We carried out an inspection of Autonomy Care Limited on 15 and 16 December 2016. This was an announced inspection where we gave the provider 48 hours’ notice. This was because the location provides a domiciliary care service and we wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf. Autonomy Care Limited provides a range of services to people in their own home including personal care, companionship, and shopping in Devizes and the surrounding areas. The regulated activity for this service was the provision of personal care and at the time of inspection 34 people were using the service under this regulated activity.
A registered manager was in place and available throughout the inspection. 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.
Risk assessments had been completed and actions recorded to manage identified hazards and concerns. There was good documentation of some risks and clear documentation which provided guidance to staff on how to mitigate these risks. However, new risk assessments and guidance had not always been documented in people’s care records. The registered manager told us they had recently identified gaps in some care records where risk assessments and necessary supporting guidance required more information. In response to this they had delegated two senior care staff to perform regular quality checks and help to update records where documentation had not been completed.
People were protected from potential harm and abuse by staff who were aware of the different types of abuse and the actions to take if they suspected someone was at risk of harm. Staff were aware of the responsibility to report any concerns they had about people’s safety and welfare and who to report concerns to.
People said they were satisfied with the support they received with regards to their medicines however; medicines were not always managed safely. The recording of information on Medicines Administration Records (MAR) was not always consistent with other care records although in line with their recent identification of some gaps in care records the registered manager had taken action to address this prior to the inspection. In addition, gaps that were seen during the inspection were immediately addressed and current documentation was revised to correct this.
Processes were in place to ensure staff recruitment procedures were followed and staff received training and support from management to ensure they had the right knowledge and skills to meet people’s needs. The service also enabled staff to undertake nationally recognised training to help them progress in their work.
There were enough staff deployed to fully meet people’s health and social care needs. People received their care at the correct time and had support given by the same members of staff to ensure consistency of care.
Staff completed competency assessments as part of their induction followed by regular supervisions and training. Staff were knowledgeable about people’s needs and said they received the necessary training to equip them with the skills they needed to provide the care people required.
People told us staff sought their consent before providing any care or support. Staff had an awareness of the Mental Capacity Act (2005) and knew how to support people to make their own decisions.
People had access to health care professionals to make sure they received appropriate care and treatment. The service maintained accurate and up to date records of people’s healthcare and GP contacts in case they needed to contact them.
People and their relatives spoke highly of the staff and said for the managers, office staff and care staff, no task was too great. People said staff knew how to deliver care in a person centred way and were very flexible according to their changing needs. People told us whenever possible, visit times were arranged to suit people’s needs and when changes to visit times had been requested the service did this “without any fuss being made”.
Staff spoke fondly about the people they supported and gave good examples of how they developed positive relationships with people using the service. People, their relatives and staff gave examples of when staff had gone the ‘extra mile’ to help and support people. People told us that if certain tasks were required which were not part of people’s care packages, staff would willingly help even if this meant doing certain things in their own time.
People’s needs were assessed and care plans developed to identify the care and support people required. There were effective communication systems in place to ensure any changes or updates about people were communicated to staff immediately. Any changes in people’s health or emotional well-being were responded to straight away.
The service actively involved people in assessment of their care requirements which enabled them to make choices about the support they needed to help them to be as independent as possible.
Staff and the registered manager were very responsive to people's individual needs. Staff knew people well and what was important to them. The service actively sought feedback from people, their relatives, community professionals and their staff to monitor and continually improve the quality of the service. One example of this was feedback from staff that during visits to people they had told them they would like to have the opportunity to socialise more outside of their homes. In response to this, the service set up a coffee morning which people said they really enjoyed and was a huge success.
People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received.
The service had received a large number of compliments from people, their relatives and community professionals stating the care provided was flexible and person centred.
The service promoted an open and honest culture and the registered manager was transparent in their discussions with us. Staff spoke highly of the management team and felt well supported.
Staff were confident they could raise any concerns or issues, knowing they would be listened to. One staff member told us “This is a very nice company to work for. They are very accommodating and always listen. This is the best company I have ever worked for”.
The registered manager spoke passionately about the service and staff. They were very proud of their staff team and believed in valuing their staff as much as the people using their service. The service had an ‘employee of the month’ and staff were also recognised by the management team for ‘going the extra mile’.