Home Instead Chester

Deva Senior Care Services Limited t/a Home Instead Senior Care is a domiciliary care agency providing personal care to 60 people at the time of the inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People received a caring service and felt supported and valued as individuals. People spoke very positively about staff and described them as ‘very helpful’, ‘caring’ and ‘attentive’. People told us they were treated with respect and staff upheld their dignity during care visits.

People were supported by small, consistent staff teams who knew people extremely well and trusting relationships had been formed. We saw numerous examples where the staff had ensured people’s emotional, leisure and cultural needs were met through the use of technology and social activities. These helped to reduce the risk of loneliness and isolation.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People had been involved in developing their care plans and signed documentation to evidence this. Care plans were person centred and people could change their care plans when they chose.

Systems were in place to manage risks to people’s health and wellbeing and medicines were managed safely.

The provider was also involved in initiatives to improve people’s wellbeing. This included providing advice and support to enable people to stay safe from the risk of scams. This initiative was not restricted to people receiving care and was accessed by the wider community.

The service was well led and staff felt well supported by an open and honest culture with a clear focus on continuous improvement. The provider also worked with other professionals and organisations to share training and ensure positive outcomes for people.

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

Rating at last inspection

The last rating for this service was good (published 12 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Home Instead Senior Care is a service which provides personal care and support to adults in their own homes. In addition to providing personal care, Home Instead also provides a companionships service which supports people with activities and help with domestic duties. This element of the service, although provided by Home Instead Senior Care would not need to be registered with the Commission if this was their sole purpose. We focussed our inspection on the people in receipt of personal care only. On the day of our inspection there were people using the service, of which received personal care.

There is a Registered Manager at this location. 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 in June 2016, we asked the registered provider to take action to make improvement. This included the safe management of medicines, acting in line with the Mental Capacity Act 2005, record keeping and ensuring good governance of the service. We found that these actions had been completed.

People were kept safe by staff. They had a good understanding of their safeguarding adult’s responsibilities to protect the people they were supporting from harm or abuse.

People’s needs were met effectively and they were supported by sufficient numbers of regular staff. The risks to people were identified and reviewed to ensure people remained safe. Records of support required were up to date and personalised which ensured people received their support in line with their preferences and wishes.

People had a positive relationship with the staff and were confident in the service. There was a strong value base instilled in the service which helped to ensure staff were caring and compassionate. People who used the service felt they were treated with kindness and said their privacy and dignity was respected.

Medicines were managed and administered safely by staff assessed as competent and confident in this role. Staff members understood their responsibilities in this area and policies supported this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service support this practice.

The registered manager conducted regular audits and improvements were carried out when shortfalls had been identified. The quality of the service was monitored and assessed consistently. People who used the service, family members and staff were regularly consulted about the quality of the service they received.

People who used the service, family members and visitors were made aware of how to make a complaint and there was an effective complaints policy and procedure in place.

Deva Senior Care Services Limited is part of the Home Instead Senior Care franchise which provides care and support to people in their own home. At the time of the inspection, the service provided support to around 140 people, of which 47 received personal care .This equated to approximately 950 hours per week. The service provided care and support for older people, people living with dementia, end of life care, long term conditions, respite care and night care.

There was a registered manager in place and she had held this position since the service started in October 2010. 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.

Whilst people were extremely happy and satisfied with the support they received, we found that the service was in breach of a number of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

We checked medicines management. We found that clear and accurate records were not being kept of medicines administered by care workers. Care plans and risk assessments did not support the safe handling of some people's medicines. This meant that there was a risk that people would not get their medicines as prescribed.

People told us that staff knew them well and met all of their needs. However, the care plans and risk assessment in place were not always accurate and up to date. Therefore, a staff member, less familiar with the person, may not know how best to meet someone’s needs and to support them safely.

People were asked for consent prior to care being undertaken. They were encouraged to make as many choices and decisions for themselves as they could. However, where a person potentially lacked in mental capacity to make certain decisions, the service had not followed the principles of the Mental Capacity Act 2005 (MCA) which meant that people's rights may not be protected. The MCA governs decision-making on behalf of adults who may not be able to make particular decisions for themselves.

The quality of direct care provided was continually reviewed by the service and people who used it. However, there were systems in place to monitor many aspects of the service that had not been fully implemented. There were a number of key aspects not monitored such as management of medicines, daily records and care plans. This meant that the concerns highlighted on this inspection had not been picked up and addressed directly by the service.

Each person had an environmental risk assessment. This enabled the staff to familiarise themselves with a person's home, and noted where important points were such as gas, water and electricity cut off points should they encounter any problems. The registered provider needed to ensure that the equipment staff used to assist a person with mobility was safe and serviced.

People were safe when using the service because staff had been trained and knew how to protect people in their care. Staff had access to safeguarding information, contact numbers and were confident that they would report concerns. There was a current safeguarding policy in place to guide staff but this needed to reflect the requirements of local policy to report specific concerns.

People were extremely satisfied with the level of support that they received. Relatives felt that the service was excellent and responsive. People told us that there was enough staff working for the service and that they were dependable. People said they always had the same members of staff visit them and this continuity was essential. When staff were on holiday or unavailable, someone else would always cover the call.

Staff were trained, well supported and had the knowledge and skills required ensuring people's health and well-being needs were met. The service respected people and staff's diversity by providing individualised care and appointing care staff who were able to meet any specific needs people had.

Care staff (called 'CAREgivers') had been recruited, using a robust recruitment process, to check they were suitable and safe to work in people's homes.

The management team and care staff were committed to the people they cared for. Care staff and people who used the service described the registered manager and office staff as very supportive and approachable. Staff told us they could approach any of the management team, including the owner, who was open and responsive, at any time. Any concerns were dealt with promptly and to a person’s satisfaction.

We spoke with five members of staff. They knew what action to take if they recognised signs of abuse and were aware of the whistle blowing process should they have any concerns. They also demonstrated they were knowledgeable about the different types of abuse that could occur and confirmed they had completed training in relation to safeguarding people from the risk of abuse.

People told us that give or take a couple of minutes, staff were always on time to provide the care and support in their homes. They also said that their needs were met in line with their individual plan of care.

We saw supervision sessions took place for all staff with the manager on a regular basis. Appraisals had also been completed annually. This meant that staff had the opportunity to review their roles and look at their personal development.

We found that people who used the service and their relatives were asked for their views about the care that was received. The people we spoke with told us they felt involved in assessing the service and helping them make improvements.

"The girl's are excellent. I can't say anything bad about them"

"The carer's are like friend's to me but are very professional at the same time"

We looked at five care records and all had assessments of their health and social needs completed. There were individual support plans and risk assessments in place. There was evidence within them to show they were evaluated on a regular basis. This meant that the service could demonstrate they could meet people's needs and maintain their health and wellbeing.

We contacted Chester and Cheshire West Local Authority who confirmed there were no issues of concern with regards to the service.

We have received no concerns about the service.

We found that the provider has robust and effective systems in place in relation to the recruitment and training of its employees. We spoke to six members of staff. Comments from them included

"I love my job and making a difference to people's lives"

"I love meeting different people"

"I get on well with all my colleagues. We work well as a team"