We undertook an announced inspection of Home Instead Senior Care on 25 May 2017. Home Instead Senior Care is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides support to people of all ages and different abilities. At the time of inspection the service provided care to six people. There was 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.
The service was registered with the CQC in June 2016. This inspection on 25 May 2017 was the first inspection for the service.
People who used the service spoke positively about the care provided. They told us they felt safe around care workers and were happy with the care provided by care workers and management at the service.
Systems and processes were in place to help protect people from the risk of harm. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. The service was part of an external initiative called “Friends Against Scams”. This is a National Trading Standards scam initiative which aims to protect and prevent people from becoming victims of scams.
Risk assessments were in place which detailed potential risks to people and how to protect people from harm. Risk assessments included detailed information about preventative actions that needed to be taken to minimise risks as well as clear and detailed measures for care workers on how to support people safely.
We checked the arrangements in place in respect of medicines. Care workers had received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that there were no unexplained gaps in these. The service had a medicines audit in place.
There were comprehensive and effective recruitment and selection procedures in place to ensure people were safe and not at risk of being supported by staff who were unsuitable.
The service had an electronic system in place to monitor care worker’s punctuality. People told us their care workers turned up on time and they received the same care worker on a regular basis and had consistency in the level of care they received. Management at the service explained that consistency of care was an important aspect of the care they provided.
Care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers were provided with an extensive induction which provided practical training. Care workers also received on-going training. Care workers spoke positively about their experiences working for the service. They told us that they received continuous support from management and morale amongst staff was positive.
Care workers were aware of the importance of treating people with respect and dignity. Feedback from people indicated that positive and close relationships had developed between people using the service and their care worker.
Care plans provided information about people’s life history and medical background. There was a detailed support plan outlining the support people needed with various aspects of their daily life such as personal care, continence, eating and drinking, communication, mobility, medicines, religious and cultural needs. Care plans detailed people’s care preferences, daily routine likes and dislikes and people that were important to them. Records showed when the person’s needs had changed, the person’s care plan had been updated accordingly and measures put in place if additional support was required
Daily communication records were in place which recorded visit notes, daily outcomes achieved, meal log and medication support. The registered manager explained that these assisted the service to monitor people’s progress.
A complaints procedure was in place. People spoke positively about the service and told us they thought it was well managed and raised no concerns.
There was a clear management structure in place with a team of care workers, the registered manager and nominated individual. Care workers spoke positively about the management and culture of the service and told us the management were approachable if they needed to raise any concerns.
We spoke with management about the aims of the service and the nominated individual explained that they aimed for the service to grow in a slow and controlled manner where they can ensure that the standard of care is high.
Staff were informed of changes occurring within the service through staff meetings. Staff told us that they received up to date information and felt able to raise issues without hesitation during these meetings. They told us that there was an open culture at the service.
Systems were in place to monitor and improve the quality of the service. The service had a comprehensive system in place to obtain feedback from people about the quality of the service they received through review meetings, telephone monitoring and home visits. The service had their own “quality assurance process” which included a next day courtesy telephone call after a new client started receiving care from the service, followed by a visit by a member of staff after four weeks of receiving care, followed by three monthly visits by management.
The service undertook a range of audits of the quality of the service and took action to improve the service as a result. Audits had been carried out in relation to care documentation, staff files, medicines and training.