Archived: Kenwith Castle Gardens Domiciliary Care Agency

The registered manager is also the registered manager of kenwith Castle nursing home, which is situated on the same site. 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.

The service was well run by the registered manager and two staff who provided the support to people in their own homes. Care and support was well planned, with the consent of people who used the service. People were actively involved in the development and review of their care plan. Plans were person centred and described how to support people in ways they wished and ensuring they maintained their independence.

Care and support was delivered by staff who understood the needs of people, their wishes and preferred routines. Staff had training and support to do their job effectively. This included regular opportunities to talk about their role and any training needs they had.

People were cared for in a way which protected their dignity, privacy and respect. One person said ‘‘The staff are very kind and helpful.’’

People were kept safe because staff had a good understanding about types of abuse and who they should report any concerns to. Safe recruitment practices meant staff were only employed if they had the right checks in place to ensure they were suitable to work with vulnerable people.

Systems were in place to ensure people’s medicines were handled safely and any support needed in these areas were recorded following the agency policies and procedures.

Daily records showed people were supported to maintain a healthy balanced diet and their healthcare was being monitored. One relative said ‘‘The staff are very good and keep me informed of any issues, particularly where health is concerned.’’

There were regular opportunities for people and people that matter to them to raise issues, concerns and compliments. People were confident their concerns would be listened to by the registered manager/staff and acted upon. There were also regular opportunities for people using the service to get together for social events and chats about how they would like to see the service working for them in the future.

As part of the inspection we visited the two people who currently received a service from the agency. We met and spoke with 15 other people who lived in either a bungalow or cottage within Kenwith Castle Gardens and spoke with two visiting relatives. We spoke with the care coordinator and the carer who between them delivered the service. We reviewed policies and records relating to the management of the service which included, care plans and daily care records for the two people who received care and one staff file.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People told us they felt safe. Every morning staff from the agency walked around the grounds to either visit, or check, that everyone living on the Kenwith Castle site in either a bungalow or in one of the cottages was well and to ask if they needed any extra help. People told us this helped them to feel safe in their home. One person said, 'People are safe here and that's why we are here' another said 'We look out for each other'.

People told us they were supplied with call alarms both in the form of a pendant and also fitted in their property which helped to ensure people were safe. One person said, 'If there was an emergency ' the staff respond almost immediately'.

Is the service effective?

People's care and support needs were assessed and agreed with their full involvement before the service commenced. People were offered choice and remained in control of decisions which affected their care and their lives.

Care plans were regularly reviewed and changes made to the care provided where this was requested or required.

Through the informal processes and close relationships in place staff were able to alter care or support easily to meet people's changing needs. A staff member said 'because we know people so well we can tell if something isn't working and then we can make suggestions and alter the care package to meet their needs'.

The agency enabled people to stay in their own home with support from the agency. People's dignity, independence, choice and privacy were given maximum priority.

Is the service caring?

The service was very personal and all the people who lived on site knew the agency staff well. We observed friendly, warm and caring relationships between staff and people in their care and everyone else living on the site.

We found the care and support provided was very personal and took account of individual preferences, wishes and choice.

People told us they looked forward to seeing the staff pop in and always enjoyed 'a little chat'. Where anyone had a concern or worry staff were able to act promptly to assist in resolving the matter.

We observed communication between staff and people which was respectful and caring. Staff listened carefully to what people said, asked them how they wanted their care and support provided and gave people time to choose.

We saw the staff encouraged and supported people in making their own decisions about how they needed help and spent their time

Staff told us that they 'really enjoyed spending time with people and building up a close relationship'. They said, 'We want to keep people living in their own home as long as possible', 'we provide a transition from home, to extra care and then if necessary residential and nursing care'.

Is the service responsive?

The agency provided a flexible and responsive service that enabled people to remain in their own homes and to live independently within a community setting.

People told us the service was very approachable. People gave us several examples of where agency staff had stepped in and made arrangements for medicines to be delivered, for their dog to be taken for a walk or extra care provided at short notice.

The service was arranged from 8.00am to 8.00pm over seven days a week. Out of hours and emergency support was arranged through the nursing home on site by named staff who knew the people who required care.

Any 'concerns' or worries raised with the staff were immediately dealt with. Everyone we spoke with said they had never had cause to raise a complaint but they did know who to speak with if they did.

Is the service well led?

The small staff team was led by the registered manager. The care coordinator had responsibility for the day to day operation of the agency supported by another member of care staff.

Daily records were maintained which were clear. Records noted changes in a person's well-being and were up to date.

People were clear about who to contact if they needed help and the staff understood their roles and responsibilities.

Staff told us they were well supported and trained. They were clear about their roles and responsibilities and had a good understanding of the ethos and values of the agency.

Management structures and lines of accountability were clear, which helped to ensure efficient communication.

Daily handover sessions ensured staff were aware of any changes in the care or support provided to people within their care. Informal monitoring systems in place helped to ensure a quality service was provided and protected people from risk of inappropriate care.

People told us "They're fine. We have a little chat as well. (A care worker) was very quick to pick up on when I was unwell": "(A care worker) has been absolutely brilliant for me" and "Very good; couldn't be better."

People did not receive any care which they had not consented to.

Each person stated that the care workers had too much work to do but we saw that people's personal care needs were being met by sufficient numbers of skilled and knowledgeable care workers.

There were systems for people to comment and complain about the service. None had done so.

Records were sufficient to protect people against the risks of unsafe or inappropriate care.

We met two of the people receiving a service and one informal carer, the registered manager and two staff who were on duty. We looked at their training records and some of the agency's policies and procedures.

We found a reliable and personal service. People said that staff arrived on time and carried out their care in the agreed way. They had records in their homes that backed this up.

People told us the staff were, 'Excellent, very nice and reliable, quiet and gentle.' 'They don't rush you. Confidentiality is good, they never talk about anyone else.'

We saw that medication was handled in a safe and appropriate way, and recorded accurately. Staff training covered the necessary topics and was up to date. Staff visited people regularly to speak with them and gathered feedback to ensure that the service continued to meet people's needs in a satisfactory way.