This inspection took place on 21 and 22 November 2017 and was announced. We told the provider 48 hours before our visit that we would be coming. At the last inspection we found the provider was meeting the regulations and we rated the service Outstanding in Responsive and Well Led and Good in Safe, Effective and Caring and Outstanding overall. Home Instead Senior Care provides domiciliary care and support to 185 people living in Wimbledon, Kingston and the surrounding areas. Home Instead Senior Care is part of a franchise that delivers care to people in many areas of the United Kingdom. This includes personal care such as assistance with bathing, dressing, eating and assistance with medicines. Other help provided covers all aspects of day-to-day housework, shopping, meal preparation and household duties as well as companionship services such as escorting people on visits or appointments, simple conversation and company. When we visited the provider 185 people were in receipt of a service; 85 received personal care and the remainder received help in their home or companionship. We only looked at the service for people receiving personal care during this inspection as this is the service that is registered with Care Quality Commission. The staff who support people are known as ‘caregivers,’ we have called them this in the report and office personnel are referred to as office staff.
The service had a registered manager. A registered manager is a person who has registered with the CQC 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.
The service continued to provide outstanding support to people and was very responsive to people’s needs. The service also provided outstanding support to staff.
One person said “This is as good a service as it can be. I would be very happy to recommend it to anyone” and a relative commented “My relative now has a regular core of carers who know her very well. They treat her very kindly and speak to her with great respect, upholding her dignity and they are always very polite to other relatives in the house.”
People continued to be extremely well supported by caregivers to engage in activities to stimulate and promote their overall wellbeing. The provider had continued to recognise and respond to people’s needs by starting up several new not for profit clubs, as well as continuing to support clubs previously started. A new coffee and culture club had started at the Wimbledon Tennis club, a men only lunch club, a supper club and a new memory café at Kingston Hospital. Home Instead had also continued to sponsor the Alzheimer’s Singing for the Brain service. An observer at one of the clubs told us “Without exception the clients are enjoying the session and being encouraged and supported by the carer with them.” The caregivers gave many examples of where the positive feel of the activities had stayed with people throughout the week.
There was an extremely positive culture within the service, the management team provided strong leadership and led by example. The registered manager had developed a new structure to the office team which enabled the service to develop and grow. Staff support had been enhanced through a buddy system, effective training, systems to keep staff safe and recognition of staff’s dedication to the care of people. One person commented “Staff are very, very well trained. If my regular caregiver is away the caregiver who replaces her knows exactly what to do.” A caregiver said “The company supports its staff to care for clients to a high standard through a good support structure and training.”
The registered manager was an excellent role model who actively sought and acted on the views of people. Staff said Home Instead was ‘like being part of a family and we all really like one another.’ Home Instead continued to have clear visions and values that were person-centred and ensured people were at the heart of the service. Their principle objective is to provide supportive care and companionship which both enables and encourages people to remain independent, in their own homes, for as long as possible.
A healthcare professional commented “The management is experienced, caring and well-regarded locally, and we know that many clients’ lives are considerably better off thanks to the services they provide. We are fortunate to have them.”
People remained safe in their homes. Caregivers and office staff could explain to us how to keep people safe from abuse and neglect. People had suitable risk assessments in place. The provider managed risks associated with people’s homes, to help keep people and staff safe. Recruitment practices remained safe. Medicines continued to be administered safely. The checks we made confirmed that people were receiving their medicines as prescribed by staff qualified to administer medicines.
Staff were providing support in line with the Mental Capacity Act 2005. People were supported to eat and drink sufficient amounts to meet their needs. When required staff supported people to access a range of healthcare professionals.
People and relatives told us staff were caring, kind and efficient and staff respected their privacy and treated them with dignity. People’s needs were assessed before they started to use the service and care was planned and delivered in response to their needs. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.
Staff we spoke with described the management as very open, approachable, positive and easy to get on with. Systems were in place to monitor and improve the quality of the service. The provider had audit systems for staff training and supervision and the national office conducted an annual standards renewal audit; this included scrutinising all aspects of the business. The last audit in 2017 was positive, with no actions to be taken. These systems continue to help ensure people received the care they needed as detailed in their support plans.