 21 January 2015. The inspection was announced to ensure the manager was available.

The service is a domiciliary care agency providing personal care support to people in their own homes. People’s needs were mainly related to old age. The service was providing personal care support to almost 100 people across Reading, Wokingham and West Berkshire.

The service is required by law to have 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.

The service has not had a registered manager since April 2014. A manager had managed the service for part of the period since then but did not apply for registration. The current manager was appointed in November 2014 and her application for registration was being processed at the time of this inspection.

At the last inspection on 20 and 27 May 2014 we told the provider to take action to make improvements in five areas, obtaining consent, assessment, care planning and risk assessment, recruitment procedures and staff training and support.

Although action had been taken these issues remained only partially addressed and further work was needed in each area.

Although people told us they felt safe when being supported by the agency we found that some potential risks remained. The provider’s risk assessments had been improved but were too generic and lacked sufficient detail about specific risks related to individuals. Staff had not always been assessed following training in moving and handling and medicines management, to ensure they were competent in these areas. This meant that there was a risk that these aspects of care might not be delivered safely. The practice of hand copying medicines instructions from pharmacy labelled packaging to the medicines record sheets is potentially unsafe and could lead to medicine administration errors.

Staff had all completed training on safeguarding and whistle-blowing and demonstrated an understanding of their responsibilities. A rolling programme of staff training was provided but some staff had not had recent training updates.

The service could not always demonstrate that appropriate consultation had taken place or that consent had been obtained in accordance with the law.

Staff demonstrated they had the skills to meet people’s day-to-day care needs and communicated well with them while providing support. The provider had significantly improved the support provided to staff through supervision, appraisal and team meetings.

We saw staff provided care patiently, respected people’s wishes and supported them to make choices and to contribute to their own care where possible. Where people had stated a gender preference regarding the staff providing their care, this was respected. People also told us the staff listened to and involved them and sought medical assistance for them when necessary.

The provider had reviewed care plans and made further improvements. However, care plans and the records of care provided sometimes lacked sufficient information to reflect the needs of the individual. Where safeguarding issues had arisen the provider had taken appropriate action with the exception of a delay in reporting of one event.

The provider had sought the views of people through a survey and quality monitoring phone calls. However, survey conclusions had not been shared with participants to show what action had been taken in response to their feedback. Complaints records had improved and issues had been investigated and addressed appropriately.

The provider had improved the way they conveyed their values and expectations to staff. Plans for the on-going improvement and development of the service were clear. The service had a manager in post who was also working to address the issues previously identified.