The inspection took place on 5 and 6 December 2016 and was announced to ensure staff we needed to speak with were available. Home Instead Senior Care is registered to provide personal care to people living with dementia, people with a learning disability, people living with mental health issues, older people, people with a physical disability and younger adults. In addition to the regulated activity Home Instead Senior Care provides companionship and home help services to people in their homes. At the time of the inspection there were 17 people receiving the regulated activity. The service had a manager who had applied to become the 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 told us they felt safe in the care of staff who understood how to manage risks to them. People’s experience of the service was that their care was provided to them safely.
Staff had undertaken relevant training to enable them to understand their role and responsibilities in relation to safeguarding people. Processes were in place to safeguard people from abuse.
The provider ensured risks to people were assessed and measures put in place to manage them. Staff had a good understanding of their responsibilities for responding to and reporting accidents, incidents or concerns about people. Processes were in place to manage any unexpected or out of hours events for people’s safety.
There were sufficient staff to provide people’s care. People received consistency in the care staff rostered to provide their care. People’s care was provided by staff who had received guidance about their care needs and to whom they were introduced prior to their care commencing.
Staff had undergone relevant recruitment checks to ensure their suitability to work with people.
Medicines assessments identified the level of support people needed with the administration of their medicines. Peoples' medicines were managed and administered safely by trained and competent staff.
People’s experience of the service was that their care was provided effectively.
There was a process in place to ensure staff received a relevant induction and that their competency to deliver people’s care safely and effectively was then assessed. Not all staff had updated their training as required to ensure it remained current. The manager was aware of this issue and these staff were booked to attend refresher training.
People’s consent was sought for their care. People were cared for by staff who had undertaken Mental Capacity Act training relevant to their role. The provider was able to tell us how they had assessed that where people lacked the capacity to consent to their care, it was in their best interests to provide the care. They have assured us they will now be documenting these decisions for people to ensure there is a record of how these decisions have been reached.
People’s records documented their arrangements for meals; this ensured there was clear guidance for staff. Where risks to people associated with eating or drinking had been identified there were arrangements in place for staff to manage them.
Staff supported people to access health care professionals as required and liaised with them to ensure the effective provision of people’s care.
The provider and staff understood the importance of people experiencing caring relationships from caring staff. The provider told us and records confirmed that staff visits to people were a minimum of one hour; this ensured staff had sufficient time to spend with people, focused on them. Staff listened to people and empowered them to make decisions about their care.
People told us staff upheld their privacy and dignity. Staff did not wear uniforms this made it more dignified for people when they were supported out in the community by staff.
People’s experience of the service was that their care was provided responsively.
People or their relatives were involved in developing their care plans which were personalised and detailed the daily routines specific to each person. The service was flexible in response to changes in people’s needs. People with dementia experienced care from staff who were responsive to their needs. People were supported by staff to identify and pursue their interests in order to meet their need for social stimulation. People were provided with regular opportunities to review their care and to provide their feedback on the service.
People were provided with information about how to complain. People’s concerns were listened to and responded to appropriately.
The provider had a clear set of values which underpinned the delivery of peoples’ care. Feedback received from people and professionals showed that staff understood and demonstrated the provider’s values during the course of their work with people.
Feedback from relatives was that the service was well-led, with regular communications.
There was a clear managerial structure in place for people and staff also felt the service was well-led. The provider demonstrated a good understanding of the challenges to the service and used their role within the community to promote the needs of older people locally.
Processes were in place to audit people’s records in order to improve the service people received. The results of feedback had been used to improve the service for people.