Background to this inspection
Updated
25 December 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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by five inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in [their own houses and flats.
The service had 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.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a domiciliary care service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. We also required the registered manager to arrange for us to have information about people who we could speak with on the telephone.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
Two inspectors checked documentation at the office. This included looking at eight people’ care plans, medication records, six recruitment files and a variety of records relating to the management of the service, including policies and procedures. The other inspectors carried out telephone interviews with people. We spoke with 23 people in total and one relatives. We also, as part of the inspection, spoke with three staff, the registered manager and the provider’s operations manager.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.
Updated
25 December 2019
Fir Tree House is a domiciliary care agency that was supporting 141 people in their own homes. Not everyone using the service receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene, medicines and eating. Most of the people using the service were older people, some of whom were living with dementia. At the time of our inspection 92 people were receiving the regulated activity from the agency.
People’s experience of using this service
People were aware they had care plans and told us they felt staff met their needs. However, we found a lack of person-centred and individualised information in care plans and some records which were not clear or contradictory. We have issued a recommendation to the registered provider in both respects.
People were cared for by staff who they said were very kind and caring, attentive and kept them safe. Staff had developed good relationships with people and were thoughtful in their approach to help people have the best care possible. People were happy with the food made for them, the way staff supported them with their medicines and access to healthcare professional input should they need it.
People said they felt listened to and asked if they were happy with the service they received by the agency. They told us staff timekeeping was satisfactory, staff stayed for the time expected and on the whole they saw the same staff.
People were cared for by a sufficient number of staff who were well trained and staff who understood how to keep people safe. Staff understood their responsibility in helping people retain their independence as well as gaining their consent before they carried out any care.
Staff felt supported and valued by management and the registered provider had introduced incentives to create a positive culture within the staff team. The service was constantly trying to improve its service to people by introducing new technology to assist with timekeeping and reducing the chance of a missed call. Governance arrangements were robust which helped the service identify shortfalls and areas for improvement.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (report published 9 February 2018). Since this rating was awarded the registered provider has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.
The service has now improved to Good as the registered provider had addressed the shortfalls we identified which related to monitoring calls to people. Since the last inspection, the registered provider has introduced a home care software system which enables the office to track care calls.
Why we inspected:
This was a planned inspection based on the previous rating.
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.