We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. The Together Trust Domiciliary Care Agency The Together Trust Centre, Schools Hill, Cheadle, SK8 1JE Tel: Date of Inspection: 24 October 2013 We inspected the following standards as part of this inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Cooperating with other providers Safeguarding people who use services from abuse Supporting workers Assessing and monitoring the quality of service provision Inspection Report The Together Trust Domiciliary Care Agency November

2 Details about this location Registered Provider Registered Manager Overview of the service Type of services Regulated activity Together Trust Mr. Kevin Clarke Together Trust Domiciliary Service is managed from the organisation's premises in Cheadle, Cheshire. The service provides support to adults, young people and children with acquired brain injury, physical and learning disabilities, with Autism Spectrum conditions and who have complex support and personal care needs. The service operates in several local authority areas across the North West, with each project supported by its own management structure. Domiciliary care service Supported living service Personal care Inspection Report The Together Trust Domiciliary Care Agency November

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Cooperating with other providers 10 Safeguarding people who use services from abuse 12 Supporting workers 14 Assessing and monitoring the quality of service provision 15 About CQC Inspections 16 How we define our judgements 17 Glossary of terms we use in this report 19 Contact us 21 Inspection Report The Together Trust Domiciliary Care Agency November

4 Summary of this inspection Why we carried out this inspection This inspection was part of a themed inspection programme specifically looking at the arrangements for transition from children's to adults services. The programme focussed on young people aged years with complex physical health needs. This was an unannounced inspection. How we carried out this inspection We carried out a visit on 24 October 2013, checked how people were cared for at each stage of their treatment and care, talked with people who use the service and talked with carers and / or family members. We talked with staff and talked with other authorities. What people told us and what we found During our inspection we visited the main offices of The Together Trust and met with The Principal manager, Registered Manager, Team leader and four support workers. We also spoke with one person who used the service and four relatives of young people, two of whom had recently transferred from children to adult service. This process is referred to as 'transition'. The relatives we spoke with made positive comments about the staff and services provided. Comments included :"We enjoy effective communication with all the staff and know they respect and value the people they support"; "Transition from children to adult services has been great. Staff have worked together to enable YP1 and YP2 to feel at ease and not be afraid of the change" and " Staff have worked with us to ensure we understood the transition and agreed with the way it was happening." We looked at two care records. We saw people's personal preferences, likes and dislikes had been clearly recorded throughout. Young peoples needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People who use the service were protected from the risk of abuse, because the provider had ensured staff received appropriate training and had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People who use the service, their representatives and staff were asked for their views about the way the service was run. You can see our judgements on the front page of this report. Inspection Report The Together Trust Domiciliary Care Agency November

5 More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report The Together Trust Domiciliary Care Agency November

6 Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Reasons for our judgement People expressed their views and were involved in making decisions about their care and treatment. During our inspection we met with one person who used the service and two relatives. We also spoke on the telephone to relatives of people who used the service. People told us that they were fully involved with the interactions between young people and staff of The Together Trust. Comments included; "We enjoy effective communication with all the staff and know they respect and value the people they support." Staff spoken with were able to demonstrate how they understood individual communication and responded to people appropriately. One young person told us that staff treated people very well and were kind and helpful. Comments included; "Staff are my friends. They help me to do the things I want; like clothes shopping and holidays." We spoke with four relatives who told us they had regular involvement in the planning of care and staff discussed any changes that may occur. They told us: "Transition from children to adult services has been great. Staff have worked together to enable YP1 and YP2 to feel at ease and not be afraid of the change" and " Staff have worked with us to ensure we understood the transition and agreed with the way it was happening.," The manager told us that the service arranged regular meetings between young people and their representatives to ensure that the care and support plans reflected current need, choice and capacity. We looked at two care records. We saw people's personal preferences, likes and dislikes had been clearly recorded throughout. Communication had been clearly documented providing staff with guidance as how best to communicate with people and how the young people expressed themselves. For example, a staff member told us that they had worked closely with people to enable them to identify systems to assist them to enjoy effective communication. We noted there was a care plan in place for communication in each person's care record. Inspection Report The Together Trust Domiciliary Care Agency November

7 We saw consent documents in place in both care records which had been signed by relatives and signed documents in relation to sharing information. There were clear details of the decisions people could make for themselves and the support that would be provided for people who lacked the capacity to make their own decisions. Records showed that the young people required support from staff to access the community. We saw activities and community involvement care plans were in place, some young people attended college others were supported to enjoy holidays and go on shopping trips. We saw records of how the manager and staff had arranged frequent meetings with the young people and their representatives to discuss the changes that would occur during the transition period. People's diversity, values and human rights were respected. Staff spoken with told us that they supported people in ways which maintained people's dignity. They told us that they used whatever communication systems that were appropriate to each individual. They said they asked for people's agreement prior to carrying out any tasks and ensured people were afforded privacy if they required personal care. Staff told us: "We provide personal care in people's private rooms, shut the door and let other staff know so we are not disturbed." "We find out what people want us to do and what they can do for themselves" and "We make sure that we only provide the care and support that people want." Inspection Report The Together Trust Domiciliary Care Agency November

8 Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement We spoke with staff of Together Trust, one person who used the service and four relatives to gain information about the way care and support was planned. Relatives of people who used the service told us that care and support was well planned and "everyone was involved in the planning." Comments included; "This is not just a baby sitting service. The staff support X and provide a lot of support for us as well." and "Staff have been very open and transparent about everything. We feel privileged to have the support of such an excellent service." Young people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at two care records and saw assessments of needs and risk assessments had been carried out and care plans were in place to meet individual's needs. Individual likes and dislikes were clearly documented and included what was important to them and the important people in their lives. Care plans included care and treatment of individual conditions, nutrition and hydration, medication, bathing, communication, cultural needs and social skills. Each care plan outlined the outcomes for the young person, what was known about the specific area of need and how support should be provided to enable them to achieve the outcome. We saw a record of appointments, reviews and contact with health and social care professionals was maintained, and a list of upcoming appointments had been recorded to ensure that the young person attended. Guidance from external professionals had been incorporated into care plans. The young people we case tracked had recently commenced the process of transition into adult services. The manager showed us the plans which were in place to support the transition into a supported tenancy property. The manager told us, they had provided continuity of staff between the residential placement the young people had attended prior to transition and the supported tenancy they had since moved into. We spoke with two of the young person's relatives who told us: "Everybody has supported us with this move, we are happy with the way things have been handled, staff liaise with me a lot, they keep me fully informed which minimises my stress." They told us that the support they had received Inspection Report The Together Trust Domiciliary Care Agency November

9 from Together Trust had been excellent. We saw from staff training records staff had received training and support to enable them to meet the assessed needs of the young people who used the service. We saw training was up to date and the manager told us that if required they would ask specialists to provide training to staff to ensure they could meet all individual needs. We looked at the daily records and we saw that care and treatment was delivered in line with people's care plans. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw risk assessments had been carried out and control measures in place to ensure people's welfare and safety. We saw that control measures that had been identified were being carried out. There were arrangements in place to deal with foreseeable emergencies, these included personal emergency evacuation plans for each young person and hospital pathways if any of the young people required admission to hospital. Inspection Report The Together Trust Domiciliary Care Agency November

10 Cooperating with other providers People should get safe and coordinated care when they move between different services Our judgement The provider was meeting this standard. People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others. Reasons for our judgement People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others. We looked at the care records for two young people and saw that all the relevant health and social care professionals involved in their care and treatment had been recorded. These included GP, Social worker, consultants and community nurse. We saw that where other professionals were involved in the person's care full contact records were clearly documented. The manager provided us with minutes of multi-agency meetings which identified staff of Together Trust met monthly with other professionals who were involved with the young people to discuss and implement future plans. We were shown the information sharing policy and saw in the two care records we looked at, consent to share information had been signed by relatives. We saw documents were in place if young people required hospital admission, detailing current condition, medication and communication needs. We saw two transition plans that were in place for the young people who had recently transferred from children to adult services. The manager told us this was led by the young people's social workers but Together Trust were very much involved with the transition. The manager provided us with detailed plans that had been drawn up for the young people's transition and showed us minutes of multi agency meetings that had been held to plan the transition process. Documentation viewed held details of accommodation and budgetary issues and identified that some of these issues were outside of the providers remit. However feedback received from local authority social workers was most positive in respect of the input from the provider in respect of transition. Comments included; "We have been most impressed with the level of knowledge and understanding of the people Inspection Report The Together Trust Domiciliary Care Agency November

11 they support. This has greatly assisted us to enjoy effective communication with the young people and ensure they are afforded choice and their needs are fully met." Records show that the provider has also worked with housing networks, neighbourhood police and other associations to ensure the young people were respected and accepted in the community. Inspection Report The Together Trust Domiciliary Care Agency November

12 Safeguarding people who use services from abuse People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The care plans that we looked at contained appropriate assessments of risk. Detailed guidance had been written down for staff to explain what they must do to keep each person safe from accidental harm. We spoke with relatives of the people using the services about whether they felt the provider maintained people's safety and what they might do if they didn't. They told us that they would speak to staff about any concerns they had. They also told us that they had great faith in the staff in respect of their ability to protect people from harm. Comments included; "I can now sleep at night knowing that X will be safe and well looked after." The Together Trust had a safeguarding policy in place. This included local procedures which staff would follow if they needed to report an alleged incident to the correct authorities. This was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm. The manager was aware of the relevant process to follow. He would report any concerns to the local authority and to the Care Quality Commission. Staff members had received training in recognising abuse and how to report an incident of abuse or a suspicion of abuse. During discussions with them they were able to show an understanding of their responsibilities when caring for vulnerable people. They were also familiar with the term whistle blowing and each was confident in reporting any concerns they had to senior staff. This is also covered in the induction process for new staff members and could be revisited during appraisals, supervisions and staff meetings. This was confirmed by the staff members we spoke with during our inspection. Inspection Report The Together Trust Domiciliary Care Agency November

13 There was a consistent team of staff within the organisation and we did not have any concerns regarding either their numbers or suitability. The staff members we spoke to were very positive about the service. Comments included; "I love my job" and "I receive lots of training to ensure I am able to provide safe care to the people I support." Inspection Report The Together Trust Domiciliary Care Agency November

14 Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff members who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement Staff received appropriate professional development. The manager provided us with an up to date record of staff training, supervisions and appraisals. All new staff members completed an induction training programme so they would have the skills they needed to do their jobs effectively and competently. This induction included an introduction to the job they would be doing and as part of it they would shadow existing staff members and would not be allowed to work unsupervised, [shadowing is where a new staff member works alongside either a senior or experienced staff member]. The manager monitored and maintained the staff training records. In addition to this centralised records were held. We looked at the training matrix and the training courses staff were due to undertake that had been arranged by the training department and could see that network staff members had access to a variety of courses. These included mandatory training in areas such as safeguarding and moving and handling and a variety of 'e' learning courses. We asked four staff members about training and they all confirmed that they were receiving regular training and that it was up to date. The staff members had regular one to one supervision meetings, [these were regular meetings between an employee and their line manager to discuss any issues that may affect the staff member; this would include a discussion of any on-going training needs]. The staff members we spoke with were very positive about the organisation and the support they received. Support staff told us that they had supervisions with their line managers at approximately eight week intervals. However, they said that they could speak to a senior person in the organisation at any time if they felt it was necessary. One of the support staff said, "There is always someone we can phone. Other comments included; "We work very well together as a team"; "The registered manager leads by example; he does not just sit in his office, he works with us in the community when needed" and "We feel valued and proud to work for this organisation." The staff members also had regular staff meetings. Information could be passed on, issues could be discussed and staff or managers could raise concerns. Inspection Report The Together Trust Domiciliary Care Agency November

15 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Reasons for our judgement People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Information about the safety and quality of service provided was gathered on a continuous and on-going basis with feedback from the people who used the service and their representatives. We found that the provider used a variety of methods in order to assess the quality of the service they were providing to people. This included the use of monthly improvement and development meetings and monthly quality monitoring checks to all the premises where people were being supported. This check was to make sure that people being supported were happy. The support plan was up to date and being maintained appropriately. The records of any finances handled by staff and medication administered were being completed properly. Processes were in place to record any complaints received and to ensure that these would be addressed within the timescales given in the policy. Inspection Report The Together Trust Domiciliary Care Agency November

16 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report The Together Trust Domiciliary Care Agency November

17 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report The Together Trust Domiciliary Care Agency November

18 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report The Together Trust Domiciliary Care Agency November

19 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report The Together Trust Domiciliary Care Agency November

20 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report The Together Trust Domiciliary Care Agency November

21 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report The Together Trust Domiciliary Care Agency November