Background to this inspection
Updated
22 December 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.
The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident was subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.
However, the information shared with CQC about the incident indicated potential concerns about the management of risk of reporting injuries. CQC was aware of past injuries sustained and that the police and safeguarding teams have reviewed the incident. Following a comprehensive review into the incident the police are not taking any further action and the safeguarding team have closed their process. The actions that Stayathome have taken in line with this incident have been reviewed as part of this inspection. This in particular has looked at care planning, records and staff skill and experience.
This was a comprehensive inspection. It took place on 7 and 17 November 2017 and was announced. The reason it was announced was so people who would find our visit a challenge, could be informed that we would be visiting or contacting them. This was to help them prepare for our contact. The inspection team included one adult social care inspector.
Inspection site visit activity started on 7 November 2017 and ended on 22 November 2017. We visited the office location on 7 November 2017 to see the manager and office staff; and to review care records and policies and procedures.
We used a range of methods to help us make our judgements. This included talking to twelve people using the service, ten relatives, interviewing staff, pathway tracking (reading people’s care plans, and other records kept about them), and reviewed other records about how the service was managed.
Before the inspection we reviewed information we held about the service and notifications of incidents we had received. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing potential areas of concern. We also reviewed the Provider Information Record (PIR). The PIR provides key information about the service, what the service does well and the improvements the provider plan to make. We also spoke with professionals and relatives of people who used the service to find out what they thought about the service.
Updated
22 December 2017
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults, younger disabled adults, and children. The packages of care that Stayathome provide range from 30 minutes a day to 24 hour care dependant on the person’s care needs. The care provided is in the Roseland and surrounding area of Cornwall.
Not everyone using Stayathome 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.
There was a registered manager in post who was responsible for the day-to-day running of the service. 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.
We carried out this announced inspection on 7 and 17 November 2017. At the last inspection, in August 2015, the service was rated Good. At this inspection we found the service remained Good.
Stayathome notified us of an incident following which a person using the service sustained a serious injury. Following a comprehensive review into the incident the police are not taking any further action and the safeguarding team have closed their process. There have been safeguarding discussions around the reporting procedure and recording of incidents. Due to this the registered provider had provided a series of training to all staff in the importance of ensuring that all incidents are reported, that records are completed accurately and that staff know the correct procedure to follow. This training remains on going and continues to be a regular discussion in staff supervisions and team meetings.
Staff were aware of the reporting process for any accidents or incidents that occurred and there was a system in place to record incidents. Where accidents, incidents or near misses had occurred these had been reported to the service’s managers and documented in the service’s accident book.
The registered provider and team leaders were confident about the action to take if they had any safeguarding concerns and had liaised with the safeguarding teams as appropriate. Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.
People were extremely satisfied with the quality of the service they received and the caring approach from staff. People told us; “Carers are brilliant, they give me all the help I need” and “They (care staff) look after me very well.” With the exception of one relative, they echoed people’s views on the care that their family members received. Comments included: “My wife and I receive good care at all times,” “All the girls [staff] are excellent, I’d put them on the top shelf”, “We see the staff as companions they are so supportive to us. They are lovely. They genuinely care” and "They always come in with a smile and make me feel better too.”
People told us they had “never” experienced a missed care visit. The service had robust and effective procedures in place to ensure that all planned care visits were provided. The service’s visit schedules were well organised and there were a sufficient number of staff available to provide people’s care visits in accordance with their preferences.
People told us that their visits were on time but there were ‘rare occasions’ when care staff could be late for their planned visits. However people, and relatives, did not have a concern regarding this as they understood that any lateness was due to care staff needing to provide extra support to a person in an emergency or due to travel issues, especially in holiday seasons. People told us that Stayathome office staff would phone them if a care worker was going to be late which gave them reassurance that their visit would still continue.
People and relatives told us their staff never rushed their visits and stayed for the correct duration. Stayathome operated an on call system outside of office hours. Care staff told us managers would respond promptly to any queries they might have.
There were processes in place to protect people and the security of their home when they received personal care, including staff wearing uniforms and carrying identification. People received information about who they should expect to be delivering their care so they were aware of who was due to call upon them.
People told us staff had sought their consent for their care. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Staff had received relevant training and understood the principles of the Act.
People were supported by stable and consistent staff teams who knew people well and had received training specific to their needs. Training records showed staff had been provided with all the necessary training which had been refreshed regularly.
Staff were recruited in a safe way and available in sufficient numbers to meet people’s needs. Staff were supported by a system of induction, training, one-to-one supervision and appraisals to ensure they were effective in their role.
Staff knew how to ensure each person was supported as an individual in a way that did not discriminate against them in any way. People’s legal rights were understood and upheld. Everyone told us staff ensured their dignity and privacy was promoted.
Staff were respectful of the fact they were working in people’s homes. The service offered flexible support to people and were able to adapt in order to meet people’s needs and support them as they wanted.
People’s care plans were detailed, personalised and provided staff with sufficient information to enable them to meet people’s care needs. The care plans included objectives for the planned care that had been agreed between the service and the individual. All of the care plans we reviewed were up to date and accurately reflected each person’s individual needs and wishes. The service’s risk assessment procedures were designed to enable people to take risks while providing appropriate protection.
The registered provider and management team provided clear leadership to the staff team and were valued by people, staff and relatives. There was a whole team culture, the focus of which was how they could do things better for people.
The provider had developed strong links with the local community. They worked alongside other organisations to ensure they followed current good practice in the delivery of people's care. The management team had a role in promoting the importance and value of social care locally. Stayathome alongside the domiciliary care service, run a farm and café in the local community. Strong links with the community had been formed via these services. People told us that they were supported by staff to meet with friends in the local café which reduced social isolation.
In addition Stayathome supported some employees who have had difficulty gaining employment due to their own vulnerability, work with them through an apprenticeship scheme. This showed that Stayathome supported and gave people an opportunity to enter the workforce and continuously provide them with assistance to carry out their role.
People and relatives all described the management of the home as open and approachable. People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.