13 May 2014
During a routine inspection
At the last inspection, in November 2013, we found there were not enough qualified, skilled and experienced staff to meet peoples' needs. We asked the provider to make improvements. As part of this visit we checked whether improvements had been made.
We considered all the evidence we had gathered under the outcomes we inspected.
We used the information to answer the five key 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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
People were protected from abuse and avoidable harm.
Staff employed at the service had the skills, knowledge and experience needed to support the people using the service. There were sufficient numbers of suitably qualified staff to meet the needs of the people using the service. People and staff we spoke with all told us the service had enough staff. The registered manager told us additional staff had been recruited since the last inspection.
People were cared for in environments that were safe and secure. We saw the environment in peoples' homes had been assessed for risks.
All the people we spoke with told us they felt safe when care workers visited their homes. One mother told us, 'I feel safe and sound leaving my child with your staff when I go out;' the wife of a person who used the service said, 'They are all very trustworthy;' and a person who had visits from care workers to help them with renal dialysis in their home said, 'I'd trust them with my life I really would; well, I already do that don't I?'
People were protected from the risk of infection because appropriate guidance had been followed. People and staff told us personal protective equipment, such as aprons and gloves, were always used when carrying out personal care. The nurse we spoke with said, 'We could build a house with all the gloves, aprons and gels they are supply us with; if anything they provide us with too much.'
Is the service effective?
People told us they were happy with the care provided by the service and their care, treatment and support needs were being met. One person, whose husband received 24 hour care from the service, told us, 'They've been fantastic, every which way.'
People were cared for by staff knew them well and staff were aware of peoples care and support needs. The nurse we spoke with said, 'They (the staff and managers) know their clients really well. They're very good at maintaining consistency.'
Staff received appropriate training to meet peoples' needs One person, whose son was cared for by the service, told us, 'My son's needs are quite specific and not all nurses know how to provide them. They ensure the nurses they send have been on training courses before they come.'
Staff all told us they got 'lots of training' and were given additional support when they needed it. One care worker told us, 'When the little boy I was caring for previously passed away I got some bereavement counselling; I found that really helpful.'
This showed us the service promoted a good quality of life for the people that used the service. Peoples' care, treatment and support achieved good outcomes.
Is the service caring?
People who used the service and their relatives all told us they were very happy with the care provided. One relative said, 'The staff are really good. I think the agency provides good care for my child and all of the staff are hard-working and committed.'
People also told us they were supported by caring and attentive staff who treated them with dignity and respect. One relative told us, 'All the staff adore him. They are all wonderful with him.'
Care workers were patient and encouraging when they were supporting people. The social worker we spoke with told us, 'The two staff that regularly spend one to one time with X (person's name) are very good at preventing them from getting agitated. We are working at trying to get X more relaxed.'
People and staff told us people who used the service were well-cared for. All of the staff we spoke with told us they would recommend the service to friends or family. The social worker for one person told us, 'She's always been a smart lady and she always looks well-kempt when I call; her hair is always immaculate and her clothes are co-ordinated. I call in once a month, at different times, and it's always the same.'
This showed us staff working for the service treated people with compassion, kindness, dignity and respect.
Is the service responsive?
The service was organised so that it met peoples' needs.
People and their relatives all told us their needs had been thoroughly assessed before starting to use the service and on an ongoing basis.
Care records documented people's preferences, interests and diverse needs. Care and support was provided in accordance with peoples' wishes. One mother told us, 'Overall I would rate Advantage 10 out of 10 because they have helped me a lot.'
The majority of people and their relatives told us they had never needed to make a complaint or raised a concern. One relative told us there had been a couple of occasions when they had raised concerns. They told us, 'They picked it up quickly and dealt with it immediately.' Another relative said they had never had any problems but they were, 'confident they (the service) would sort it out.'
People had access to activities and were supported to maintain relationships with their friends and relatives and pursue their social interests. One relative told us care workers regularly took their husband out in their wheelchair. They said, 'Everybody is brilliant. They take him out on the train. We're waiting for the better weather so we can get out and about more and in the garden.'
Is the service well-led?
The leadership and governance of the service assured the delivery of high quality, person centred care and supported learning and innovation.
The registered manager had been in post for 14 months. They told us the new staff included a lead nurse, who had previously worked at a local children's hospice. The service employed three branch co-ordinators, who were based at the Halifax office, six nurses and 53 care workers.
People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People and their relatives told us they regularly filled in feedback questionnaires about the care workers. We saw completed copies of these questionnaires in peoples' care records.
Staff told us they were clear about their responsibilities and felt well supported by the managers. They told us their opinions were taken into consideration. For example one care worker told us when they visited a new child for the first time they noticed some things in the care plan were not correct, so they told the office staff. They said, 'The next time I visited, a week later, the care plans had all been changed.' This showed the service promoted an open and fair culture.