One adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions:' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
We considered the evidence we had gathered under the outcomes we inspected. We spoke with ten people we randomly selected using the service, and looked at care records for three people in detail and a selection of other records in relation to other people's care. We also spoke to ten care staff, looked at two staff files, spoke with the registered manager and care co-ordinator and a senior carer.
This is a summary of what we found:
Is the service safe?
Before people received home care services, they had an assessment of their needs to determine the level and type of help they needed. Some areas of the assessment needed attention in recording to reduce the risk of information being missed. Arrangements were in place to make sure people continued to receive the correct care.
People told us visits were never missed. The agency had good arrangements in place to respond quickly if there was an unexpected staff absence. People told us they felt safe 'I feel safe with the carers. I'm not a person that feels safe easily but I know they are only down the road and I have an emergency number I can ring. They are very trustworthy.'
All staff had been trained in safe moving and handling of people and we were told this was up to date. Care plans were detailed to support staff to deliver safe and effective care. Risk assessments had been carried out to make sure staff worked in a safe environment. Protective equipment was provided for staff such as disposable gloves and aprons.
Safeguards were in place to make sure staff were recruited properly. Staff contractual arrangements and a code of conduct and practice helped to protect people. Financial policies and procedures needed to be updated and completed to make sure staff followed the right protocol in the financial protection for people
Staff were trained to deal with emergencies such as first aid, and were able to contact management for support out of hours.
Care had been taken to make sure people were kept safe by good recruitment procedures. Staff contractual arrangements prevented them from gaining financially from people they cared for.
People told us they felt safe in their homes when staff visited. Arrangements were in place for staff to gain entry to their home without placing them at risk.
The manager had been trained and understood principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions.
Is the service caring?
People told us they were happy with the care they received and the staff team. Surveys carried out showed people considered the service they received was very good.
People we spoke with said, 'I get all the help I need and want. The carers know exactly what to do and will always do that little extra. I usually get the same group of carers visiting and they will always say, 'shall I do this, or that'." "I have found the service on the whole very satisfactory. They visit four times a day. I've got to the point where I can wash myself and get dressed. Some mornings I struggle but they help without taking over.'
A family member said, 'They are always very polite, caring and very well mannered. He likes his carers. I was a bit anxious at first, it was a big thing for me to get help. They always offer to help me as well. It's a good service.'
People commented how they 'valued' the service. 'It is very much a community based service. I have opportunities to say what I want and they make me feel very relaxed. I'd be lost without them. They're my link with the outside world and it's a good feeling.' 'It's nice for people to be in their own home. That's where you want to be, especially at my age and with this type of service it's possible. I enjoy their visits.'
People told us staff treated them with respect and kindness. Staff worked to care plans that were person centred and sufficiently detailed on how best to meet individual needs.
Is the service responsive?
People generally felt the agency operated a flexible service and would always try to accommodate their needs. Assessment of people's needs and care plans were reviewed regularly and adjustments made where needed.
People using the service and their relatives had completed a satisfaction survey. A system was in place for receiving comments, compliments and complaints. People told us that they would know how to make a complaint, should they need to do so.
Is the service effective?
People we spoke with told us, 'I have a file here and they write in it. It tells them what help I need. I usually get the same carers and I think that helps because they notice changes quicker. That's the difference between friends helping and my carers. They understand me and my needs better.' Another person said, 'They have a file they write in. I know they do what they should as I have the same group of carers visiting. (Anonymised ) is in charge of them and she checks that everything is done right. I look forward to seeing them.'
Staff we spoke with told us they were well trained and were given enough information to know what people required. Work was arranged to let staff visit the same people on a regular basis. Arrangements were made for emergency staff cover in the event of sickness or absence.
People considered the service they received helped them stay in their own home. One relative commented, 'For the last five years I have had the most fantastic service and I am so pleased we were able to keep my parents at home for as long as possible.'
People told us they were consulted with and listened to. Quality monitoring showed action was taken with regard to comments they received.
Staff used a tele-monitoring system to support managers to know they were meeting their obligations in arriving at people's homes within the agreed time slot and that they stayed the right length of time. Spot checks on staff ensured staff met their obligation to provide the right standard of care for people.
Is the service well led?
A manager was responsible for the day to day management of the service. The manager was registered with the Care Quality Commission (CQC) and was supported by the owner of the organisation.
Staff were clear about their responsibilities and duty of care and were able to raise their views and concerns. Some staff expressed lack of confidence their views would be taken seriously. The manager said this would be addressed and was planning to introduce, 'reflection in practice' for staff to support improvements in the service. Supervision of staff was established with spot checks carried out on their performance by team leaders. Meetings were held to keep staff informed of changes within the organisation and provide staff with an opportunity to discuss issues relating to their work.
Policies and procedures were not kept up to date to protect the interests of people using the service, staff employed and the provider.
There were systems in place to regularly assess and monitor how the service was managed and to monitor the quality of the service. The company held a current Investors In People (IIP) award. This is an external accredited quality assurance award that monitors staff training and development and the management of the service. The service had a Quality and Compliance assessment overview completed by social services that gave a 100% rating of compliance. This included, support planning, personalisation, choice, safety of the service, safeguarding, risk management, infection control, communication, dignity in care and staffing.