16, 22 September 2014
During a routine inspection
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People's needs were assessed and risk assessments were carried out before care was provided. These were regularly reviewed every six months so that staff were aware of the best way to provide support.
The manager and other supervisors were available on a daily basis and out of office hours to oversee the staff, and monitor that people were being safely supported, for example in helping people to be safe during personal care. The staffing levels were agreed appropriate to people's assessed care needs. We were told by staff and people who used the service that the agreed numbers of staff were available when providing support, and that staff were on time and responded to requests for additional support such as making telephone calls if requested.
There were arrangements in place to deal with emergencies and to make sure people were safe. People's health needs, such as physical disability support were included in their care planning to ensure that important health needs were met. The staff and manager were trained in protecting people from neglect or abuse. All of the 16 people we spoke with whom use the service told us they felt safe and well looked after by staff in their home. They said they felt safe in the way staff supported them, and the staff were well trained and knew how to support them.
Staff carried photographic identification issued by the agency, to ensure that people who used the service were able to identify them and feel safe. All of the 16 people we spoke with who used the service or their relatives said that the staff always carried identification, and they felt that this was reassuring and gave them confidence.
Is the service caring?
We spoke with 16 people who used the service or their families and people told us that the staff and supervisors were very caring and supportive. Many said staff always took the time to speak with them and spoke with them in a manner they understood. One person said: 'the staff are very polite and nothing is too much trouble to them.' Another person said:' I think the standard is high, the staff are good people to have in my home.'
Is the service effective?
We saw from 10 people's records we looked at that people's needs were assessed and a plan drawn up to meet those needs. Staff were aware of the importance of consent and people were asked for their consent before care was provided. People we spoke with told us they were happy with the plan provided. Regular reviews were made of the plan provided and people or their families told us they were involved in the reviews. Four people told us that the agency allowed them a choice of staff at the start of their service provision, and care was taken to ensure they were happy with the staff allocated to them. The manager told us that when people request not to have certain staff that this is recorded on the computer so that these staff are not selected to provide care for that person. The manager said this was to do with personality preferences and not normally staff-conduct issues.
There were suitable policies in place for consent to care, assessing and planning care, safeguarding people and medication. All of the people we spoke with told us the staff knew how to support them well. People who used the service were consulted for their views on the service they received a regular basis, which involved the person, their family or advocate and social services. We saw that any changes they requested were included in a revised care plan.
Staff were provided with adequate support, guidance and training to do their job. They were experienced in supporting people with care needs such as dementia and physical disabilities and they told us that the training they received equipped them to support people with confidence.
Is the service responsive?
People we spoke with who used the service told us that the staff and manager always listened to their concerns and did something to help sort out any problems they are experiencing. People were asked for their views about their service and action was taken to address any problems, for example one person told us that their comments expressing concerns about not feeling comfortable with their allocated staff were listened to and resulted in a change of staff.
People's support plans were reviewed and changed when necessary in response to changing needs, for example in negotiating higher levels of support when necessary, or in changing the time of visits to accommodate people's needs such as activities.
Is the service well led?
The registered manager was qualified and experienced and was involved in the day to day management of the service. There was an out of office hours on call system in operation to ensure that management support and advice was always available. There was a system for doing spot checks on staff working with people to monitor the quality and safety of care provided. Comments received from people who used the service and families included: 'the supervisors are very good and regularly call in to see how the staff are doing, I once had a problem with one staff and it was dealt with immediately,'
Seven staff we spoke with told us that they felt the agency was very well managed and they received direction and training to help them to support people. Regular staff meetings and supervision sessions were held, and staff said they felt able to raise any issues with the management openly and honestly, and felt the manager followed up on any issues quickly. All of the staff said they had been to a team meeting at some point but felt that these meetings could be more regular to improve communications and teamwork.
People who used the service told us that they felt the agency was well managed and that they had regular contact from the office to check that their support was happening as planned.
There were a range of systems in place to monitor the quality of people's care, and to make sure any concerns about staff, management or the way in which care was delivered were addressed. This included quality assurance procedures and process for checking that people's care was being planned and for asking people for their views about their care. The provider used a quarterly newsletter to give people information about their findings and what they were doing to improve services.