26 September 2018
During a routine inspection
At the time of the inspection 369 people were receiving the regulated activity ‘personal care’.
This inspection was announced and took place on 26 and 27 September 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be at the office and able to assist us to arrange home visits.
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.
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
Why the service is rated Good.
People told us they felt safe with the care provided and staff who visited them. One person said, “I have never felt anything other than safe. They[staff] are excellent and I look forward to their visits.”
There were sufficient staff to meet people’s needs. People confirmed they had a small team of care workers whom they had got to know. People’s comments on the timing of visits varied. Some people were happy that staff arrived at the agreed time and stayed the agreed length of time. Many commented on staff who stayed longer and did more than they expected. However, some people said they experienced staff arriving either earlier or later than planned. One person said they went to bed at 9pm and got up at 7am which they thought was too long in bed. The registered manager explained they tried to accommodate all time requests but they were open and honest with people at the start of the care package about any timings they could not achieve.
People were protected from harm because the provider had a robust recruitment process and staff received training in how to recognise and report abuse.
People’s medicines were managed safely and people told us they received support to take their medicines correctly and at the right time.
People were supported by staff who knew their needs and understood the importance of delivering effective care and support. Records showed all staff completed the organisations mandatory training and training relevant to the needs of the people. Staff received regular supervision and support from the management team. This was carried out either in one to one or team meetings. People told us that senior staff carried out ‘spot checks.’ This meant the senior staff arrived unannounced to check on staff and ask people what they thought about the team supporting them.
All new staff received an induction and initial training. Before working alone, they were able to shadow more experienced staff and meet the people they would be supporting. Staff told us the training provided was good and that they could also access training specific to people’s needs.
People were supported to have a balanced and nutritious diet. Some people required meals cooked for them and support to eat. At other times, staff supported some people to prepare their own meal and maintain their independence.
People were supported to have maximum choice and control of their lives. Staff helped them in the least restrictive way possible. The policies and systems in the service also reinforced this practice.
People were supported by staff who were very kind and compassionate. People thought staff often went over and above their job roles to ensure their comfort and well-being. People told us how staff had worked in their own time to ensure they were safe. Staff had supported one person to move into a new home. Another person was assisted when they were in hospital and confused. During adverse weather conditions staff had gone above and beyond to ensure people continued to receive a visit.
People told us they could talk with staff if they wished to raise a concern. One person said, “I know who to talk to but I also know I can trust the carers to take anything I am concern about back to the office for the manager to deal with.”
People were supported at the end of their life to have a comfortable pain free death. Care plans showed people’s advance decisions were taken into consideration and acted upon. Staff worked with the community team and local hospice to ensure people could remain in their own home towards the end of their life if that was their wish.
People received care and support that was responsive to their changing needs. Staff had a clear understanding of people’s needs and how to meet them effectively. People were involved in discussing and setting up their care plans.
The service was well run by a registered manager who had the skills and experience needed to run a domiciliary care agency. This meant people received good person-centred care. The registered manager led a team of staff who shared their commitment to providing a good standard of care.
There were systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and complaints and learnt from the issues raised. The provider sought people's views and opinions through regular telephone monitoring and an annual survey.