5, 12 and 13 February 2015
During a routine inspection
This inspection took place on 5 February 2015 and on 12 and 13 February 2015 and was announced. Forty eight hours’ notice of the inspection was given because the managers are often out of the office supporting staff. We needed them to be available during the inspection. At the previous inspection in January 2014, there were no breaches of legal requirements.
Guardian Home Care provides care services to people in their own homes, mainly in the Medway, Maidstone, Sidcup and Bromley areas. The care they provided was tailored to people’s needs so that people could maintain their independence. From what we saw during the inspection people had been assessed as low risk in terms of the care they needed. This included older people who have been discharged from hospital who needed help with day to day tasks like cooking, shopping, washing and dressing and help to maintain their health and wellbeing. Other people had moved into extra care housing schemes. This was their home and they remained as independent as possible, but staff were available to deliver care where needed. There were 200 people using the service at the time of our inspection.
There was a registered manager employed at 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. The registered manager was not available on the day of our inspection; we were informed that they had a new position within the organisation. A new manager had been appointed and they were applying to register with CQC.
People spoke about the staff in a positive light regarding their feelings of being safe and well cared for. They thought that staff were caring and compassionate. People said “I feel very safe when they help me have a bath as I am partially sighted and can’t see very well”. The manager and staff assessed people’s needs and planned people’s care to maintain their safety, health and wellbeing. Risks were assessed by staff to protect people. There were systems in place to monitor incidents and accidents.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. As the service is provided in people’s own homes DoLS did not necessarily apply, however we found that the manager understood when an application should be made and they were aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. They were also aware of when people should be assessed under the Mental Capacity Act (2005) Code of Practice
Staff were trusted and well thought of by the people they cared for. People’s comments included, ‘Staff arrive on time’, and ‘They always ring if they are going to be late’. There was mixed feedback about the reliability of staff and people knowing which staff were coming to their call. We have made a recommendation about the way staff were deployed.
Working in community settings staff often had to work on their own but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people. Staff had received training about protecting people from abuse and showed a good understanding of what their responsibilities were in preventing abuse. Procedures for reporting any concerns were in place.
The service could continue to run in the event of emergencies arising so that people’s care would continue. For example, when there was heavy snow or if there was a power failure at the main office.
Staff were recruited safely and had been through a selection process that ensured they were fit to work with people who needed safeguarding. Recruitment policies were in place that had been followed. Safe recruitment practices included background and criminal records checks prior to staff starting work. Some people needed more than one member of staff to provide support to them. The manager ensured that they could provide a workforce who could adapt and be flexible to meet people’s needs and when more staff were needed to deliver care they were provided. People said, “Compared with other companies I think they are quite well organised, reasonably on the ball”. They went on to say “I am getting all that can be expected”.
People felt that staff were well trained and understood their needs. They told us that staff looked at their care plans and followed the care as required. People told us that staff discussed their care with them so that they could decide how it would be delivered.
Staff had been trained to administer medicines safely and staff spoke confidently about their skills and abilities to do this well.
The manager gave staff guidance about supporting people to eat and drink enough. People were pleased that staff encouraged them to keep healthy through eating a balanced diet and drinking enough fluids.
There were policies in place which ensured people would be listened to and treated fairly if they complained. The manager ensured that people’s care met their most up to date needs and any issues raised were dealt with to people’s satisfaction.
People were happy with the leadership and approachability of the service managers. They said “I am very pleased with the service” and “It’s excellent – I would recommend it to anyone” They felt that they were well communicated with and that they could approach staff and managers with no reservations. Staff felt well supported by managers.