Ipswich

Updated 8 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 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 announced comprehensive inspection on 15 and 18 June 2018, was carried out by one inspector. The provider was given 48 hours’ notice because it is a small service and we wanted to be certain the registered manager and key staff would be available on the day of our inspection. We also wanted to give them sufficient time to make arrangements with people so that we could visit them in their homes to find out about their experience of the service.

As part of our inspection planning, we requested that the provider complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This was received from the provider. We also reviewed information we held about the service including feedback sent to us from other stakeholders, for example the local authority and members of the public. Providers are required to notify the Care Quality Commission (CQC) about events and incidents that occur including unexpected deaths, injuries to people receiving care and safeguarding matters. We reviewed the notifications the provider had sent us.

Inspection activity started on 15 June and ended 22 June 2018. The inspector visited the office location on 15 June 2018. We received electronic feedback from four members of staff and six community professionals involved with the service. We met with four people who used the service and two relatives. We spoke with the registered manager, two supervisors and eight support workers. We reviewed the care records of three people to check they were receiving their care as planned. We looked at records relating to the management of the service, staff recruitment and training, and systems for monitoring the quality of the service.

On 18 June 2018 with their permission, we visited two people in their ‘supported living’ setting and spoke to one person’s relative. We also spoke with a support worker. Some people had complex needs, which meant they could not always readily tell us about their experiences. They communicated with us in different ways, such as facial expressions, signs and gestures and used communication aids. On both days of the inspection we observed the way people interacted with the management team and support workers.

Updated 8 September 2018

Ipswich is a domiciliary care agency. It provides personal care to people who live in their own houses or flats. It provides a service to adults. Not everyone using Ipswich 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. This service also provides care and support to people living in a ‘supported living setting’, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the time of this announced comprehensive inspection of 15 and 18 June 2018, there were eight people who used the service and received ‘personal care’. The provider was given 48 hours’ notice because it is a small service and we wanted to be certain the registered manager and key staff would be available on the day of our inspection. We also wanted to give them sufficient time to seek agreements with people so that we could visit them in their homes to find out about their experience of using the service.

When we completed our previous inspection on 17 November 2015, we rated the service overall Good. The key question Safe was rated as Outstanding. The key questions, Effective, Caring, Responsive and Well Led were rated Good. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new frame work some topic areas in Safe are now included under the key question of Responsive. At this inspection 15 and 18 June 2018 we found that the key questions Safe, Effective and Caring were Good. The key questions Responsive and Well Led had improved to Outstanding. Therefore, the service had improved to an overall rating of Outstanding and met all the fundamental standards we inspected against.

The service had a registered manager. 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. Statutory notifications received showed us that the registered manager understood their registration requirements.

Ipswich was exceptionally well led. The service provided high quality care and support to people to enable them to live the lives they wanted and to remain in their own home. There was visible and highly effective governance in an open and transparent culture that resulted in an organised and well-run service. The registered manager demonstrated an open, reflective leadership style working in partnership with other stakeholders to drive continual improvement within the service and local community.

Morale was extremely high within the service with employees describing how well supported and appreciated they were by the registered manager. All of the staff were proud of where they worked and told us they felt valued and respected. They shared positive experiences about the leadership of the service, and how they were continually motivated and encouraged to professionally develop by the registered manager.

The registered manager was able to demonstrate how their robust quality assurance systems had sustained continual development and improvement at the service. They were clear about their expectations relating to how the service should be provided and led by example. They were supported by a management team, office staff and support workers that were passionate and fully committed to delivering the highest standard of care to each person.

Without exception people and their relatives were extremely complimentary about their experience of using the service. They were full of praise about their support workers and described how they were provided with personalised, tailored care by support workers who fully understood their individual needs. Support workers and the management team had developed positive relationships with people and knew them well. Support workers consistently protected people’s privacy and dignity and promoted their independence.

People were enabled by the service to make choices about their care and support arrangements and to have as much control and independence as possible. Care and support was consistently delivered in line with people’s needs and promoted equality. Everybody we spoke with said that they would highly recommend the service.

Detailed care and support plans were in place. These covered all aspects of a person’s health, social and personal care needs, how they wanted to be supported, their daily routines and preferences. The care plans were regularly reviewed and updated. Where changes were identified peoples' care packages were amended to meet their changing needs. The service was extremely flexible and responded positively to people's requests where possible.

People’s feedback was valued and acted on. Their comments, concerns and complaints were appropriately investigated and responded to and used to improve the quality of the service.

Ensuring people received safe quality care and were fully protected continued to be integral to the running of Ipswich. The registered manager was clear about the importance of keeping people safe and their expectations relating to how the service should be provided and led by example. All of the staff understood their roles and responsibilities and the importance of keeping people safe. This encouraged creative, innovative and practical thinking in relation to people’s safety and managing risk.

Robust procedures and processes to ensure the safety of the people who used the service had been fully embedded. These included risk assessments which identified how the risks to people were minimised but also ensured their rights and choices were promoted and respected. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

A culture of listening to people and positively learning from events so similar incidents were not repeated had been established. As a result, the quality of the service continued to develop. The registered manager shared and discussed examples with their team of accidents and incidents that had occurred within the care industry to learn from these experiences and to drive the service forward.

Staff had received safeguarding training and understood what actions to take to protect people from abuse. They continued to be confident in describing the different types of abuse that may occur and how it should be reported.

Robust recruitment checks were carried out with sufficient numbers of support workers employed who had the knowledge and skills through regular supervision and training to meet people’s needs.

Where support workers and or the management team had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment. Where required, people were safely supported with their dietary needs. There were infection control procedures and equipment in place to guide support workers in how to minimise the risks of cross infection.

People were supported to have maximum choice and control of their lives and were supported by staff in the least restrictive way possible; the policies and systems in the service supported this practice.

Feedback from professionals involved with the service cited collaborative and extremely effective working relationships