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Inspection Summary


Overall summary & rating

Outstanding

Updated 9 February 2017

In Home Care provides services to people who live in their own home

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.

Inspection areas

Safe

Good

Updated 9 February 2017

The service is safe.

Medicines were stored and administered safely. Staff had received safeguarding training and were aware of actions they needed to take to keep people safe.

Assessments had been completed for people and their environments. Staff demonstrated a good knowledge of the risks people lived with and any actions needed to minimise the persons identified risk.

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.

Effective

Good

Updated 9 February 2017

The service is effective.

Staff received an induction and on-going training that gave them the right skills and knowledge to carry out their roles. They received support, supervision and an appraisal and were given the opportunities for personal development.

The service was working within the principles of the Mental Capacity Act 2005. Staff understood the legal requirements for obtaining peoples consent. They were aware of power of attorney legal arrangements for people and the scope of decisions they could make on a person’s behalf.

People had good access to healthcare professionals and staff reported concerns appropriately

Caring

Outstanding

Updated 9 February 2017

The service is very caring.

Healthcare professionals, relatives and people consistently told us staff provided outstanding care, compassion and kindness in all aspects of their work.

People received personal care and support when they needed it and in a way that enabled them to stay in control and maintain their dignity and independence.

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.

Responsive

Good

Updated 9 February 2017

The service is responsive.

A pre-assessment was completed with people, their families and other professionals and used to create care and support plans that met 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.

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. Complaints and there outcomes were shared with staff to reflect on practice and learn lessons when appropriate.

Well-led

Outstanding

Updated 9 February 2017

The service is extremely well led.

People, their relatives, healthcare professionals and staff all told us the service was well managed, approachable and efficient. They consistently told us the leadership was outstanding and provided us with many examples of management going the extra mile for people.

Staff were supported and encouraged to share ideas about how the service could be improved. They spoke enthusiastically about the positive teamwork and staff morale. They felt their achievements were recognised and felt valued. The management had implemented best practice guidance to ensure staff were supplied with excellent instructions.

The registered manager had a good understanding of their responsibilities for sharing information with CQC and this was done in a timely manner. Audits had been completed and were linked to CQC’s regulatory standards. They effectively captured the level of detail sufficient to provide reliable data and lead to positive change. Best practice guidance has been implemented in people’s care records where necessary.