Homecare Services

Homecare Services is a domiciliary care agency which provides personal care and support to older people, younger adults and people living with dementia, living in their own houses and flats. At the time of our inspection the service was providing support to 86 people.

At our last inspection, we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing 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.

At the time of our inspection 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.

People told us they received safe care. Records showed that staff had been recruited safely and staff were aware of how to safeguard adults at risk. There were safe processes in place for the management and administration of medicines.

Most people told us staff visited them on time and stayed as long as they should. People liked the staff who supported them and told us staff were kind and caring.

Staff received an effective induction and appropriate training which was updated regularly. People supported by the service and their relatives felt that staff had the knowledge and skills to meet their needs.

People received support with eating, drinking and their healthcare needs. Appropriate referrals were made to community health and social care professionals to ensure that people’s needs were met.

People told us staff were caring and kind and respected their right to privacy and dignity. They told us staff encouraged them to be independent and did not rush them when providing support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005.

People told us their care needs had been discussed with them and they received care that reflected their needs, risks and preferences.

People were happy with how the service was being managed. They found the manager and staff approachable. Staff told us the manager was approachable and they felt well supported.

The registered manager regularly sought feedback from people being supported and their relatives. We noted that people had expressed a high level of satisfaction about most areas of the service.

Audits and checks of the service were completed regularly. We found the checks completed were effective in ensuring that appropriate levels of quality and safety were maintained at the service.

Further information is in the detailed findings below.

Homecare services is a domiciliary care service. The agency's office is located in the centre of Rossendale in Lancashire. The service provides flexible personalised care and support for people who require additional support to live independently within the community. The agency provides support to people currently residing in East Lancashire and surrounding areas.

The service was last inspected in October 2014 and was found compliant in all areas inspected.

At the time of the inspection there was a registered manager at the service. 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.

We gathered verbal feedback about the service from people who used the service, families and staff. All the feedback that we received was positive. We also reviewed service questionnaires completed by people using the service and again noted no negative comments. People expressed their satisfaction with the service they received and how it was provided. People were complimentary about all the care staff, informing they were treated with dignity, kindness and respect.

The provider had robust processes in place to ensure a safe environment was maintained for people using the services and the care staff. People told us they felt safe and their homes were left secure by care staff following a visit. Safeguarding procedures were in place and followed, care staff showed an appropriate level of knowledge around the subject and were aware of who to contact should they have any concerns. Safeguarding training was also provided to all staff.

People told us they had never experienced a missed visit and never felt rushed with their care routine. Care staff indicated they were never expected to ‘overlap’ visits and were allowed the allocated time period assessed to support people correctly and safely. People told us if care staff were, “Running late” they would receive a call from the office to inform them. We looked at staffing rotas and time sheets and noted sufficient numbers of staff were employed to deliver safe and effective care to people using the service

Recruitment procedures were thorough and robust. Care staff told us their induction process contained the correct amount of detail to provide them with the knowledge to carry out their care role effectively. People spoken with confirmed that care staff were, “Good at their job.” Staff files we looked at contained relevant information and appropriate checks on staff character, this ensured the provider was following a detailed and safe recruitment selection of all care staff.

An appropriate level of training was offered to all care staff. This ensured care staff were equipped with the correct knowledge to support people effectively. All people spoken with were very positive about staff knowledge and skills and felt their needs were being met appropriately.

The service had processes in place for the appropriate administration of medication. Staff were adequately trained in medication administration. People told us they received their medication when required and on time.

Each person using the service had care plans and risk assessments individual to their own personal need. These documents gave clear information about people's needs, wishes, feelings and health conditions. Changes to people’s needs and requirements were communicated well which meant staff were kept up to date with these changes.

Staff spoken with were aware of the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). These provided legal safeguards for people who may be unable to make their own decisions. The management team also demonstrated their knowledge about the process to follow should it be necessary to place any restrictions on a person who used the service in their best interests.

We had positive feedback from people using the service, relatives and staff about the management team. People told us they were happy to approach management with any concerns or questions.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

We considered the evidence we had gathered under the outcomes we inspected. We spoke with ten people we randomly selected using the service, and looked at care records for three people in detail and a selection of other records in relation to other people's care. We also spoke to ten care staff, looked at two staff files, spoke with the registered manager and care co-ordinator and a senior carer.

This is a summary of what we found:

Is the service safe?

Before people received home care services, they had an assessment of their needs to determine the level and type of help they needed. Some areas of the assessment needed attention in recording to reduce the risk of information being missed. Arrangements were in place to make sure people continued to receive the correct care.

People told us visits were never missed. The agency had good arrangements in place to respond quickly if there was an unexpected staff absence. People told us they felt safe 'I feel safe with the carers. I'm not a person that feels safe easily but I know they are only down the road and I have an emergency number I can ring. They are very trustworthy.'

All staff had been trained in safe moving and handling of people and we were told this was up to date. Care plans were detailed to support staff to deliver safe and effective care. Risk assessments had been carried out to make sure staff worked in a safe environment. Protective equipment was provided for staff such as disposable gloves and aprons.

Safeguards were in place to make sure staff were recruited properly. Staff contractual arrangements and a code of conduct and practice helped to protect people. Financial policies and procedures needed to be updated and completed to make sure staff followed the right protocol in the financial protection for people

Staff were trained to deal with emergencies such as first aid, and were able to contact management for support out of hours.

Care had been taken to make sure people were kept safe by good recruitment procedures. Staff contractual arrangements prevented them from gaining financially from people they cared for.

People told us they felt safe in their homes when staff visited. Arrangements were in place for staff to gain entry to their home without placing them at risk.

The manager had been trained and understood principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions.

Is the service caring?

People told us they were happy with the care they received and the staff team. Surveys carried out showed people considered the service they received was very good.

People we spoke with said, 'I get all the help I need and want. The carers know exactly what to do and will always do that little extra. I usually get the same group of carers visiting and they will always say, 'shall I do this, or that'." "I have found the service on the whole very satisfactory. They visit four times a day. I've got to the point where I can wash myself and get dressed. Some mornings I struggle but they help without taking over.'

A family member said, 'They are always very polite, caring and very well mannered. He likes his carers. I was a bit anxious at first, it was a big thing for me to get help. They always offer to help me as well. It's a good service.'

People commented how they 'valued' the service. 'It is very much a community based service. I have opportunities to say what I want and they make me feel very relaxed. I'd be lost without them. They're my link with the outside world and it's a good feeling.' 'It's nice for people to be in their own home. That's where you want to be, especially at my age and with this type of service it's possible. I enjoy their visits.'

People told us staff treated them with respect and kindness. Staff worked to care plans that were person centred and sufficiently detailed on how best to meet individual needs.

Is the service responsive?

People generally felt the agency operated a flexible service and would always try to accommodate their needs. Assessment of people's needs and care plans were reviewed regularly and adjustments made where needed.

People using the service and their relatives had completed a satisfaction survey. A system was in place for receiving comments, compliments and complaints. People told us that they would know how to make a complaint, should they need to do so.

Is the service effective?

People we spoke with told us, 'I have a file here and they write in it. It tells them what help I need. I usually get the same carers and I think that helps because they notice changes quicker. That's the difference between friends helping and my carers. They understand me and my needs better.' Another person said, 'They have a file they write in. I know they do what they should as I have the same group of carers visiting. (Anonymised ) is in charge of them and she checks that everything is done right. I look forward to seeing them.'

Staff we spoke with told us they were well trained and were given enough information to know what people required. Work was arranged to let staff visit the same people on a regular basis. Arrangements were made for emergency staff cover in the event of sickness or absence.

People considered the service they received helped them stay in their own home. One relative commented, 'For the last five years I have had the most fantastic service and I am so pleased we were able to keep my parents at home for as long as possible.'

People told us they were consulted with and listened to. Quality monitoring showed action was taken with regard to comments they received.

Staff used a tele-monitoring system to support managers to know they were meeting their obligations in arriving at people's homes within the agreed time slot and that they stayed the right length of time. Spot checks on staff ensured staff met their obligation to provide the right standard of care for people.

Is the service well led?

A manager was responsible for the day to day management of the service. The manager was registered with the Care Quality Commission (CQC) and was supported by the owner of the organisation.

Staff were clear about their responsibilities and duty of care and were able to raise their views and concerns. Some staff expressed lack of confidence their views would be taken seriously. The manager said this would be addressed and was planning to introduce, 'reflection in practice' for staff to support improvements in the service. Supervision of staff was established with spot checks carried out on their performance by team leaders. Meetings were held to keep staff informed of changes within the organisation and provide staff with an opportunity to discuss issues relating to their work.

Policies and procedures were not kept up to date to protect the interests of people using the service, staff employed and the provider.

There were systems in place to regularly assess and monitor how the service was managed and to monitor the quality of the service. The company held a current Investors In People (IIP) award. This is an external accredited quality assurance award that monitors staff training and development and the management of the service. The service had a Quality and Compliance assessment overview completed by social services that gave a 100% rating of compliance. This included, support planning, personalisation, choice, safety of the service, safeguarding, risk management, infection control, communication, dignity in care and staffing.

We found people spoken with were happy with the care and support they received. People told us, 'They organise social events and I got a letter inviting me'. Other comments made were, 'On the whole they are very good, and very diligent' and 'We are very happy with the company and the care they are giving'.

One person told us they were 99% happy with the care their relative received and they felt they were, 'Getting a good service, showing dignity when needed. They are very pleasant and are doing a good job'. They told us, 'Staff are very obliging and they have a good banter', with their family member.

We found that people's medicines were managed safely. Regular medicines accuracy checks minimised the risk of errors.

There were systems in place to monitor and assess the quality of the service. People were asked their opinion of the service and were given the opportunity to complete customer satisfaction questionnaires. We saw the results of the questionnaires completed in August 2013 and noted most people had a high level of satisfaction with the service with 39 out of 41 people who returned the questionnaire stating they were overall happy with the service.

We found records were maintained appropriately and held securely in the homecare services office or within people's homes where they received care.