Home Instead Senior Care

Updated 18 July 2019

The inspection:

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

Inspection team:

This inspection was conducted by two adult social care inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Service and service type:

Home Instead Senior Care is a domiciliary care service providing support and personal care to people in their own homes.

The service is required to have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of the inspection the service did not have a manager registered with us although a suitable manager had been recruited and was in the process of registering as the manager.

Notice of inspection:

We gave the service two days’ notice of the inspection site visit because this is a small service and we needed to make sure that the appropriate people would be available and allow time for consent to be obtained for visits and telephone calls.

Inspection site visit activity started on 15 April 2019 and ended on 16 April 2019. We visited the office location on 15 April 2019 to see the manager and office staff, to review care records, policies and procedures and to visit people in their own homes. We made telephone calls to people who used the service and staff on 16 April 2019.

What we did before the inspection:

Our planning considered information we held about the service. This included information about events and incidents the provider must notify us about. We asked commissioners of services for their experiences of the service. We asked the service to complete a Provider Information Return (PIR). This is information we require providers to send us at least annually to give some key information about the service, what the service does well and improvements they plan to make. We used this information to plan our inspection

During the inspection

We spoke with five CAREGivers about their experiences of working for this service. [The provider uses the term CAREGiver when referring to care staff]. We spoke with the manager, the CAREGiver Operations Manager, the recruitment coordinator and both the organisation’s directors. We reviewed care records and records relevant to the running and quality monitoring of the service. We looked at five care plans and a selection of records including, medication administration, quality monitoring records, training and recruitment records for ten staff employed in the last year. We spoke with two people in their own homes and looked at the records they kept at home. We telephoned and spoke to four people who used the service and six relatives to ask about their experience of the service and the care provided. We spoke with five care staff about their experiences of working for this service

After the inspection

We continued to seek clarification from the manager and provider to corroborate what we found. This included training information, feedback from clients and confirmation on actions taken by the service.

Updated 18 July 2019

About the service:

Home Instead Senior Care is a domiciliary care agency that provides personal care and support to people living in their own homes. Not everyone using the service received the 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. When we inspected the service 15 people were receiving the regulated activity.

People’s experience of using this service:

Audits checks were in place to monitor the quality of service provision and systems. However, some issues about recording changing needs and risk assessment had not been picked up. All these things were dealt with immediately and had not resulted in a negative impact for people but should have been identified by the systems in use.

Some staff supervision records retained personal client information after being used at supervision. We have made a recommendation the provider and manager consult and take advice from a reputable source to make sure any confidential details are managed in line with current legislation and best practice.

The service had a strong person centred and community based ethos. Everyone we spoke with who used the service was overwhelmingly positive about the compassionate and highly individualised care and support they received. People told us they felt “very safe” with the carers who visited. People told us, “I look forward to them coming in every day” and “Always on time, I can set my clock by them.”

The provider had safeguarding systems to protect people from the risk of abuse or unsafe care. Staff were aware of the procedures, had received training on it and knew what action to take. The service was very involved in the local communities and provided 'scam awareness' talks in the communities they served to help inform and protect vulnerable people.

We saw, and people confirmed that staff treated them with kindness, compassion and respect and made sure their dignity was maintained. People spoke highly of the care and support they received from regular staff who knew them well and often "went the extra mile". There were many examples of staff going "over and above" to help and support the people they cared for.

Staff assessed and reviewed people's physical, mental health and social needs. Holistic are plans had been developed with the close involvement of the person and where appropriate their families and representatives to give a vivid picture of the person and their needs. People's communication needs were thoroughly assessed and understood by staff. This helped to support people's communication needs and the Accessible Information Standard (AIS). A relative noted, "A small team of wonderful carers gained [relatives] trust and built up fantastic relationships in a very short time."

There was a high staff to client ratio of suitably qualified and skilled staff to meet people’s individual needs. Staff had received a range of training and developmental support to help them to carry out their role safely. People told us they received care and support from staff who were well trained and knowledgeable about them and what they needed. Only staff who had received training in safe medicine administration were able to give medicines.

People told us staff were often more likes friends coming to visit were very reliable and had always responded very quickly if they needed any help, additional support or if they were feeling unwell. The service had a recruitment process to help make sure new staff were suitable to work with the people in their homes.

People received support to maintain good nutrition and hydration in line with their personal choice and preferences and their healthcare needs were well understood and met promptly The service worked collaboratively with other agencies and professionals to support people’s health and well-being.

Staff were supplied with personal protective equipment for use to prevent the spread of infections. Staff had received training in infection control.

The registered provider had procedures in place for assessing a person's mental capacity in line with the Mental Capacity Act 2005. 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 and their relatives were aware of how to raise concerns or complaints and told us they would feel comfortable raising any matter. They and staff expressed confidence in the management to address any complaints or concerns raised quickly.

People's social and emotional needs were considered as part of the overall service and the risk of social isolation was recognised as an issue for some people. Staff actively promoted people's independence and social participation and respected their privacy.

The leadership of the service promoted a positive, open culture. People, family members and staff all described the provider and manager as supportive and approachable. People and their relatives were happy with how the service was managed and several said they would happily recommend it.

The registered manager and provider showed a clear desire to continue to develop and improve the service in a planned and managed way as it grew. They displayed knowledge and understanding around the importance of openness and working closely with other agencies and healthcare professionals to make sure people had good care.

Rating at last inspection: This is the first inspection of the service since their registration with us.

Why we inspected:

This inspection was part of our routine scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor intelligence we receive about the service and plan to inspect in line with our inspection schedule for those services rated good. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk