Archived: Home Support Matters West

Updated 29 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 carried out on two separate days including the 8 and 10 January 2018. We gave the service 48 hours’ notice of the inspection visit because it is small and the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in. The second visit was arranged with the registered manager.

One inspector undertook the inspection. Prior to the inspection, we considered any information we already held about the service including notifications, which are important events the service is required to tell us about. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least annually to give some key information about the service, what the service does well and improvements they plan to make.

We met with four staff and the registered manager. We also spoke with two professionals and one relative. We looked at one care/support plan and other records relating to the business. These included three staff recruitment files and records relating to staff training, induction and training. The statement of purpose and business reports. The complaints procedure and medication policy.

Updated 29 March 2018

The inspection took place over two dates. The first date was 8 January 2018. This was an announced inspection in line with our methodology for domiciliary care agencies. We gave the service 48 hours’ notice. During our visit to the office, we arranged to meet a service user, their family member and carer, which we did on 10 January 2018.

This was the first inspection to the service since its registration on 18 September 2015. At the time of our inspection, the service who are registered to provide personal care were only supporting one person and have rarely supported more than one or two people. However, the organisation provides support to about 15 hundred people across Norfolk. These are for services, which do not currently require registration and are not regulated by the CQC. For example, they provide community support services such as managing day services and supporting people in their own homes with paying bills, budgeting, housing issues, accessing the community and social support. They were also providing staff to residential homes where a person might require one to one support. For example, staff worked with a person with a learning disability who was in a care home for people who were predominantly older. The person with the learning disability was a younger adult with an unmet social need. The purpose of the one to one support was to help them access the community and engage in age appropriate, specific activities of their choosing. Another example is where a person might need an increased level of supervision due to ill health or behaviours, which might compromise the safety of others. The local authority would purchase care and support on an individual basis for a specified period to help support people in a crisis or due to change in circumstances, which might put them at increased risk.

The service had 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.

We found the service was well managed. Staff knew how to support people and risk assessments and needs assessments were completed before support could be provided. Staff did support people with a range of tasks and received training to help them carry out their duties appropriately. For example, staff were trained in safe moving and handling practices, medication administration and how to safeguard adults from abuse. Staff we spoke with were knowledge about all aspects of their role. There was sufficient management oversight of the services provided to help ensure staff were competent and people got the support they needed.

Staff recruitment processes were adequate. However, we could not find all the original documentation required to demonstrate that the service had safe recruitment practices. This was because some records were held at head office and we did not have sight of them. The registered manager confirmed they would address this. Staff were supported through induction, which included skills for care, which is a nationally recognised induction framework for new care staff working in adult social care. In addition, staff were given opportunities to shadow staff that were more experienced and they received regular supervision and annual appraisal.

There was sharing across the organisation to help ensure lessons were learnt from any possible avoidable harm. Areas of good or poor practice were identified and shared so these could be implemented more widely or actions agreed to improve the service in any areas where a deficit was identified.

People were supported to access health care services as deemed appropriate and staff monitored people’s health as appropriate. Some people being supported required more practical support with budgeting and shopping where others required support to eat and drink. This was agreed in the care plan, which highlighted any risk.

“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. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

We checked whether the service was working within the principles of the MCA. We found staff were and had a good understanding of the law.

Staff spoken with demonstrated a passion and commitment to the people they were supporting. They demonstrated good interpersonal and communication skills. The organisation had clear expectations of its staff and monitored their performance in line with these. Staff recruitment and staff training was sufficiently robust which helped to ensure staff had the right attributes and skills.

People were consulted about their care but for most people the service was based on a short-term intervention, which was then reviewed with the agency and local authority if they commissioned the service. People did not have a say in wider organisational issues and there was not much evidence of feedback from people.

Care plans gave enough information for staff to be able to support people. Further information about what the person was able to do for themselves was documented. There were goals set, which enabled the care to be evaluated against what was agreed.

Staff sometimes supported people and their relatives when a person was approaching the end of their life. Staff received training to help them be aware of people’s needs so they could support them appropriately.

There was an established complaints procedure and feedback was regularly sought from staff, people using the service or their families. No complaints had been received and there was little in the way of feedback although we saw people did have the opportunity. Everyone we spoke with were confident that management were approachable and acted on feedback given.

The service had an experienced registered manager who we had confidence in. They were knowledgeable about people’s needs and how to access and signpost people to the right services. They had enough staff so they could deploy them as they needed and were responsive to people’s changing needs.

There were systems in place to measure the effectiveness of the service against agreed aims and objectives and staff were aware of these. There was learning across the organisation to ensure areas for improvement were identified and implemented.