Home Instead North Devon & Exmoor

Updated 11 September 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 checked 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 comprehensive inspection took place on 25 and 26 July 2018; it was announced on both visits. We gave the service 48 hours’ notice of the inspection site visit because the registered manager is often out of the office visiting people or supporting staff. We needed to make sure they would be in.

Inspection site activity started on 11 July and ended on 8 August 2018. It included reviewing information about people's care and how the service was managed. We visited the office on 25 July 2018 to see the registered manager and to review information related to the running of the service. These included: three people's care files and medicine records; three staff files which included recruitment records of the last staff to be appointed; staff rotas; staff induction, training and supervision records; safeguarding information, quality monitoring systems such as audits, spot checks and competency checks; complaints and compliments; incident and accident reporting; minutes of meetings and the most recent quality questionnaire returned.

One adult social care inspector carried out the inspection with the support of an Expert by Experience who made telephone calls to people, relatives and staff related to the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection, the Care Quality Commission (CQC) sent questionnaires to four people who used the service and received three replies. We reviewed the information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually 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. This included safeguarding alerts and statutory notifications. A notification is information about important events which the service is required to send us by law.

At inspection, we spoke with the provider, registered manager, two office staff, seven caregivers (care staff), two relatives and seven people who used the service. We visited four people in their own homes to gain their experiences of the service.

Following the inspection, we requested feedback from commissioners, the local authority safeguarding team and health and social care professionals. We also received feedback from a further fourteen staff and one relative.

Updated 11 September 2018

This announced comprehensive inspection took place on 25 and 26 July 2018. This was the first inspection since the service was registered in July 2017.

Home Instead Senior Care North Devon and Exmoor is registered with the Care Quality Commission (CQC) as a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Not everyone using Home Instead receives regulated activity; 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. At the time of inspection, there were 14 people who received a regulated activity. The frequency of visits ranged from one a fortnight to two a day. The length of visits ranged from one hour to two hours.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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 had been in post since the service commenced in July 2017.

People received outstanding individualised care and support from the management team and caregivers. People were put at the heart of the service and their wishes and choices were always respected. Caregivers were dedicated, extremely kind and very caring. They had developed strong, trusting and respectful relationships with people. There was a strong work ethos and staff were extremely dedicated, enthusiastic and proud of their jobs. People told us of staff going the extra mile to support them and examples were given on when this was done. One caregiver said, “We have caregivers I trust to look after my mother and that says a lot.”

People were well respected and valued as individuals. There was a strong, visible person-centred culture. Management and caregivers were highly motivated and offered care and support that was exceptionally compassionate and individual. They demonstrated a real empathy for the people they supported. Respect for privacy and dignity was at the heart of the service’s culture and values.

Caregivers involved people’s families, friends and pets in their care. Relatives felt they were also cared for and supported by staff. A relative commented, “Finding them (Home Instead) was a Godsend … light is now coming from within again which gives me such hope for the future … (family member) is achieving, improving and motivated. We are supported, empowered and listened to.”

There was a strong and knowledgeable management team in place who treated caregivers with the same care as people who used the service. The registered manager employed staff based on whether they would want them to look after their own family member. Staff praised the management team and spoke very highly about them. They felt valued, included and that their opinions mattered. One caregiver said, “From my first point of contact, I knew I was in the right place. A very professional, accommodating and most of all caring organisation to work for. Best care company I have had the pleasure of working with.”

Caregivers undertook a bespoke training package to ensure they were prepared for their care roles. Caregivers were carefully matched with people with the same interests, hobbies and attitudes. People and relatives told us they felt part of a family and safe with the caregivers who supported them.

Strong community links were fostered by the provider who was part of several organisations, particularly related to dementia. Good practice and innovations in practice were introduced into the service where possible. The service had robust quality assurance systems in place and the management team used this information to develop and improve the service. There was a complaints policy in place which was accessible although the management team had a proactive approach to resolving complaints before they became serious issues.

Caregivers supported people nearing the end of their life to enable them to remain in their own homes. People who had passed away were treated with respect and dignity by all staff who ensured they were cared for even after death.

People were protected by staff who were safely recruited, trained and supervised in their work. They underwent a thorough recruitment process and undertook training relevant to their role. Supervisions were held regularly and staff felt these were useful.

Staff had received training in safeguarding and knew what to do in the case of suspected abuse. They had been appropriately trained in medicines and people received their right medicines at the right time. People were supported to eat a healthy balanced diet of their choice and caregivers cooked their meals to people’s specific taste.

People had personalised care and support plans in place. People were supported to have access to health and social care professionals when needed. Staff accompanied people to GP’s, dentists, hospital and opticians.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible: the policies and systems in the service support this practice. Staff understood the Mental Capacity Act 2005 and how it applied in their daily practice. Any decisions made in people’s best interests were carried out and recorded with all the appropriate people involved.

People were supported to be part of the local community and accompanied to undertake activities, hobbies and interests of their individual choices.