Archived: Basing Care Limited

The service had a registered manager who was appointed in March 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

In May 2015 the service experienced a phase of transition due to being taken over by a new provider and new commissioning arrangements with the local authority.

People were supported by staff who made them feel safe. People and relatives told us the continuity and consistency of staff had improved since the new provider had taken over and the registered manager had been appointed. People told us they liked to know who was coming to support them in their homes, which reassured them and lessened their anxiety.

People were kept safe and protected from abuse because staff understood their role and responsibility in relation to safeguarding procedures. There had been three incidents since May 2015, which had been referred to the local safeguarding authority. These incidents had been reported, recorded and investigated in accordance with the provider’s safeguarding policies and local authority guidance.

Designated staff completed needs and risk assessments, which promoted people’s independence, while keeping them safe. Risks associated with people’s care and support needs were identified and managed safely to protect them from harm. Risks to people in relation to the provision of their personal care and environmental risks had been assessed and control measures put in place to minimise their occurrence. Staff provided people’s care safely in accordance with the guidance contained within their care plans.

People received a high degree of continuity in the staff providing their care. If people needed two staff to provide their care safely this was rostered and provided. The registered manager ensured they did not overcommit the service and did not accept requests for care which they could not meet safely. People and their relatives had no concerns regarding staffing levels. Staff told us there were always enough staff to provide the required support, which we observed in practice.

Staff had undergone relevant pre-employment checks as part of their recruitment, which had been verified by the provider. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider.

Staff were able to explain the purpose of medicines prescribed for individual’s health and wellbeing and supported people to understand what their medicines were for, so that people understood the importance of taking their medicines to maintain their health. People received their medicines safely, administered by staff who had completed medicines management training and had their competency assessed by the registered manager.

The provider supported staff to meet people’s needs with an effective programme of induction, supervision and appraisal. The provider’s required staff training was up to date and refreshed regularly to ensure staff had retained and updated the skills and knowledge required to support people effectively. The provider’s allocation system prevented staff being allotted to cover visits if their training had not been completed or needed to be refreshed.

People’s human rights were protected by staff who demonstrated clear understanding of guidance and legislation relating to consent and mental capacity. The registered manager and staff had initiated best interest processes where required to ensure people’s human rights were protected.

People were supported to maintain a healthy balanced diet by staff who understood their dietary preferences. We observed people supported appropriately to ensure they received sufficient to eat and drink.

Staff were alert to people’s changing needs and took prompt action to promote their health and wellbeing by ensuring they were referred to relevant health professionals where required.

Staff had developed caring relationships with people and knew about peoples’ needs and the challenges they faced. Staff understood people’s care plans and the events that had informed them.

People and staff had meaningful conversations which did not just focus on the person’s support needs. Staff spent time to sit and chat with people and always spoke with them in an inclusive manner, enquiring about their welfare and feelings. People were supported by thoughtful staff who treated them with dignity and respect.

People were involved in developing their personalised care plans which detailed their daily routines. People told us the registered manager committed to ensuring people were involved as much as they were able to be in the planning of their own care. There was guidance for staff about how to support people to promote their independence and maximise the opportunity to do things of their choice.

People their relatives and professionals told us the way care was provided reflected people’s preferences. Staff understood the need to enable people to make choices in their daily lives as far as they were able and were active in enabling people to make choices. Staff understood people’s different communication needs and ensured they followed the guidance provided in people’s care plans to enable them to communicate their views.

People’s needs were assessed and regularly reviewed to ensure their care and support was responsive to changes identified. Care plans and regular reviews documented the support and care people required, and how this should be provided in accordance with their wishes. Records accurately reflected people’s needs and were up to date. Staff were provided with necessary information and guidance to meet people’s needs. People’s and staff records were stored securely, protecting their confidential information from unauthorised persons.

People told us they felt able to raise any issues or complaints with staff and that they would be listened to and appropriate action taken in response. Records demonstrated that when any complaints had been received, the manager had investigated them, in accordance with the provider’s policy and responded to the complainant with the actions taken. The service was responsive to people’s feedback.

Staff told us the registered manager was highly visible and regularly went out to provide care, which made them feel part of a team. People and relatives praised the registered manager saying they were very approachable and always willing to listen.

The provider’s values were based upon caring passionately about people, supporting and enabling them to live life to the full, promoting their independence and to deliver personalised services which met their needs. Staff knew these values which we observed them demonstrate while delivering people’s day to day care.

People we spoke to were complimentary about the management of the service. There was a clearly defined management structure in place and the provider had good oversight of the service.

The registered manager effectively operated systems to assure the quality of the service and drive improvements. Feedback from people, their relatives, and staff was sought to identify changes required to improve the quality of care people experienced. The provider’s audits were used to review changes implemented, and ensure all required actions had been taken.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found;

Is the service safe?

We found that people were cared for safely. People's needs had been assessed and reflected in their care plans. Where necessary assessments had been completed which identified and reduced risks, whilst supporting people to remain independent.

Where people needed support with more complex health needs we saw there were specific plans which detailed the care needed and how staff should provide this. We found that staff received appropriate training in relation to complex needs from health

professionals, which had ensured that people's needs were met safely.

The service ensured that valid consent had been obtained from people before providing their care. Staff told us that they had received training about the Mental Capacity Act 2005 during their induction course.

People who use the service said they felt safe with staff, who treated them with dignity and respect. One person said "The care staff treat me gently and never rush. They are like daughters to me and do lots of little things which show they genuinely do care." Another said, "I feel safe with them because they know how to help me without having to be told."

Staff understood the different signs of abuse and knew who to raise concerns with if necessary. People told us they would report any concerns to the registered manager and had no worries that this would affect the quality of their care.

The service ensured that people were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents.

Is the service effective?

We found that the service placed people at the centre of all decisions regarding their care and support. Where the service identified a person lacked capacity to make a decision, a best interest meeting was held with people who knew and understood them, which ensured their human rights were protected.

People we spoke with were complimentary about the care received. One person we spoke with said "The staff are excellent and know when I need to take more time if I'm having an off day." It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One relative told us, "I'm very pleased with the staff. They happily chat away and take an interest in my dad so it doesn't seem like they're doing a job." Another relative said, "The staff know when she's not feeling well and always ring me if they're worried."

Staff had received an induction recognised by the care sector, covering core subjects including safeguarding, infection control, management of medicines, food hygiene and moving and positioning.

We found that staff were knowledgeable about people's specific health and personal care needs and had received training to update their skills and knowledge. Staff had received training to meet the specific needs of the people. Such training included physiotherapy to assist with the management of multiple sclerosis and percutaneous endoscopic gastrostomy (PEG) feeding. PEG feeding is a form of tube feeding for people who are unable to or have difficulties in swallowing. People told us their support plans and risk assessments reflected their current needs.

The provider had ensured that people received appropriate care form competent staff who had been supported in their personal development by an effective system of supervision and appraisal.

Is the service caring?

People were supported by kind and compassionate staff, who spoke to people in a friendly, caring manner. We saw that care workers gave encouragement to people who were able to do things at their own pace. One person told us "Staff are always cheerful and smiling, which cheers me up." Another person said, "I know they are very busy but they make time to talk to me and always ask if there is anything else they can do for me."

We observed that staff supported people to make their own daily living choices and to be as independent as they were able to be. This promoted people's self-esteem and gave them a sense of achievement. The care staff we spoke with enjoyed working with people they supported. One person told us, "It's all about the people we care for. If I can leave them with a smile on their face I know I have done a good job." Another person said, "I know there have to be boundaries but you can't provide good care if you don't actually care for the people."

Is the service responsive?

The service was organised to respond to the diverse requirements of different people. People's needs had been assessed and their care was planned and delivered in accordance with their personal preferences. Staff had a clear understanding of each

person's needs and how they should be met. For example, the service had responded well to an incident where a person displayed behaviours which may challenge. The person's behavioural support plan had been updated to ensure staff knew how to respond appropriately to such behaviour in the future.

We found that the service was responsive to the changing needs of people, which had been continually reviewed. Where staff required further training this had been planned in advance or where anticipated arranged immediately.

People knew how to make a complaint if they were unhappy. They told us that they frequently received visits from the care coordinator who was "always asking if they were happy". One person told us, "I wouldn't call them complaints, just grumbles. But every time I've had a problem it has been sorted out."

Is the service well-led?

The service was well led. The registered manager and staff we spoke with were clearly passionate about the health and wellbeing of people being supported by the service. Care workers spoke positively and with pride about the service they provided for people.

Staff told us that the manager's spoke with them about any changes planned and they felt part of a team where their contribution was valued. They told us that the office based staff were always helpful. One care worker told us, ''you can speak to the on call supervisor at any time and they always listen and help you to sort things out." This meant that care workers felt confident to raise concerns.

During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the service was monitored on a consistent basis to ensure that people experienced safe and appropriate support, care and treatment.

We found that people were involved in planning their own care and understood the choices and support available to them. We were told by people that they were treated with respect and dignity. One person said, 'They are so kind and do all sorts of things to help my day. It's the little things they do that mean so much to people living on their own.'

Care plans contained relevant information to enable staff to give support in the way that people preferred. The relative of one person said, 'The care is very good and they always keep me informed if they are concerned'.

People said they felt safe, trusted the people caring for them and had no fear of raising concerns. Whenever they had any issues they told the manager, who acted swiftly to resolve them.

Since the last inspection there had been one medication error. This was correctly investigated and the necessary learning and development from this error had been shared with staff.

There were effective recruitment and selection processes in place which ensured that people were supported and cared for by appropriately trained and qualified staff.

The self auditing by the manager meant they could effectively identify, assess and monitor risks relating to the health, welfare and safety of people using the service.

Staff demonstrated a good awareness of the needs of the people they supported.

People were actively encouraged and supported to be as independent as possible, whilst ensuring individual healthcare needs were met and relevant records kept.

People felt the staff and management of the agency listened and dealt with issues promptly.

All of the people supported by the agency and their representatives told us they were very pleased with the care and treatment being provided. One person told us, 'They are brilliant; they help as much as they can and always listen to me.'

A relative of one person using the service said, 'The manager is very good and the dementia specialist is absolutely amazing, she is always there to talk things through.'

Concerns were also raised by most of these people who were worried that the recent reorganisation of care staff may have lead to a reduced quality of care.

The staff received an induction and continued training to support their work. They were supported through regular meetings with their manager and care coordinator.

The agency monitored the effectiveness of its operation regularly and sought the views of the people it supported.