Privilege Home Care

People’s experience of using this service: Systems to assess, monitor and improve the service were not sufficiently robust. Recording in daily notes was not detailed and staff did not accurately record their arrival and leaving times. There were no audits taking place to demonstrate oversight of the service.

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 procedures in the service supported this practice.

A person and people’s relatives told us they felt safe receiving this service. Staff had received safeguarding training and knew how to protect people from harm. Risks to people had been assessed, monitored and reviewed.

No new staff had been recruited since our last inspection. Staff were receiving regular formal support and training needs were up-to-date. This included training in the Mental Capacity Act (2005) which resulted in a breach of regulation at our last inspection.

People received a service from a small number of staff which provided consistency. There were no missed calls reported and feedback indicated staff arrived on time and stayed for the full duration of their visit.

Staff were trained in providing medication, although no one required this assistance at the time of our inspection. People were supported to receive enough to eat and drink.

Relatives confirmed staff supported them to access healthcare services, although they were able to arrange this independently.

Feedback received regarding the care and support staff provided was good and surveys supported this. Staff knew how to protect people’s privacy and dignity and they met the religious and cultural needs.

Care plans were detailed and contained step-by-step guidance for staff to follow. Care was provided around people’s preferences and their routines.

No complaints had been made since out last inspection, but people using this service were aware how to provide feedback if they were unhappy. Feedback regarding the registered provider was positive.

We made recommendations regarding the recording of supervision to make this more personalised to individual staff and introducing body maps.

Rating at last inspection: At the last inspection the service was rated as Requires Improvement (April 2018). The rating has stayed the same at this inspection.

Why we inspected: This was a planned inspection.

Follow up: We have asked the registered provider for an action plan. We will continue to monitor intelligence we receive about the service until we are scheduled to return. We inspect according to a schedule based on the current rating, however may inspect sooner if we receive information of concern.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At our previous inspection on 18 September 2015 we found that not all training was up to date and staff were not offered the opportunities through appraisal or supervision to identify and develop their knowledge and skills. This was a breach of Regulation 18, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found supervision and appraisal of staff had improved as had the majority of training. However staff had still not received training in Mental Capacity Act 2005.

There was 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.

There were arrangements in place to keep people safe and to help safeguard people from the risk of abuse. Staff understood their responsibilities for safeguarding people from harm and followed the registered provider's policy and procedure. Potential risks associated with people, the environment and equipment had been identified and managed.

People's needs and choices continued to be assessed when they started using the service. People received care that was personalised to their needs. People were encouraged to raise concerns or complaints and were asked for feedback about the service they received.

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 involved in their care. Care plans were personalised and reflected people’s current needs and preferences. They contained the information staff needed to provide people with the care and support they wanted and required. Staff understood the importance of treating people with dignity and respect. People and relatives had developed positive relationships with care staff and management.

Staff were positive about the support and development opportunities they received. The registered provider had not ensured staff had all the skills and knowledge to meet people's needs as staff had not received training in the Mental Capacity Act 2005.

There were systems to monitor and improve the service, which included systems to gather people's feedback about the service. The registered manager carried out checks to monitor and improve the quality and safety of the service. However, the registered manager did not always take action to address issues and make improvements when needed. For example, despite training in Mental Capacity Act 2005 being highlighted at our inspection of September 2015 staff had still not received training in this area.

Further information is in the detailed findings below.

We found people were consulted and informed about the care they wanted. Their individual care plans illustrated their needs and how these were to be met by staff.

Staff we spoke with told us they enjoyed their role and knew the people they cared for, which meant they could meet individual needs.

One person we spoke with said staff were reliable and knew what they wanted. This person said they were always asked about their care and their consent was obtained.

We spoke with two relatives of people who used the service; one relative we spoke with in their own home and the other over the telephone. Both relatives said care staff were reliable and they regarded them as family members because they knew their relatives so well.

We found staff were robustly recruited and their suitability was monitored. We saw evidence to show how the quality of the provision was monitored and maintained.

On the day of the visit, we met with the Registered Manager who told us they currently employed nine care staff, who provided personal care for people with learning and physical disabilities. At the time of our visit four people were using the service and the manager told us that all four had specific religious and cultural needs.

We spoke with the next of kin for one person who used the service. They told us they were very satisfied with the service they said, 'The carers are brilliant they are like part of the family'.