5 January 2017
During a routine inspection
The service employed a registered manager. 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.
This was the first inspection of this service since it registered with the Care Quality Commission in January 2016. The inspection took place on 5 and 6 January 2017 and included visits to the office, staff interviews and visits to people in their own homes. At the time of this inspection 10 people were using the service, seven of whom were receiving treatment or support with their personal care needs.
People, their relatives and staff told us the service was managed well. One person said, “I have nothing but praise for them.” People said they felt safe with the staff when receiving care. They said they had a stable staff team whom they had come to trust and know well. One person described them as “family”. Staff had received training in safeguarding adults and children and knew how to recognise signs of potential abuse. They understood how to report any concerns in line with the service’s safeguarding policy and said any issues would be dealt with thoroughly.
Risks to people’s health and safety had been assessed and were regularly reviewed. Assessments related to people’s health care and mobility needs, as well as environmental considerations, such as stairs or the safety of kitchen equipment. Staff were given information about how to minimise the chance of harm occurring to people and themselves. Should an accident occur in a person’s home, the circumstances of the accident were reviewed to identify any actions needed to reduce the likelihood of a reoccurrence. The service supported some people to take their medicines. Care plans provided information about each person’s medicines and when these should be taken. People told us the staff supported them safely and they received their medicines as prescribed.
The service employed safely recruited and well trained staff to meet people’s needs. Staff told us they had the training they needed to carry out their role, including moving and transferring people safely, infection control, first aid, pressure area care and caring for people living with dementia. The nursing staff responsible for using specialist equipment such as ventilators received regular training to ensure they remained competent with its use. Staff told us they enjoyed their job and felt supported.
There were sufficient numbers of staff available to carry out people’s visits and meet their needs safely. People told us they had a stable team of core staff. People told us they did not have staff sent to them who didn’t know them and they had never had a missed visit. One relative said, “We have never been let down, never had a missed visit.”
People and their relatives were very positive about the way staff supported them. Each person we spoke with told us their care staff were kind and compassionate. One person said the staff were “Brilliant and the care is fantastic” and a relative said, “My wife receives excellent care.” Staff performance was regularly reviewed through observation, spot checks and supervisions to ensure they were meeting people’s needs respectfully and in the manner people preferred.
Each person had a care plan that detailed their care needs and provided staff with step by step guidance about how staff should keep people safe, meet their needs and also respect their preferences. These plans were developed with each person, and their relatives if appropriate, following an initial assessment. Staff knew people well and were able to tell us how they supported them. The service employed sufficient staff to be flexible and responsive to changes in people’s needs. The service provided visits of no less than four hours to ensure people’s needs were met and staff were not rushed in providing care.
The registered manager and the staff had a good awareness of the Mental Capacity Act 2005. The registered manager explained that if a person was unable to make decisions about their care, they would discuss these changes with the person, their family and any relevant healthcare professionals, to support a mental capacity assessment to be carried out.
People and their relatives told us they had no concerns over the care and support they received and they felt able to make a complaint if something was not right. When asked if there was anything within the service that could be improved, one person said they felt staff cover for sickness could be improved and the remainder of people told us they couldn’t think of anything. We discussed this with the registered manager who described to us the contingency plans for covering staff sickness which were well managed. The service had received a number of letters and cards of thanks. One letter recently received said, “I am writing to let you know how impressed we all were with the care given.”
The provider had robust systems in place to monitor the quality and effectiveness of the service. In addition to the monthly audits completed by the management team, the regional operations’ manager visited the service every two weeks to review the performance of the service. The provider’s ‘highly complex referral’ and ‘clinical assistance’ teams also provided the service with clinical support and guidance.