R4R Home Care Services Ltd/Watford

Updated 23 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection activity started on 29 November 2017 and ended on 13 December 2017 and was announced. The inspection process included visiting people within their own homes, speaking on the telephone to relatives and friends of people who used the service and staff members in order to obtain their views.

The provider had not been asked on this occasion, to complete a Provider Information Return [PIR] This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed other information we held about the service including statutory notifications. Statutory notifications include information about important events which the provider is required to send us.

During the inspection we spoke with one person who used the service, two relatives, one befriender, three staff members and the provider. We looked at two people’s care records and three staff files. We reviewed other documents including audits and records relating to the management of the service. Prior to our inspection we also sought the views of the local authority’s contract monitoring officers.

Updated 23 February 2018

R4R home care services is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older people, some of whom are living with dementia, people with physical or learning disability, and people with a mental health need. The service also provides a 24 hour live in care service. Not everyone using R4R home care services received a regulated activity; Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

R4R home care services provided the regulated activity of personal care from an office based on the outskirts of Watford. At the time of this inspection there were two people using the service.

This inspection took place over several dates. On the 29 November 2017 we visited the site office. On the 5 December 2017 we visited people in their own homes and on13 December 2017 we telephoned relatives and staff members in order to obtain their feedback about the service. We gave the provider 48 hours’ notice of our intended inspection to make sure that appropriate staff were available to assist us with the inspection.

The service had a registered manager in post. 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.

When we previously inspected the service on 8 February 2016 we found that procedures in relation to the recruitment of staff was not always robust and the care and support people received was not always safe. We also found that staff did not always receive the necessary training to carry out their role effectively and the provider’s governance systems were not always effective in identifying and improving shortfalls. Following the inspection the provider submitted an action plan which detailed how they were going to implement and sustain the necessary improvement.

At this inspection we found that the provider had made the necessary improvements to ensure people received care and support in a safe, effective and personalised way and there were now systems in place to monitor and review the service provided.

Staff knew what keeping people safe meant as well as how to achieve this by managing any identified risk. Staff were trained in safeguarding people and were informed about who they could report any incident of harm to.

People were given information in a format that they could understand about staying safe.

People's needs were met by staff who were trained appropriately for their role and they were deployed to ensure people’s needs were met.

People were supported to take their prescribed medicines safely. Staff were trained and deemed competent to support people's medicines by staff who had the skills to do this.

Staff were supported in their role and they knew what standard of care was expected. Incidents were used as an opportunity for learning and to help drive improvements.

People were enabled to access healthcare services. People's nutritional needs were met by staff who knew each person's needs well. Staff knew when people needed support and also when to respect people's independence.

The equipment that staff supported people with was regularly checked to make sure that it was safe.

A positive and good working relationship existed between the provider, registered manager, staff and relevant stakeholders. People were supported in partnership with other organisations including healthcare professionals to help provide joined up care.

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 supported this practice.

People were involved in their care and relatives or friends helped provide information, which contributed to people's independent living skills.

People's care plans contained sufficient information about the person to assist staff with providing person centred care. Staff understood how to provide care that was compassionate as well as promoting people’s independence.

People were provided with information about, and or enabled to access, advocacy services when required.

Complaints were investigated in line with the provider's policies and procedures. Concerns were acted upon before they became a complaint.

Support arrangements and procedures were in place to help staff to understand and meet the needs of people requiring end of life care when this was required.

The provider motivated the staff team with regular meetings, formal supervision, mentoring and being shadowed by experienced staff.

The registered manager and provider notified the CQC about events that, by law, they were required to do so. Regular audits were completed and effective in identifying areas that required further development or improvement.

An open and honest staff team culture had been established by the provider and this meant incidents were reported where they needed to be.