Archived: Amegreen Complex Homecare Buckinghamshire

Amegreen Complex Homecare is a domiciliary care service that supports adults and children in their own homes. They also provide specialist care to people who have complex medical needs. At the time of our inspection 24 people were using the service.

The service had a registered manager in place. 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 told us they felt safe using the service. The provider had systems in place to assess the risks to people and their environment. Where risks were identified these had been minimised. The risks to people, staff and families were kept under constant review.

There were sufficient numbers of staff to ensure people’s needs were met. Plans were in place to recruit additional staff to ensure there was sufficient cover in the absence of permanent staff. This was important due to the complex needs of some people using the service.

Staff were suitably trained and the training was monitored and kept up to date to ensure people received appropriate and safe care. Staff received training in how to safeguard people from abuse. They knew the indicators of abuse and how to report concerns. Where people required assistance with medicines, these were administered by trained staff. Specialist training was available to staff in areas such as tracheostomy care and ventilation. Competency checks were carried out on staff to make sure they were practicing correctly. This ensured staff had the necessary skills to care for people safely.

Staff were supported through supervision, appraisals, team meetings and training. They spoke positively about the support they received from the registered manager and the senior staff.

Staff understood the Mental Capacity Act 2005 and how this influenced their work with people.

Staff were described as caring, friendly and loving. It was clear positive relationships had been built between people and staff. Staff knew how to encourage people to be as independent as possible and understood the benefits of this on people’s wellbeing. Communication between staff and people was positive. People gave examples of how staff had worked over and above the expected time to support them in times of need.

Comprehensive assessments took place prior to care being offered. Care plans reflected people’s needs. Staff were knowledgeable about people’s needs and also about their preferences and how they wished care to be provided.

People knew how to raise a complaint. People told us that when they had raised an issue with the provider it had been dealt with quickly and appropriately. People were also able to feedback to the provider about the quality of care provided.

The service was well managed. Systems were in place to review the service and make improvements where necessary. The registered manager supported staff and made themselves available to assist them individually or to work with people when needed. Staff understood the aim of the service and worked together to accomplish providing good quality and effective care.

The registered manager kept up to date with current practice and implemented this within the current service provision.

We looked at five standards during this inspection and set out to answer these key questions: Is the service caring? Is the service responsive? Is the service effective? Is the service well led?

Below is a summary of what we found. This is based on our observations during the inspection and discussion with people using the service, their relatives, the staff supporting them and management team. Please read the full report if you want to see the evidence supporting our summary.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Any potential risks to people's safety had been identified and discussed with them. Strategies had been put in place to minimise any identified risks whilst maintaining their independence as much as possible.

People told us they were treated with dignity and respect by the staff. One person added ''It's such a personal intrusion so it is important...''

The provider responded appropriately to any allegation or suspicion of abuse. We were informed of one incident, in January 2014, which the provider reported to the local authority. The provider took appropriate actions in conjunction with the local safeguarding team to ensure the safety and welfare of the individual concerned.

Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. We were told each team had the specific contact details for the relevant local safeguarding of adults/children boards. (Amegreen Complex Homecare operates within a number of local authority areas, each with their own safeguarding teams and contacts.) We viewed the staff training matrix which showed where staff worked with children they were provided with child protection training. Those who worked with adults were provided safeguarding vulnerable adults training. Where staff worked with both adults and children they were trained in both. Staff demonstrated a clear understanding of what constituted abuse and they were clear of their responsibilities to report any concerns to their line manager.

The service had procedures in place for staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and how to submit one. We found no applications had been submitted as they were not required. This ensured there were proper safeguards in place.

These findings demonstrated to us that the service was safe.

Is the service effective?

People's care packages were bespoke and tailored to their individual diverse needs. The service provided very individualised complex packages of care and each member of staff had been specifically matched with people according to their skills and experiences. This ensured people could be confident the staff providing their care and treatment had the knowledge and skills to provide them with care and support effectively and competently.

We found the care and support provided was reflective of people's needs and detailed in their care plans. Care plans were regularly updated where any changes in health were evident. Any accidents or incidents were recorded appropriately. They detailed the actions taken and showed risk assessments had been updated to document any further measures put into place to prevent a recurrence.

The staff took an active part in liaising with relevant health care professionals for advice when required. These included contacting GP's, district nurses, care managers and commissioners of people's health and social care requirements.

It was evident through discussions with people using the service, our observations and speaking with staff that they had a good understanding of people's needs and knew them well.

These findings demonstrated to us the service was effective.

Is the service responsive?

People knew how to make a complaint or raise any concerns if they were unhappy. We looked at the complaints log and saw there had been eight complaints during the last twelve months. We looked at three of those in detail. We found they had been responded to appropriately and records were kept of responses taken. We were informed all complaints and concerns were audited on a monthly basis. This enabled the provider to look for any trends or indicators in which improvements in the service provision could be made.

These findings demonstrated to us that the service was responsive.

Is the service caring?

During our observations we found staff were attentive to people's needs, assisted people where help was required and interacted with people positively. One example was where a child presented as unwell. The carer addressed the child's needs and supported the parent to contact health care professionals who were part of the larger multidisciplinary team involved in the provision of their care. The staff member remained calm and dealt with the situation in a caring and professional manner.

People told us care staff were always introduced to them before coming to provide care and asked for feedback. One person told us they were encouraged to ask questions applicable to themselves and their care needs to ensure they were happy with the choice of staff matched with them. This ensured people were involved in choosing staff who they felt comfortable with.

One parent who received support with their child said of their carer ''I can't praise her enough...I am very comfortable with her and feel she can completely care for X (named child) whilst here.'' They went on to tell us how they had been very ill a couple of weeks before and the member of staff had contacted the appropriate professionals for additional support during this period and told us the carer herself had been concerned and ''Came in the next day on her day off.''

These findings demonstrated to us that the service was caring.

Is the service well led?

People we spoke with told us they were consulted about the care and support they were provided with and their views and choices were acted upon. We were told their views about the service and provision of care were sought through general day to day discussions and during reviews of their care. The provider was further producing a satisfaction survey to send to people who used the service, staff and other health care professionals involved in people's care. They were awaiting the final draft. This meant the provider looked for further ways to gain people's feedback and include them in making suggestions on where improvements could be made. This in turn provided people with the opportunity to contribute to improving the service.

There were a range of monthly audits undertaken. These were in place to assist the provider to continuously monitor the quality of service people received, manage any risks and assure the health, safety and welfare of people who used the service. A report of the findings was reported to the Clinical Governance Committee and where any concerns were evident, actions were put into place to address them.

These findings demonstrated to us that the service was well led.