We visited three people in their homes and spoke with eight people on the telephone to gain their views and experience of the service. We spoke with the manager and four care staff about the service. At the time of inspection over 70 people were being supported by the service. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found-
Is the service caring?
People were treated with consideration and respect. One person told us, 'They listen to me natter. It breaks my day up. I don't get many visitors.' Another person said, 'They are very respectful of me and my husband.' A further person commented, 'They respect my routines.' We saw that staff were polite and considerate when visiting people in their homes. Staff spoke with people with ease and talked about topics of interest to people. For example, one person told us, 'They get to know you personally. They chat about things that interest me.'
People were involved in decisions about their care. We looked at three people's care records which were held in the homes. We found that these records had been signed by the person to indicate their agreement with the content. One person told us, 'The manager came out and we talked about the help we needed before they started with us.' Another person said, 'I was involved in developing my care plan. The times of the calls, and all the things that need doing.' A further person commented, 'I only want female staff so that's all they send.'
Is the service responsive?
People received the support they required at the time they needed it. One person told us, 'They are rarely late.' Another person said, 'They always turn up.' Staff arrived on time for the three visits we made to people's homes. People told us that the agency was responsive to their needs. One person told us, 'They are very flexible. If I need to change the time they come for some reason, they have always made the change.' Another person said, 'They are so flexible. They don't start until 7am, but we had a hospital appointment so they came at 6am to help him get ready.'
The provider had a system in place to deal with emergencies. The manager told us that there was a person on call outside of office hours and during their hours of business. Staff could contact the on call person for advice and guidance. We saw that the provider had an on call folder which contained information such as staff contact details, contact details for equipment repairs and people's emergency contacts. We found that there was a procedure to follow in the event of staff not being able to gain access to a person's home.
Is the service safe?
People were told in advance of the staff who would provide support to them for the week. The manager told us that each person was sent a schedule that detailed which staff would attend each visit. One person told us, 'I always know who is coming in. They send a list through on a Saturday and it generally stays the same.' Another person said, I have a list that comes through every week telling me who is coming in.'
The provider had a policy detailing the actions to take if abuse was suspected. This policy provided information regarding abuse and the actions which needed to be taken and the reporting arrangements. The policy detailed the need to take immediate action to protect the person and the contact numbers for external agencies such as the local authority safeguarding team. We saw that a poster displaying the actions to take if abuse was suspected was displayed prominently in the office and contained contact details for relevant external agencies. The provider may find it useful to note that the policy did not contain information regarding the requirement to inform the Care Quality Commission (CQC) of any allegation of abuse. However, the manager was aware of the need to inform CQC. The provider had access to the local multi agency safeguarding policy which provided details of the local arrangements for safeguarding vulnerable adults.
Is the service effective?
People's needs were assessed and care was planned and delivered to meet their needs. We looked at three people's care records which were held in their homes. We found that plans were in place which detailed the care which staff were to provide and these were followed by staff. For example, one person's plan stated that they required assistance to use the toilet and for their catheter bag to be emptied on one visit. We saw that that staff supported the person with these activities. Where people required the use of moving and handling equipment such as hoists we found that there was a detailed plan in the person's home directing staff as to how this equipment should be used. One person told us, 'They always follow the plan and do everything I need. When they have finished they always ask if there is anything else I need.' Another person said, 'It's all written down in my folder.' A further person commented, 'They have a care plan to follow.'
People told us that their needs were met. One person told us, 'You couldn't have better care than I'm getting.' Another person said, 'If I didn't have their help I wouldn't be able to stay at home.' A further person commented, 'They meet all his needs and he is very happy with the carers.'
Staff received training in a variety of relevant topics. For example, we found that the majority of staff had received training in safeguarding and infection prevention and control. One person told us, 'I feel they are very well trained. They have never had any problems using the equipment.' Another person said, 'They all know how to use my hoist.'
Staff were supported and supervised to carry out their roles. The majority of staff had received an annual appraisal and had regular 'spot checks' of their performance. Staff told us that they felt supported and found the feedback from spot checks useful in their development. New staff were supported in their roles. One person told us, 'The two who were here this morning only started a couple of months ago. They did a couple of shadow shifts with the regular staff and now come in on their own and do it perfectly.' Another person said, 'The new ones shadow the trained ones and learn as they go.' A further person commented, 'They are very competent. The newer ones come with the older ones.'
Is the service well led?
People were able to express their views of the service. One person told us, 'I feel able to complain. I have complained about a carer who was never on time. She doesn't come anymore.' Another person said, 'I am able to make complaints and the manager would sort them out.' A further person commented, 'They are open to complaints.' We found that the provider carried out an annual survey. We looked at the most recent survey which asked for people's views on a variety of topics such as, timekeeping, privacy and whether staff met people's needs. The responses to the survey were largely positive.
Senior staff and managers regularly checked on the quality of the service. One person told us, 'The management comes out to actually do the work.' Another person said, 'I am so confident with the manager. She is always checking that all is well.' A further person commented, 'The manager is very hands on. When she comes out she looks through all the care plans and checks what the carers write.' We found that there was a process of regular checking of staff performance through 'spot checks' which focused on aspects of care such as infection prevention and control practices, moving and handling and staff dress. We spoke with four staff who confirmed that their performance was regularly checked and that they felt that this was supportive.