This inspection took place on 9 February 2017 and was announced. The service was given 48 hours' notice. This was to ensure that someone would be available at the office to provide us with the necessary information.At our last inspection on 2 March 2016 we found that the provider was not meeting all the standards that we inspected. We identified breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not have effective systems in place to record and monitor the quality and safety of service provision in order to improve, learn and develop. Staff did not receive regular supervision to support them in their role. Staff appraisals were not taking place which meant that staff performance was not being effectively monitored and reviewed. At this inspection we found that the provider had addressed these concerns.
Advance Home Help and Support Services is a domiciliary care agency based in North London which provides care in the community within people’s own homes, predominately in Enfield. At the time of this inspection there were 14 people using the service. The service provides personal care, to older people some of whom are living with dementia and or have physical disabilities.
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.
People using the service and a relative told us that they were happy with the care and support that they received from Advance Home Help and Support Services. People told us that they received care and support from care staff that respected their privacy and dignity and supported them according to their needs and wishes.
Systems and processes were in place in order to protect people from harm. Care staff demonstrated a clear understanding of safeguarding adults and were able to describe the steps they would take in order to protect people from abuse or significant harm. Other procedures that the service followed in order to keep people safe included personalised risk assessments which assessed people’s individual identified risks and robust recruitment processes.
The registered manager told us that at present they felt that they had sufficient numbers of staff to meet the needs of the people they supported. In addition the registered manager and deputy manager were always available to deliver care where required. Rotas seen allowed for travel time between each call.
There were suitable and safe arrangements in place in relation to the administration and recording of medicines. The registered manager carried out weekly and monthly audits to ensure that where a person required support with medicines that this was monitored regularly.
The provider ensured that all staff recruited had received the necessary training to deliver good care. Most care staff had been through the mandatory social care training through previous employments and were able to provide evidence of this. Where gaps in knowledge were identified by the registered manager, appropriate training was organised and delivered. Opportunities were also provided to all staff to develop their knowledge and skills.
Care staff told us and records confirmed that regular supervisions were taking place and that these were an opportunity to discuss any concerns or issues that staff may have and the areas where further support maybe required. Annual appraisals were also taking place which addressed future development and training.
The registered manager and all care staff were able to demonstrate a good understanding of the key principles of the Mental Capacity Act 2005 (MCA) and how these were to be applied when supporting people. People told us that they were supported to make their own choices and decisions where possible. Care staff were able describe ways in which they encouraged and supported people to make their own choices and decisions.
Each person receiving care and support had a care plan in place which was individualised and provided detailed information about the care and support that they required. Each care plan clearly set out the person’s needs and the support they required taking into account their wishes, likes and dislikes. Care plans were regularly reviewed and updated as and when required.
The registered manager ensured that details of all communication that took place between people, relatives and the service were clearly documented and held as part of the person’s care plan. This also included details of all actions taken by the service in response to the communication which included follow up to medical appointments, financial clarifications and any other issues or concerns related to the care and support that the service provided.
People told us and rotas confirmed that they received care from a regular team of care staff with whom they had developed good working relationships. People and relatives told us that they were treated with respect and dignity. We were told that although staff were present to support people they also encouraged and promoted people to build their independent living skills.
The registered manager confirmed that had not held any team meetings as most staff worked part time for the service and also were in employment elsewhere which made organising staff meetings difficult. However, the registered manager told us that they were always in regular contact with all care staff and were always available to care staff when required. In addition the registered manager planned to develop and produce monthly newsletter as a method of information exchange.
People and relatives knew who the registered manager was and felt able to raise concerns or issues relating to the care and support that they received. They also felt assured that any concerns or issues raised would be appropriately addressed by the registered manager.
A number of quality assurance systems were in place to monitor the quality of the service being provided and to identify any issues or concerns. These included medicine audits, spot checks, regular telephone monitoring, quality surveys and staff questionnaires. This allowed the provider to learn and improve the quality of service provision.