In Home Care Ltd

In Home Care Ltd is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 80 people with personal care at the time of the inspection, including older people and those living with dementia, people with a physical disability, sensory impairment or a mental health condition.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People and relatives told us the service continued to provide safe care. Safeguarding concerns were acted on and risks to people were assessed and managed safely. Staff worked proactively with other professionals and agencies to ensure people had the care and resources they needed to live safely. People were supported by enough staff with the competence and skills to meet their needs. Staff were recruited safely and employed because they shared the values of the service, to provide person centred care. People received their medicines from trained staff who were assessed as competent in their role. Staff used safe infection control processes to protect people from the risk of infection. The service analysed incidents and any trends to make improvements to the care people received.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People and relatives spoke highly of the staff who they found to be skilled, professional and competent. Staff completed an induction into their role and were supported in their on-going professional development. The service ensured people were supported by staff who had the training and skills to meet their specific needs. There was a holistic approach to the assessment of people’s needs and to ensuring people had access to the support and resources they needed which had resulted in positive outcomes for people.

The service provided outstanding care from staff who delivered an exceptionally kind and compassionate service. Staff often exceeded expectations by going the extra mile to promote people’s wellbeing and quality of life. Staff built positive relationships with people, their families and these relationships were valued by people and staff. The culture of the service supported staff to provide high-quality person-centred care. People and relatives told us they were fully involved in expressing their views so that care could be delivered in line with their preferences and decisions. People were asked about their protected characteristics under the Equalities Act (2010). This provided people with the opportunity to discuss their diverse needs, should they wished to do so and supported person-centred care.

People told us their needs were met and care plans described how they preferred these to be met. This included people’s communication and activity needs to help prevent social isolation. People and relatives told us the service was responsive to their needs and acted on any concerns or complaints promptly. No one was being supported with end of life care at the time of our inspection however, the service had the experience and guidance available for staff should the need arise.

Feedback from people, relatives and staff was consistently positively about the management of the service. The culture of the service was inclusive, and person centred and achieved good outcomes for people. People told us, and evidence confirmed they were regularly consulted about their experience of the service and their feedback was acted on. Systems were in place to monitor the quality and safety of the service and staff were supported to be accountable in their role through supervision, team meetings and observations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was outstanding (published 08 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information 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.

At our previous inspection on 13 October 2014, the provider was in breach of two regulations that related to; Regulation 21 HSCA 2008 (Regulated Activities) Regulations 2010 Requirements relating to workers. The provider did not operate an effective recruitment procedure to ensure staff were suitable to provide care to people, and Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Supporting staff. The provider did not have suitable arrangements in place to ensure staff were supported to deliver care to an appropriate standard by providing training and supervision.

After the inspection the provider sent us an action plan which detailed the steps they would take to meet the requirements.

At our announced inspection on 10 and 11 January 2017 we found the provider had made significant improvements and met the requirements.

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.

Staff and management consistently went the extra mile to provide outstanding care. People, their relatives and healthcare professionals told us the service was outstanding. Interactions between staff and people constantly showed an exceptional level of person centred care.

Management provided outstanding leadership, were constantly working to drive for improvement and always celebrated success. Feedback from all staff, relatives and healthcare professionals confirmed management were respected and led by example.

The registered manager had a good understanding of their responsibilities for sharing information with CQC and our records told us this was done in a timely manner. People and their families had been given information so that they knew what to expect from the service.

New legislation had been shared with staff which had been incorporated into the providers policies. Training had been reviewed and changed to reflect any new regulations. The service used the expertise of other recognised professional organisations to support practice development and continually improve the quality of service people received.

Staff told us that they felt their achievements were recognised and that they felt valued. Staff had a clear understanding of their roles and responsibilities. We observed staff were confident in performing their jobs and when speaking with people, other staff and the registered manager.

Audits had been completed and were linked to CQC’s regulatory standards of ensuring a service is safe, effective, caring, responsive and well-led. The audits effectively captured the level of detail sufficient to provide reliable data and lead to positive change. Audits and there outcomes were shared with staff at team meetings and through individual supervisions.

People who required assistance with their medicines were supported by appropriately skilled and qualified staff. They had received training and competency checks and had a good understanding of the risks associated with the medicine people were taking.

People, their families and other professionals told us they felt the service was safe. Staff had received safeguarding training and had their competencies checked. They were aware of the types of abuse that could happen to people, what signs to look out for and their responsibilities for reporting any concerns.

Risk assessments had been completed for people and their environments. Risk had been managed with the minimum restrictions on the people’s freedom and choices. Accidents and incidents had been recorded by staff and reviewed by the registered manager. This included reviewing risk assessments and updating care plans. Feedback was shared with staff to improve learning and practice.

Staffing levels met the needs of the people using the service. Staff had been recruited safely.

Processes were in place to manage any unsafe practice. We saw evidence that these processes had been used effectively.

New care staff completed the Care Certificate. The Care Certificate is a national induction for people working in health and social care who did not already have relevant training. Staff consistently told us the training they received supported them to meet the needs of people safely.

Staff received on-going training which was relevant to the people they supported. Training had included safeguarding, moving and handling, food hygiene, fire safety, infection control and dementia awareness.

Staff said they felt supported in their role. Staff told us they received regular supervision and had a yearly appraisal. Supervisions also took place with staff when they were supporting people. They included checking staffs dress code, their knowledge of the people they were supporting and any risks they lived with, health and safety and a check of record keeping.

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.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met.

People had good access to healthcare. This included GP’s, district nurses, occupational therapists opticians and chiropodists.

People wherever possible had care workers who shared common interests and had gained the knowledge to understand people’s individual health challenges. They also had a good knowledge of people’s families and others important to them.

Care files included a privacy statement which explained to people the information that the service collected about them and why they kept it and staff understood their role in protecting a persons’ privacy.

People, their families and other professionals had been involved in a pre-assessment before the service provided any support. The assessment had been used to create care and support plans that addressed people’s individual identified needs. Staff demonstrated a good understanding of the actions they needed to take to support people.

People had their care and support plans reviewed regularly. Each week care workers were involved in a two way discussion with senior staff that included whether the time allocated to support a person was adequate, any equipment requirements, any professional input, and their feelings about the persons’ mental and physical well-being. Actions and outcomes from the discussions were recorded.

The service was pro-active in supporting people to feel part of their local community by promoting links with local businesses and events. People were supported to continue with activities they enjoyed.

A complaints process was in place. People and their families knew how to make a complaint and felt they would be listened to if they raised a concern. Complaints and there outcomes were shared with staff to reflect on practice and learn lessons when appropriate.

Staff were supported and encouraged to share ideas about how the service could be improved and had been pro-active in supporting changes. They spoke enthusiastically about the positive teamwork and support they received.

We spoke to two staff and to the registered manager and the nominated individual.

We found the service had not fully complied with the previous compliance action by ensuring all staff were subject to a Disclosure and Barring Service (DBS) check before starting work, or obtaining a DBS Adult First check so that staff could work in a supervised capacity before working alone. Reference checks were obtained for newly appointed staff.

We found the service had an induction for newly appointed staff. We noted that the registered manager had trained staff in moving and handling and first aid when she was not qualified to train these subjects.

Three people and a relative of someone who received a service from the agency said they were satisfied with the care and support provided. Reference was made by two people to how the agency was flexible in responding to people's changing care needs. People said they were consulted about their care. One person, however, was not satisfied with the care they received and told us the agency had not responded to the referrals and contacts they made regarding arrangements for care.

We saw that people had care plans with details of the times care was provided and the support people needed. We noted that the agency was flexible in adjusting the times of care to suit people's needs but this was not always reflected in the care plan.

The agency had policies and procedures regarding the safeguarding of vulnerable people.

The agency had not carried out sufficient checks on newly appointed staff. This included a lack of disclosure and barring service (DBS) checks and Adult First checks.

Staff had access to a range of training including moving and handling, the safeguarding of vulnerable adults and dementia care. We noted that training and induction was inconsistent. One person was employed to provide care without training or induction and a second staff member did not have a record of induction.