Forest Homecare Limited

Forest Homecare Limited is a domiciliary care agency. The service provides personal care to people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of the inspection there were 270 people who used the service that received personal care.

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

The leadership of the service continued to be outstanding. People, staff, relatives and external professionals were extremely confident in the management of the service. The operational manager and registered manager, supported by their senior management team, had established a person-centred ethos amongst the workforce, that consistently delivered quality care. The service was extremely well-led. Robust systems to monitor and assess the service provided helped the registered manager to identify where improvements were needed, and these were addressed quickly. People were asked for their views about the service and these consistently demonstrated a high level of satisfaction relating to the service they received. All staff spoken with were extremely passionate about providing high quality care to people. Service governance systems and oversight of the service were robust. Issues were identified, and actions taken to address any shortfalls.

People were supported by staff in a way which was exceptionally caring and compassionate. The people we spoke with, their relatives and health care professionals without exception praised the staff and the organisation of the service. People considered they were truly involved in their care planning and were treated with respect and dignity.

At this inspection we found substantial evidence that demonstrated people received an outstandingly caring service which continued to be delivered by a service which was rated outstanding in the key question for well-led at the last inspection. This was due to excellent leadership from the operational manager, registered manager and well-trained staff.

Everyone we spoke with provided exceptional feedback about how caring and supportive the staff were and so often went the extra mile to ensure people were content. They told us about the positive impact the service had on their lives such as enabling them to stay in their own homes and maintain or increasing their independence. The service had worked with other professionals to develop a rehabilitation function as the need to support people out of hospital to prevent delayed discharges had been identified as under resourced in the area where the service operated. People were assessed in hospital by senior staff of the service and when possible were supported home with a six week care package of rehabilitation delivered by the service.

There was a thorough, co-ordinated and holistic approach to planning, managing and reviewing people’s care and support. Staff took time to get to know people and the comprehensive assessment of their needs identified the support required to meet their specified needs. Staff spoke empathically and respectfully about the people they supported and people told us the staff were motivated, understanding and kind to them. Relatives were extremely pleased with the level of care provided by Forest Homecare and discussed how the support had made positive differences to the quality of their relative’s life.

The operation manager was a leader and a spokesperson for various networking groups and volunteering projects, and promoted a culture of shared learning, staff development and improvement of service provision. Staff were trained, inducted and supervised to ensure they were skilled and competent in their roles. Senior managers also developed staff along with the registered manager so that some staff had become champions in various aspects of care, such as dementia.

The service continued to organise staff into small working teams so that people get to know the staff well who are supporting them. Managers take time to identify staffing interests with the interests of the people they support to increase the likelihood of them enjoying each other’s company while care is being delivered. People told us that the staff came on time and stayed for the full length of the allocated time for their care.

People told us they felt listened to and consulted when planning and agreeing what care and support they needed. Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice. Staff supported people to take medicines safely. Staff were trained in medicines management and knew how to ensure that people received their medicines on time and as they had been prescribed.

There were sufficient numbers of experienced staff to meet people’s needs. Safe recruitment practices were followed, and appropriate checks completed to ensure that only suitable staff were employed. Staff received induction and on-going training and support that enabled them to carry out their roles positively and effectively. People informed us the staff virtually always came within the schedule time of their care appointment and had never let them down. Should the staff be running late people were informed of this information.

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. Peoples preferences for eating, drinking and meal preparation were clearly recorded in care plans when staff were required to support the person with those needs.

People felt respected and valued as individuals and were fully involved in making decisions about their care and support. Their life histories and routines were discussed and recorded in care plans, and people told us they were involved and included in their reviews and care plans. Complaints were documented and responded to, and people told us they knew how to complain. There was no one receiving end of life care, however staff were trained and skilled in end of life.

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 19 May 2017). The key question for well-led was rated Outstanding

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.

This was the first comprehensive inspection of the service. The previous inspection took place on 22 January 2014; at this time the service was found to be non-compliant in one area, records. This area was reviewed on 5 February 2014 and at this point it was found to be compliant with the regulations.

The inspection took place on 20 and 21 December 2016 and was announced. The service provided support to people living in their own homes, therefore to ensure that they were at home and to arrange a convenient time for us to visit them the service was given 48 hours’ notice of the inspection.

The service had a registered manager in post; however they were on annual leave at the time of the inspection and so were not present. They were also the registered manager for three additional services within the organisation therefore the director of operations took responsibility for the day to day management of the service. 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 supported by the service, and their relatives, consistently spoke highly of the staff who visited them and the care that they received. The service placed a strong emphasis on promoting independence and empowering people wherever possible. People spoke positively about the quality of service describing staff as polite, reliable, caring and professional in their approach to their work and explained how staff went the extra mile to ensure their needs were met. We were told of occasions where the service had gone above and beyond what was expected of them.

Individual risk assessments were in place to mitigate the risk of harm. Staff were aware of the need to promote and maintain people's safety whilst taking a person centred approach to risk. This enabled people to take calculated risks which enhanced their well-being and enabled them to live as they chose within their home.

People were kept safe by staff who received training on how to recognise signs of abuse and were clear about what action to take if any concerns arose.

People were supported in line with the legislation of the Mental Capacity Act (MCA) and no unnecessarily restrictive practices were in place. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. There were effective systems in place to ensure that people’s medication, money and personal information was kept safe. Accidents and incidents were managed promptly and, where necessary, thorough investigations had been undertaken.

The service had a robust recruitment process in place to ensure that staff had the necessary skills and attributes to support people using the service. Careful consideration had been given to ensure newly employed staff shared the values and beliefs of the organisation and to ensure the delivery of high quality care alongside the existing staff team. New members of staff completed a robust induction programme during which they spent time working alongside more experienced staff members to familiarise themselves with the people that they would be supporting.

Staff were well supported by the management team and provided with the opportunity to progress through the service; consequently the retention of staff was good. People confirmed this telling us that they were supported by staff who knew them well and who consistently met their needs.

The service had created a positive learning environment which meant that people received care from highly skilled staff. Staff were encouraged and supported to continuously develop and extend their knowledge to ensure that they had the skills to meet the needs of people using the service.

People knew how to raise concerns or complaints and were confident that issues raised would be listened to and acted upon. The service actively sought and listened to the views of people supported by the service and acted promptly where areas of concern were identified.

The management team shared a clear vision for the service and this was firmly embedded throughout the service and in the actions of staff. The management team were visible and very supportive and their presence ensured strong leadership within the organisation. They empowered staff and placed a strong emphasis on maximising their potential by using innovative and creative ways to develop them and to continually improve the service.

In January we found gaps in record keeping, daily notes, risk assessments, medication records and care plans. Records were not regularly audited so these issues had not been identified by the provider.

Since the last inspection the provider has sent us information to show what improvements they had made to their service delivery to ensure people get appropriate care. They have reviewed their records and improved their quality assurance systems and reviewing processes. This enables them to identify for themselves when the care falls short of the expected action and enables the manager and staff to take the required actions.

We send out surveys to 60 people and 39 were returned. The main areas of concern raised by respondents were; carers coming late or too early and inadequate planning to cover for sickness and holidays. Some people said the service was not fully delivered either because staff did not stay the allocated amount of time or because staff were inexperienced and did not know what was expected of them.

Those that responded reported that generally when a complaint has been made to Forest Homecare Limited the respondent was happy with the outcome and action taken. Positive comments were made about individual carers.

We accompanied a care worker and a care coordinator on their rounds and met eleven people using the service. Whilst at people's homes we took the opportunity to look at their care records including financial and medication records. We found on the whole records were well kept but improvements were identified to ensure records accurately showed what care had been delivered and any changes in people's needs.

We spoke with nine people over the telephone. One person told us, 'I feel safe and well cared for. I have a copy of my care plan and it is up to date and I understand it.' Another person said, 'The staff are always, very polite and respectful and they all seem, well trained.' One person said. 'Most staff are very, respectful and, polite.' They said they did feel safe and able to complain if not happy with the care. A few people told us that they did not always have regular carers and some carers did not always keep to time particularly in the absence of their regular carers.

We saw information from the provider which showed us that the business was run effectively and they evaluated the effectiveness of the service they provided to monitor quality.

Care plans were fully completed and identified people's needs and how they wished their support to be provided.

The service had several ways of ensuring that the care provided was meeting people's needs and was of a high quality. Regular reviews, spot checks, and audits were included in the provider's quality assurance process.