Select Community Support

Select Community Support is a domiciliary care service which provides personal care to adults with a range of support needs in their own homes. At the time of this inspection the service was supporting thirty people.

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 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 were supported by a small group of regular staff, which provided continuity and familiarity and people’s comments confirmed this approach. Staff had developed relationships with people and knew them well; people received person-centred care as a result.

Staff supported some people to access other healthcare professionals when required. Staff supported a small number of people to manage their medicines safely.

People were supported in a friendly and respectful way. People and their relatives were complimentary about the staff and their caring attitude.

Systems were in place to recruit staff safely; there were sufficient numbers of trained staff to support people safely. Recruitment processes were robust and helped to ensure staff were of suitable character and had relevant experience to work with vulnerable people.

Staff had awareness of safeguarding and knew how to raise concerns. Steps were taken to minimise risk where possible.

Staff promoted people's independence and treated them with dignity and respect. People were involved in making decisions about their care and involved in reviews to ensure their care plans met their needs and supported them to achieve outcomes. Staff supported some people to access the community.

People’s needs were comprehensively assessed before starting with the service; people and their relatives, where appropriate, had been involved in the care planning process.

Staff were competent and had the skills and knowledge to enable them to support people safely and effectively. Staff received the training and support they needed to carry out their roles effectively and received regular supervisions and annual appraisals; this was confirmed by staff we spoke with.

People’s care plans were person-centred and provided staff with the information they needed to provide care and support in a way that met people’s needs and preferences. There was evidence that care plans were reviewed regularly or as people’s needs changed.

People knew how to make a complaint. There was an effective complaints process in place to deal with any complaints that might be raised in the future.

The registered manager and staff were committed to providing high quality care and support for people.

The service had an open and supportive culture. Systems were in place to monitor the quality and safety of care delivered. There was evidence of improvement and learning from any actions identified.

The provider and registered manager followed governance systems which provided effective oversight and monitoring of the service.

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 30 June 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.

Select Community Support is a domiciliary care agency, which provides personal care to people in their own homes who require support in order to remain independent. The office is located in Cadishead, Salford.

At time of inspection there was a registered manager at 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.

At the last comprehensive inspection on 23 March 2016 where three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. These were relating to staff supervision, monitoring and audit systems and the service could not demonstrate it was doing all that was reasonably practicable to mitigate risks relating to the health, safety and welfare of people who used the service. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements.

As part of this inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. We found that the service was now compliant in these areas.

We gathered verbal feedback about the service from people who used the service. The feedback we received was positive overall. People indicated staff were caring and supported them effectively. When questioned, staff gave relevant examples of how to care for a person in line with their individual needs and wishes.

Service questionnaires were completed by people with positive comments received. People expressed satisfaction with the service they received and how it was provided. People were complimentary about all the care staff, stating they were treated with dignity, kindness and respect.

The provider had robust processes in place to ensure a safe environment was maintained for people using the service and its staff. People told us they felt safe and their homes were left secure by care staff following a visit. Environmental risk assessments were established to identify any risks associated with areas such as water temperature, sharps and the control of substances hazardous to health (COSHH).

Safeguarding procedures were in place and followed by all staff and suitable training was offered to staff to ensure they were competent in recognising the various signs and indicators of abuse. Staff showed an appropriate level of knowledge around the subject and were aware of who to contact should they have any concerns.

We looked at staffing rotas and time sheets and noted sufficient numbers of staff were employed to deliver safe and effective care to people using the service. Although we acknowledged a number of staff had recently left the service, we saw an active recruitment drive was underway and people were not left without the care they required in the interim.

Recruitment procedures were thorough and robust. Staff told us their induction process contained the correct amount of information to ensure they had the knowledge to carry out their care role effectively. People spoken with confirmed staff were competent. Staff files we looked at contained necessary information along with appropriate checks of staff’s character, to ensure the provider was following a detailed and safe recruitment selection of all staff.

Staff meetings and supervisions were offered and staff felt fully supported by the management structure.

The service had appropriate processes in place for the safe administration of medicines which was in line with best practice guidance from the National Institute for Health and Care Excellence. Staff were trained in the administration of medicines. People told us they received their medicine when required and on time.

People were provided with personalised care and support based on their individual needs and requirements, with detailed care plans and risk assessments in place. These documents gave clear information about people's needs, wishes, feelings and health conditions. Changes to people's needs and requirements were also communicated well which meant staff were kept up to date with these changes.

Staff we spoke with were aware of the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions.

The service had a range of systems and procedures in place to monitor the quality and effectiveness of the service. However the registered manager told us the process of auditing was still in development.

We received positive feedback from people using the service, relatives and staff about the management team.

Select Community Support is a domiciliary care agency, which provides personal care to people in their own homes, who require support in order to remain independent. The office is located in Cadishead, Salford. Services are currently provided to people residing in the Salford and Warrington areas.

There was a registered manager in place. 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 registered manager was present through the inspection.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

As part of the inspection, we looked at a sample of ten care files to see how the service managed risk. Services must do all that is reasonably practicable to mitigate risk and follow good practice guidance to keep people safe. We looked at risk assessments, which provided guidance to staff and included moving and handling, malnutrition and dehydration, falls, pressure sores and domestic property risk assessments. However, risk assessments were limited and inconsistent. In one care file we looked at, we saw that no risk assessments had been undertaken or considered by the service. We saw no documented evidence to indicate that any of the risk assessments had been regularly reviewed by the service since the initial assessment. We spoke to the registered manager who stated immediate action would be undertaken to address these issues.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to Safe Care and Treatment. This was because the service could not demonstrate it was doing all that was reasonably practicable to mitigate risks relating to the health, safety and welfare of people who used the service.

Whist staff confirmed that they received a significant amount of ‘hands on supervision,’ we found limited documentation within staff files to confirm that both formal supervision and appraisals had been undertaken. Even though dates of when direct observation and discussions had been recorded, these were not supported with any written records. Though we saw some evidence of formal supervision having been undertaken, it was not consistent with the service policy.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of staffing. The service has failed to demonstrate appropriate support, supervision and appraisal for staff undertaking their role.

We found that the service undertook a limited number of audits and checks to monitor the quality of service provision. Where checks of medication and checks of staff competency were undertaken, no records were maintained. We found that no auditing of care files was undertaken to review the quality of the content. No training needs analysis was undertaken and training records did not accurately reflect staffs’ training record at the time our inspection, though the service responded to these concerns during our visit. We found no evidence of any staff meetings having been undertaken.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service failed to assess and monitor the quality of service provision effectively.

During our inspection, we checked to see how the service protected people against abuse. We found suitable safeguarding and whistleblowing procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse.

We found that records supporting and evidencing the safe administration were complete and accurate in people’s homes.

We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. People we spoke with told us they normally had the same members of staff to support them who were generally on time and very rarely late.

We found that before any care was provided, the service obtained written consent from the person who used the service or their representative. We were able to verify this by speaking to people, their relatives and from reviewing care files.

People confirmed they were able make choices about their care, such as the times of calls, what to eat and how their personal care was delivered.

Without exception, people who used the service or their relatives told us how caring, kind and professional staff were when undertaking their duties.

People told us they, or their family members were treated with respect and dignity and that staff were always courteous.

People and relatives we spoke with told us they were involved in determining the care and support they or their relative received on an on-going basis with the registered manager. People recalled involvement when care was reviewed and felt they were listened to by the service.

People and relatives told us they felt the care and support they received was person centred and responsive to their needs.

We found the service had systems in place to routinely listen to people’s experience, concerns and complaints. People we spoke with knew how to make a complaint, but they had never had cause to. Without exception they felt confident that any issues raised would be dealt with appropriately by the manager.

We looked at a sample of ten care files to understand how the service delivered personalised care that was responsive to people’s needs. Care files contained details such as personal information and a service user profile, which included likes and dislikes. Staff were provided with clear instruction in respect of the care and support to be delivered for each person.

Each person we spoke with told us that they believed the service was well run and singled out the registered manager for their leadership and responsibility for the compassionate culture that existed within the organisation.

Staff told us that the manager was very approachable and that they all felt valued and listened to.

Providers are required by law to notify CQC of certain events in the service such as serious injuries and deaths. Records we looked at confirmed that CQC had received all the required notifications in a timely way from the service.

During our inspection on 11th of November 2014 we found improvements had taken place to the way that people's consent to their care was recorded in their care files.

In August 2014 the provider was unable to show that a policy about consent was available to provide clear guidance to staff on the process they should follow and support people required. On 11th November 2014 we found that a new policy about consent had been created to inform staff about every aspect of consent for people using the service.

Our inspection was co-ordinated and carried out by an inspector, who addressed our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they had no concerns about their personal safety and the believed they received a safe service.

We found safeguarding procedures were robust and staff demonstrated they understood how to safeguard people they supported. They were able to describe different types of abuse and the action they would take if they had any concerns.

People told us that they felt their privacy and dignity was respected by staff and had no concerns about the quality of the service provided.

We found recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People's health and care needs were assessed with them. People said that their care plans reflected their current needs.

We found that personal care plans were regularly reviewed to meet changing needs.

Staff received appropriate professional development through regular supervision.

Though people told us they fully consulted and consented to the services provided, we found the service did not have appropriate arrangements in place to ensure formal written consent was obtained from people. This would have ensured that before any service was delivered, the service could demonstrate that they were acting with the full consent and agreement of people.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to obtaining of consent from people who used the service.

Is the service caring?

People who used the service and relatives told us they or their loved ones were support by kind and dedicated staff. Comments included; 'They seem to take pleasure in their work. I'm really pleased.' 'From our point of view the standard of care is excellent. We are very pleased with everything they have done.' 'I can't praise them enough, they really do look after him.' 'All carers are very nice, very caring in the old fashion sense, they have wonderful interaction.' 'They talk to you like a human being.'

When speaking with staff it was clear they knew the needs of each person they supported. Staff confirmed they were allocated the same clients and therefore were able to get to know their needs very well.

We found care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. There were no recorded complaints against the service at the time of our visit.

People told us that the service was very responsive to their needs. One relative told us; 'They are very responsive to any needs my X has. If my X needs anything they will always contact me such as food stocks are down.' Another relative said 'They are very responsive to any needs we have. I think that is because they are such a small agency and really care.'

Is the service well-led?

The service had quality assurance systems to ensure high standards of care were maintained. Problems and concerns were addressed promptly by the manager. As a result the quality of the service was continuously improving.

Staff told us they felt supported by the service and were clear about their roles and responsibilities.