This inspection took place on 29 February 2016 and was announced. This meant we gave the provider notice of our intended visit to ensure someone would be available in the office to meet us. The service was previously inspected in December 2013, there were no concerns at that time.Home Instead Senior Care is a domiciliary care provider based in Cornwall providing personal care and support to 49 people in their own homes. Home Instead Senior Care is part of a franchise that delivers care to people in many areas of the United Kingdom. This includes personal care such as assistance with bathing, dressing, eating and medicines; home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties; and companionship services such as escorting people on visits or appointments, simple conversation and company. Of those 49 people 27 received personal care and the remainder received help in their home or companionship. We only looked at the service for people receiving personal care during this inspection as this is the service that is registered with Care Quality Commission. The staff who support people are known as ‘caregivers,’ we have called them this in the report.
The service had 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.
People told us they felt safe when being supported by caregivers from Home Instead. No-one reported any concerns about the care provided. Staff had received training in safeguarding children and adults and had guidance available in case they needed to raise a concern outside of the organisation. Staff told us they were aware of recent changes to local reporting arrangements.
There were sufficient numbers of staff to meet the needs of people who used the service. The owner and registered manager spoke of the importance of recruiting the right people for the job. There was an emphasis on matching caregivers with people to help ensure they had shared interests and beliefs. One person told us; “We [the person and caregivers] have common ground.”
People were supported by small teams of caregivers and this contributed to the ability of caregivers to form trusting relationships with the people they supported. One person told us when they had started using the service they had stressed to the registered manager how important continuity of care and punctuality was to them. They told us; “They have been spot on, I wouldn’t criticise them at all.”
Care visits lasted a minimum of one hour and staff told us this was significant factor when developing relationships with people and providing a person centred service. The ethos of the service was that providing companionship was as important as meeting people’s health needs. Caregivers arrived on time and stayed for the allocated time. No-one reported any missed visits and people told us late visits were rare and they were always kept informed.
Induction and training was thorough and updated regularly. Staff were supported by a robust system of supervision and appraisal and regular staff meetings. Staff said they felt very well supported and were proud to work for the organisation. They told us they felt part of a team and believed they were valued by the management team.
The registered manager was flexible in their approach to ensuring people’s needs were met. They recognised that people’s needs fluctuated and spoke regularly with people to identify any changes quickly. They used a call monitoring system to highlight when visits were becoming longer and possibly indicating that the person needed an increase in their support package.
The service provided outstanding levels of care and put the person’s needs and preferences at the forefront of care planning and decision making. People who used the service, relatives and healthcare professionals were unanimous in praising the compassionate and professional care provided by staff. People and families, where appropriate, were encouraged and supported to contribute to care planning and review.
People’s preferences, likes and dislikes were identified and respected. Care plans contained information to guide staff on how to support people according to their preferences. Staff knew people well and had developed an understanding of their needs over time. People’s right to independence and choice and control was recognised and respected.
The service had a complaints policy in place. People who used the service were made aware of the complaints procedure and told us they knew how to make a complaint and who to, should the need arise.
People who used the service, relatives and healthcare professionals were consistent in their praise of the leadership of the service. The owner, registered manager and all staff demonstrated a shared approach to care and support that put people at the centre of the support. The importance of talking with people and spending time with them was recognised by everyone.
Home Instead was a well-managed and well-organised service. There were clear lines of responsibility and accountability in place. A robust system of audits helped ensure the standards set by the national office were adhered to. The owner and registered manager told us they hoped to develop and grow the service further. However, they recognised the need to ensure existing care packages were stable and well established before accepting new packages.