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

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Kumari Care Limited 5 Palace Yard Mews, Queen Square, Bath, BA1 2NH Date of Inspections: 05 December November 2013 Tel: Date of Publication: February 2014 We inspected the following standards to check that action had been taken to meet them. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Supporting workers Assessing and monitoring the quality of service provision Met this standard Met this standard Action needed Met this standard Inspection Report Kumari Care Limited February

2 Details about this location Registered Provider Registered Managers Overview of the service Type of service Regulated activity Kumari Care Limited Mrs. Santosh Kumari-Chaston Mrs. Caroline Watson Kumari Care is a domiciliary care agency that provides personal care for people aged 18 and over who have a range of needs. Domiciliary care service Personal care Inspection Report Kumari Care Limited February

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 What we have told the provider to do 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 Supporting workers 10 Assessing and monitoring the quality of service provision 12 Information primarily for the provider: Action we have told the provider to take 13 About CQC Inspections 14 How we define our judgements 15 Glossary of terms we use in this report 17 Contact us 19 Inspection Report Kumari Care Limited February

4 Summary of this inspection Why we carried out this inspection We carried out this inspection to check whether Kumari Care Limited had taken action to meet the following essential standards: Respecting and involving people who use services Care and welfare of people who use services Supporting workers Assessing and monitoring the quality of service provision This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 5 November 2013 and 5 December 2013, sent a questionnaire to people who use the service and talked with carers and / or family members. We talked with staff. What people told us and what we found We carried out a follow up inspection to check the provider had achieved compliance. At the previous inspection we judged the provider had not fully met three outcomes for compliance of essential standards of quality and safety. These outcomes included outcome 1: respecting and involving people who use services, outcome 4: care and welfare of people who use services and outcome 16: assessing and monitoring the quality of service provision. We used questionnaires to gather the views of people who used the agency. We received responses from 22 people and overall they were satisfied with the service being provided by Kumari Care Limited DCA. Although some people made positive comments minor concerns were raised. These concerns centred on inadequate planning from office staff and lack of consistency between regular staff and new staff. We spoke with a member of staff who told us they had received an induction to prepare them for the role they were to undertake. However, the manager was not able to show staff had been fully assessed to perform the role they were employed to perform. This member of staff said they were told about people changing needs. We were informed people using the agency had regular carers and they were not expected to rush the delivery of care. It was explained "I don't rush I take my time if I am running late I contact the office. The office will then contact people and tell them I am running late." You can see our judgements on the front page of this report. What we have told the provider to do We have asked the provider to send us a report by 22 February 2014, setting out the Inspection Report Kumari Care Limited February

5 action they will take to meet the standards. We will check to make sure that this action is taken. Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take. 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 Kumari Care Limited February

6 Our judgements for each standard inspected Respecting and involving people who use services Met this standard 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 privacy, dignity and independence were respected. Reasons for our judgement We conducted a follow-up inspection to check the provider had achieved compliance with this outcome. At the previous inspection we judged the provider was not fully meeting essential standards of quality and safety relating to respecting and involving people who used the service. We gathered the views of people who used the agency through questionnaires. We asked them if they were respected by the staff, if there was any discrimination and if they were asked about the service they received from agency staff. We received responses from 22 people and overall their feedback about the agency was positive. 15 people said they were always respected and four said most of the time they were respected. 20 people said they had not experienced discrimination but one said they had. Eight people told us their views about the service were sought but eight had not been asked about their views. We looked at the care records of six people. The service plans gave staff a brief overview of the person's needs and included their cultural background and communication needs. This included people's religious beliefs and how the individual communicated their needs. We saw that for three people personalised care plans had been developed. These care plans said what the person was able to do for themselves and the help they needed from staff to meet their assessed needs. The manager told us the agency delivered personal care to meet people's diverse needs. We were told before arrangements were made to deliver personal care there was an assessment of needs. At these assessments the person's social and cultural diversity needs were discussed. We were told steps were taken following the assessment to ensure the staff were skilled and able to provide personal care to these individuals. We were told at present with the exception of one person, the people who used the agency do not require staff from similar cultural backgrounds. The manager said for one person it was not essential but desirable and a member of staff with similar cultural background was rostered to care for them. We saw from the rota that where possible members of staff were assigned to deliver personal care to people with similar cultural backgrounds. We Inspection Report Kumari Care Limited February

7 spoke with one member of staff who told us they delivered personal care to people with similar cultural background to them. Staff received an induction which covered privacy and dignity. This meant the staff were aware of expectations for respecting people's rights. Inspection Report Kumari Care Limited February

8 Care and welfare of people who use services Met this standard 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 for most people and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement At the last inspection we set compliance actions because the provider was not fully meeting essential standards of quality and safety on care and welfare of people who used the service. We used questionnaires to gather information from people who used the agency. The 22 people who responded told us about the care and welfare they received from the staff working at the agency. 15 people told us they always received the care and support they needed from the staff and seven people told us this happened most of the time. 13 of the 21 people who responded indicated the care and support they received from the staff helped them do as much for themselves as they wanted and in the way they preferred. Eight people said this was most of the time. We looked at the agency records for six people who used the agency. We saw each person had a service plan which gave a brief overview of their needs. For example, the way the person communicated and the support needed from the staff. The people's care needs of three people had been reviewed and person centred plans were in place. These care plans described the person's ability to meet part of their assessed need and the support needed from the staff. Additional detail such as monitoring skin integrity, and medicines management was part of the care plans. The manager told us personalised care plans were to be developed for all the people who used the agency. We saw for three people their care plans and risk assessment had not been reviewed in a significant period of time. The provider may wish to note that not all care plans and risk assessments had been reviewed in a significant period of time. This meant the staff were not told how to meet people's changing needs. A record was maintained of the contact between the office staff and the people who used the agency. These records were computerised showed people had contact with the agency office. We read when people were made aware of changes in staff and contracted times. Staff contacted the office staff to report concerns about the people they delivered personal care. We read where office staff contacted GPs for visits and Occupational Therapist (OT) for equipment. Inspection Report Kumari Care Limited February

9 The member of staff we spoke with said care plans were in place. They reported when people's needs changed they were informed by the office staff. Inspection Report Kumari Care Limited February

10 Supporting workers Action needed Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was not meeting this standard. People were not always cared for by staff who were trained to deliver care and treatment safely and to an appropriate standard. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement We used questionnaires to gather the views of people who used the agency. We received 22 responses from people about the staff. 13 people told us the staff had the skills needed to provide their care and support, eight people said it was most of time and one said some of the staff had the right skills. Minor issues were raised about staff arriving late, lack of consistency between levels of care, new staff not trained and unpredictable timings when regular staff were off at weekends. These areas of concern were also identified by the manager through the quality assurance system and an action plan was devised to resolve some of these issues. The manager told us new staff received an induction when they started to work for the agency. We looked at the induction manual used by the manager to deliver the induction programme for new staff. This manual covered the role of the worker, the values of the organisations, the delivery of personal care and visiting people in their own homes. We saw in-house induction certificates were given to staff who had completed their induction. Topics covered and knowledge or skills used were not listed in the certificates. The date of when the induction programme was completed was recorded in the staff files but there was no documented evidence of the topics and assessments undertaken. This meant the manager could not show staff were fully assessed to ensure they understood about their role they were to perform. The manager told us staff attended mandatory training. This training included moving and handling, safeguarding adults, food hygiene, administration of medicines and pressure ulcer training. Moving and handling training was delivered by the manager who was appropriately trained to teach this topic to staff. First aid, safeguarding adults, administration of medicines and food hygiene was delivered by the manager from a training package. We saw staff knowledge was tested through questionnaires which the manager corrected. We looked at two questionnaires where it was evident from the responses the member of staff had not fully understood the questions. This meant staff may not have the competency needed to meet the required standard in the knowledge area. Inspection Report Kumari Care Limited February

11 The manager told us the agency also delivered personal care to people at the end stages of their life and to people living with dementia. The training matrix provided showed in May 2013 there had been two sessions on dementia but the staff who attended this training was not included. End of Life training was not included in the training matrix. The manager had completed end of life training and staff had been enrolled in this training. This meant not all staff had the specialist skills needed to deliver personal care to people at the end stages of their lives or for people living with dementia. The manager told us staff received supervision to ensure staff delivered care and treatment to an appropriate standard. The manager had undertaken an audit of supervisions and appraisals undertaken. The audit showed regular spot checks and individual supervision was taking place. The member of staff we spoke with told us they had received an induction when they first started work at the agency. We were told they had attended moving and handling training, first aid and pressure ulcer prevention training. This member of staff also told us they had attended end of life training during their previous employment. They told us they had regular spot checks from supervisors. Inspection Report Kumari Care Limited February

12 Assessing and monitoring the quality of service provision Met this standard 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 to regularly assess and monitor the quality of service that people receive. Reasons for our judgement We carried out a follow up inspection to check compliance actions were achieved with this outcome. We set compliance actions at the previous inspection because the provider was not fully meeting essential standards of quality and safety for the assessment and monitoring of the quality of the service provided to people. At the last inspection we judged the provider had no system in place to identify, assess and manage risks to the health, safety and welfare of people who use the agency. The manager used surveys to capture the views of the people who used the agency. The analysis of the responses showed people wanted continuity of care, for example, regular carers and better communications with people when there were changes of carers. The surveys also identified people were not always aware of the complaints procedure. The action plan recognised people's views for example; regular carers were to be assigned. The manager told us carers were assigned to new referrals as soon as possible. The audit of care plan and risk assessments carried out by the manager showed some people's needs were reviewed and their care plans updated. The audit of individual supervision and appraisals showed some staff's performance had been reviewed and plans were in place to monitor the performance of all staff. This meant the manager was aware of the progress that needed to be made with reviewing people's needs and monitoring staff performance. The provider may wish to note there was no formal system for identifying trends and patterns. A system for identifying risk was not in place for example, accidents, incidents including medicine errors and complaints. This meant there was no system for reducing risk to people. Inspection Report Kumari Care Limited February

13 This section is primarily information for the provider Action we have told the provider to take Compliance actions The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards. Regulated activity Personal care Regulation Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Supporting workers How the regulation was not being met: People were not always cared for by staff who were trained to deliver care and treatment safely and to an appropriate standard. Regulation 23 This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations The provider's report should be sent to us by 22 February CQC should be informed when compliance actions are complete. We will check to make sure that action has been taken to meet the standards and will report on our judgements. Inspection Report Kumari Care Limited February

14 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 Kumari Care Limited February

15 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. Met this standard 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 Kumari Care Limited February

16 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 Kumari Care Limited February

17 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 Kumari Care Limited February

18 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 Kumari Care Limited February

19 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 Kumari Care Limited February

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