We carried out a review of the data available to us about At Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about At Home, you can give feedback on this service.
Montague House is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and provides a service to adults. On the day of the inspection the service was supporting fifteen people with a range of health and social care needs, such as people with a physical disability, sensory impairment or people living with dementia. Support was tailored according to people’s assessed needs within the context of people’s individual preferences and lifestyles to help people to live and maintain independent lives. Staff who supported people using the service were also known as personal assistants.
At the last inspection on5 July 2016, the service was rated as good in the areas of Effective, Caring, Responsive and Well-led. The service was rated as requires improvement in the area of Safe but the overall rating for the service was Good. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
The new manager had been monitoring the quality of the service by the use of visits to people’s homes and internal quality audits they had introduced. Where these had been recently introduced by the manager they were not fully completed and information was not consistent. People and staff felt that they were not receiving effective communication about any changes that had been, and were, taking place. We identified this as an area of practice that needed to improve.
People and relatives told us they felt the service was safe. The provider had made improvements to their systems for recruitment to ensure that staff were suitable to work with people. People remained protected from the risk of abuse because staff understood how to identify and report it. People continued to receive their medicines safely. The provider had arrangements in place for the safe administration of medicines. People were supported to maintain good health and had access to health care services
Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were supported at mealtimes to access food and drink of their choice. Some people’s food preparation at mealtimes was supported by staff or themselves, staff ensured meals were accessible to people.
People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment when required.
Staff continued to have the knowledge and skills to support people. There was an induction process and a training plan in place for essential training such as, safeguarding and health and safety. Staff also received training updates when required and supervision.
People and relatives felt staff were kind and caring. Staff spoke warmly about the people they supported and provided care for. Staff were able to detail people's needs and how they gave assurance when providing care.
Further information is in the detailed findings below
The service had a registered manager in post. 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.
People said they felt safe. One person told us, “Knowing that they always turn up makes me feel safe.” However the recruitment process for staff was not robust. The provider had not undertaken the required pre-employment checks to ensure that staff employed were of good character and were suitable to work with people. The registered manager immediately addressed this when it was brought to their attention.
Staff had received training in safeguarding adults with regular updates. Staff had a good understanding of their responsibilities regarding keeping people safe and how to recognise abuse and report any concerns. Staff had been subject to appropriate checks through the Disclosure and Barring Service.
People were supported to take make decisions about taking risks and to maintain active independent lives. There were environmental and individual risk assessments in place that were reviewed and updated regularly to guide staff and minimise the risk of harm to people. Accidents and incidents were reported and monitored to ensure that appropriate actions were taken to prevent recurrence.
Staff were employed in dedicated teams to support people and rotas showed that there were sufficient staff employed to cover any absences and to provide flexibility for people to live their lives as they chose. One person told us, “They are absolutely brilliant; they provide me with a personal assistant who comes when it suits me.” Each person also had an emergency contingency plan in place to ensure continuity of service should there be an unforeseen period of staff absence.
Staff were trained to give medicines and the registered manager undertook spot checks to ensure staff were competent and administering medicines correctly.
Staff had the knowledge and skills to support people. One person said, “They know exactly what they are doing, they are well trained.” There was an induction process and a training plan in place for essential training such as, emergency first aid and Health and Safety. Staff also received training specific to the person they were employed to support. Staff received regular, documented supervision from the registered manager and they said that they felt supported and listened to.
People were supported to make choices and decisions in their day to day lives. Where people were assessed to have fluctuating mental capacity this was reflected in their individual support plans with guidance to staff on how to gently support them at times when they lacked capacity to make day to day decisions.
People were supported to maintain adequate nutrition and hydration through risk assessment and detailed individual plans. Staff were knowledgeable about people’s needs and preferences around food and followed guidelines where specific nutritional needs had been identified.
Staff monitored people’s health and wellbeing and supported them to access routine and emergency health care appropriately. Where people had complex health needs there was detailed guidance in place for staff to follow.
Positive relationships had developed between staff and people. Staff knew people well and supported them thoughtfully and with empathy. People were involved in selecting the staff who supported them and were included in team meetings. They had control of their lives and chose when, where and how support was delivered.
The provider was dedicated to supporting people to live independent lives by providing a flexible person centred service. A member of staff said, “We make the impossible possible.” People received personalised care that was responsive to their needs. People were fully involved in planning and reviewing their support and the provider sought feedback through surveys and regular reviews. People were supported to follow interests and maintain relationships through flexible staffing arrangements. A member of staff said that they were, “Supporting (the person) every day to be productive.”
People, staff and health care professionals spoke positively of the registered manager and service. A member of staff told us, “If I am feeling a bit unsure I can just call her up to ask.” The registered manager undertook regular reviews and spot checks to ensure that support delivered was appropriate, safe and met people’s needs. The quality assurance system was appropriate and the provider was working on expanding its scope as the service grew. There was a complaints procedure in place and people and health professionals told us that any issues or concerns were dealt with promptly and effectively.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.