Care Together Limited - 1st Floor The Corner House

Care Together Limited – 1st Floor the Corner House, is a domiciliary care service providing personal care to 11 people aged 65 and over at the time of the inspection.

The provider was located centrally in the village with other amenities such as the post office and shops. People and their relatives regularly visited the provider when accessing other village facilities.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

The service was exceptionally safe. Staff had in depth knowledge of safeguarding and participated in regular training updates. Risks were assessed and actions to minimise unnecessary risks were put in place, however people were enabled to take calculated risks in order to lead fulfilling lives.

Medicines were safely managed and there were clear procedures should errors occur. Staff were safely recruited through scenario-based interviews to ensure they would reflect the values of the service in practice. The provider was constantly updating training in infection control and was creative in their approach.

The provider was exceptionally skilled at achieving positive outcomes for people they supported. Detailed assessments of needs ensured that care plans reflected relevant outcomes and people’s needs under the Equality Act 2010. People were involved in the development and review of their care plans.

Staff were exceptionally well supported through regular supervisions and an extensive package of training. Support was given to staff to develop skills and the provider linked to other services in the area in order to access training that, as a small provider would not be cost effective to purchase.

Support with nutrition was creative, staff prepared meals for and ate with some people, took others out to cafes and lunch clubs and made comprehensive recordings to monitor food intake.

Very positive links had been forged with health and social care professionals and other service providers. This ensured that people had a seamless service when moving from hospital to home for example.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their relatives told us that the service was exceptionally caring and respectful. A group had been set up for bereaved relatives of people the service had cared for which had been opened up to relatives of people who had a poor medical prognosis.

A 24-hour on-call system enabled people to call for assistance at any time. Staff would often attend to someone during the night should they need personal care, or chat with them if they were upset. Priority was given to spending quality time with the person rather than completing a chore such as the washing up as the person may not see anyone else until their next care call.

New staff did not support people until the registered manager was assured they understood their role in maintaining people dignity. People and their relatives told us that staff were dedicated to ensuring people had quality of life.

The provider supported some people to transition to having care at home by providing domestic support in the home and gradually adding support with personal care. The provider was exceptionally responsive to emergencies and would adjust care calls to support people if they became unwell or needed additional support unexpectedly.

The provider offered a range of activities and supported people to access community events. They had been involved in setting up a dementia friendly ballroom class and regularly fundraised to provide additional activities for people such as visiting a local motorcycle museum.

Relatives told us they had been very well supported during the end of life care of their family members and the registered manager was proud of the way they supported people. For example, when a person had died, they would be dressed in a favoured outfit and items that meant a lot to them arranged with them. This had been comforting to relatives.

People and their relatives told us the service was exceptionally well-led, the manager and deputy manager received only positive feedback. The provider had been shortlisted for and received a number of care awards. Staff contacted us after the inspection to tell us how proud they were of the service and the support they received and provided.

The provider was holistic in their approach, though providing a service to one person, they would consider everyone in the household, the environment and support people in making future plans. The provider was committed to providing quality care and if unable to meet the specific needs of a person would signpost them elsewhere.

People and staff participated in quality assurance surveys. The registered manager was doing extensive work to develop new ways to obtain feedback as surveys were unpopular with people.

The provider had positive professional relationships with health and social care professionals, local businesses and care homes and were well known in the local community.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was outstanding (published 21 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care Together Limited – 1st Floor the Corner House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in place. 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 who received support from this agency, their relatives, staff health care professionals said they provided outstanding care and support. Staff were extremely kind and caring. Nothing was too much trouble. They had a very good understanding about what was important to people and went to considerable lengths to ensure people's needs and wishes were met. This promoted people's independence and dignity. Staff provided emotional and practical support to relatives as well and people greatly appreciated this.

The agency had a good track record of providing reliable care and support which was delivered by skilled and competent staff. They provided a very flexible service and had increased the amount of support provided, often at short notice, for example if a person became suddenly unwell. This at times had enabled people to remain in their own homes and have their care needs met without needing to leave their homes to be cared for in residential homes or in hospital.

Staff advocated on people's behalf where necessary to ensure they had equipment to promote their independence and worked collaboratively with health care professionals for example when people were coming to the end of their life. Staff had provided thoughtful and compassionate care, always putting people's wishes first.

This agency was very much part of their local community and staff actively fostered community links. People praised the social events staff organised from time to time at the local church hall. People and their relatives were involved, where they wished to be in the development of the agency, for example, people were included in staff training sessions which gave them for example a clear understanding of how staff worked to promote choice and maintain dignity. They were regularly asked their views about the quality of care they received and were encouraged to make suggestions if they felt any improvements could be made. General comments such as a request for the agency to provide more information about other health and care provision was acted upon and people received feedback in the form of a “you said we did” letter.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The agency provided safe care. Staff were trained in how to keep people safe and acted upon any risk to people's wellbeing. They followed good infection control procedures to minimise the risk of cross infection.

Managers were passionate about their agency and valued their staff team. Managers and staff had a very good knowledge and understanding of people’s care needs, interests and how they liked their care to be provided. They spoke warmly about the people and their families who used the agency and it was clear from our visits that people liked and trusted them and were at ease in their presence.

Managers regularly audited care records to ensure they reflected people's agreed plans of care. They provided staff with a good range of training and consistent support and supervision. They demonstrated a clear commitment to ensuring current clients received excellent care before they were able to agree to care packages for new clients.

Staff kept up to date with good practice guidance and initiatives and applied this guidance to help to ensure they consistently delivered care and support which was of a very high quality.

Our inspection took place over two days. On the first day we visited the agency's office and looked at documentation such as care plans, visit schedules, policies and procedures, training records, staff records, surveys and audit material. We spoke with the agency's deputy manager and the office manager.

On our second day, accompanied by the agency's deputy manager, we met with four people and/or their relatives in their homes. They told us about the service they received. We also met and spoke with two care workers and telephoned one other.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service caring?

All the people we spoke with when we visited them in their homes expressed positive views about the agency's care workers. They described them as 'marvellous', 'fabulous', 'very proficient', 'very good'.

One person said, 'They are like part of the family.' They also said, 'They are competent and new carers shadow experienced ones even if they have done the work before which is good as it means standards are maintained. I feel safe because their standards are high'.

A relative of one person described care workers as, 'Part of the family' and said, 'They are very flexible and never say that is not my job'.

The support care workers provided for people included help with personal care, dressing, housework, going out into the local community, assistance with prescribed medication, preparation of food and drinks and assistance to eat meals.

Is the service responsive?

Assessments of people's needs, potential risks to them and corresponding care plans had been regularly reviewed and updated when necessary. People we spoke with confirmed their care needs had been regularly reviewed and also when their needs or wishes had changed. One person said, 'At reviews they ask me what I want'.

Records showed the agency had liaised with healthcare and social care professionals to ensure people's needs and those of their relatives were met and their safety was promoted. For example, we saw the following personnel had been contacted to help ensure people's needs were met; an occupational therapist to provide wheelchairs and bed rails to promote a person's mobility and safety; a specialist nurse to help care workers manage and promote a person's continence; a social worker to reassess a person's need for extra visiting time because their need for support had increased; and a local residential care home to provide day care in order that a person's partner could have regular respite from caring for them.

Is the service safe?

There were arrangements in place to deal with foreseeable emergencies such as the inability to get a response when a care worker carried out a visit to a person's home. Contingent plans were also in place to manage risks such as adverse weather conditions that could prevent care workers carrying out scheduled visits.

There were enough suitably qualified, skilled and experienced staff employed by the agency and available to meet people's needs.

Potential risks to people's and care workers safety had been identified before individuals received a service from the agency. These included hazards that could arise from working and being present in people's homes, such as electrical items, pets, worn floor coverings and failure of utilities. This meant measures could be put into place to manage risks such as knowing how water, electricity and gas services into people's homes could be isolated to keep people safe from harm.

Is the service effective?

People were asked for their consent before they received any care or treatment and care workers acted in accordance with their wishes. Where people did not have the capacity to consent to the support and help they needed, the agency's owner and care workers acted in accordance with legal requirements.

The support and care plans of a married couple we visited stated the reason the people wanted the help of the agency was to enable them to remain in their own home. One of them told us it was only because of the assistance they received from care workers this was successfully achieved.

Is the service well led?

The agency's owner had effective systems in place to regularly check and monitor the quality of their service and to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

The provider told us that care planning and risk assessment documents were reviewed and updated regularly. We were told that the agency regularly obtained feedback from people who use the service and their relatives. The people we spoke with confirmed that they were regularly asked if they were happy.

They were confident that staff had the appropriate knowledge and skills to meet their needs and described the care workers as professional, well mannered, thoughtful, friendly and caring.

We were given details about the methods used to check the quality provided to people who use the service such as questionnaires. These were circulated every year to ask people's views of the service.

People told us that care workers treated them with dignity and respect and provided all the help and care they needed.

All of the people we spoke with told us they received support from a regular team of care workers who they thought were very caring and friendly.

One person we spoke with told us, "You get the whole package, good management, good administration and the care workers are excellent, they are always punctual and you always know who is coming and when".

Another person we spoke with told us, "The staff really care, they are very well organised and have a lovely relaxed manner, they do everything I ask them".