Background to this inspection
Updated
22 June 2016
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.
This inspection took place on 23 May 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in.
The inspection was carried out by one inspector and an expert by experience who carried out telephone interviews with people using the service and relatives after the inspection. An expert by experience is someone who has personal experience of using or caring for someone who uses this type of service.
Before we visited the service we checked the information that we held about it, including notifications sent to us informing us of significant events that occurred at the service. We asked the provider to complete a Provider Information Return (PIR) prior to our inspection. The PIR is a report that providers send to us giving information about the service, how they met people’s needs and any improvements they are planning to make.
We spoke with one person using the service, nine relatives and eight staff members including the owner, the care manager, two care co-ordinators and four caregivers. We looked at records including nine care records, training records, five staff records, complaints and audits.
After the inspection, we contacted two health and social care professionals after the inspection to gather their views and received responses from both.
Updated
22 June 2016
This inspection took place on 23 May 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in. At our previous inspection on 16 September 2014 we found the provider was meeting the regulations we inspected.
Home Instead Senior Care provides personal care for people in their own homes. The office is based in the Earlsfield area but provides care to people in Wandsworth, Lambeth and Dulwich. At the time of the inspection there were approximately 80 people using the service.
There was a registered manager at the service; however she was not managing the service at the time of our inspection. The owner was in the process of registering with the CQC at the time of our inspection. 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.
Care workers were known within the organisation as ‘caregivers,’ we have called them this in the report.
People and their relatives told us that caregivers were responsive to their needs and praised them for their caring attitude and empathy towards them. The minimum length of a visit was one hour. This helped to develop caring relationships with people as it meant that caregivers were not rushed and had time to sit down and speak with people and look out for their wellbeing. Both people using the service and caregivers felt the time given to them was beneficial and it made the caring seem more human rather than task based and time pressured.
People said they were offered choices and caregivers asked for their consent before supporting them with personal care. Caregivers were aware of the importance of privacy and maintaining people’s dignity when supporting them with personal care and gave us examples of how they did this. People and their relatives said they felt safe in the presence of caregivers.
The provider included people’s background and a life profile in their care plans so that a more personalised service could be provided. Caregivers were matched to people based on their skills, their interests and other factors such as language were considered.
People and their relatives told us there were no issues with timekeeping and caregivers were on time. A system was in place which alerted office staff if caregivers were running late.
The provider had thorough recruitment checks in place which helped to ensure caregivers were safe to work with people. Each caregiver was required to submit four references about their suitability for a role in care. They were also required to submit evidence of eligibility to work and criminal background checks. Caregivers completed an induction programme which helped them to prepare for their roles and they shadowed more experienced caregivers before supporting people unsupervised.
Ongoing training was provided by refreshing training every year. People were also provided with more in depth training around caring for people with dementia, in line with the provider’s aim of being a specialist dementia care provider. Although caregivers told us they felt supported, there were gaps in some of the one to one supervisions which was not in line with the provider’s own policy of four supervisions in a year.
The provider completed a thorough needs assessment when people first started to use the service, this included their support needs in relation to nutrition, medicines, mobility and other personal care support needs. Risk assessments were also carried out to help ensure people were supported in a safe manner. This information was used to develop person centred care plans that were individual to each person. People were provided with a copy of their care records and there was evidence that consent was sought before care was started.
People and their relatives told us there was an open culture at the service. They said the provider listened to them when they raised concerns and they felt comfortable calling the office if they needed to change or talk about any aspect of their care. Relatives told us they were kept informed with any changes to their family member’s needs.
Unannounced spot checks took place to monitor the quality of service and people were asked for their feedback about the service, their caregivers and any other issues. Other audits, such as checking daily care records and surveys sent to people and caregivers from independent external companies were used to improve the service.
The provider had helped to facilitate some unique community events to support people. This included helping to set up screenings in cinemas for people and their carers. The owner was passionate about supporting people with dementia and had worked with various organisations to raise awareness around dementia and supporting people with dementia to lead fulfilling lives.