Care By Us Limited

Care by Us Limited is a large organisation which offers personal care and other bespoke services in East, West and North Hertfordshire, Essex and North London. The organisation is operated from two locations. This inspection covered the services provided in East and North Hertfordshire and West Essex.

The service provided a wide range of services which included, domiciliary care, 24-hour live-in care, enablement services, prevention of hospital admission, ‘Front of House’ service that turned around people at A&E to get them home and prevent hospital admission, delirium recovery pathway, early stroke discharge service, extra care schemes and supported living for young adults with learning disabilities.

The diverse services meant that a large number of people were supported with the regulated activity of personal care. For example, at the time of the inspection, there were around 800 people who received personal care. The number of people receiving support varied significantly in numbers from day to day due to the short term support some people received. In one year, there were approximately 3000 people who received care and support from the service totalling approximately one million care hours.

The service also supported 65 people with learning disabilities. 27 people lived in 11 supported living establishments and 35 people in the community.

People were extremely positive about the service they received. Every person and relative we spoke with from the different services told us they received care which was safe and enabling. People told us they were not just enabled to live in their own homes which was their main goal, but felt in charge of their care, had become more independent and their health was promoted and did not require hospital admissions.

People were educated how to take risks safely and protect themselves from the risk of abuse. This was in addition of staff being well trained and knowledgeable about safeguarding procedures and how to report their concerns.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 using the service told us how much they achieved and developed since using the service and how happy they were with the life they were living. Staff were trained and supported to meet the diverse needs of people using the service including those related to disability, gender, ethnicity, faith and sexual orientation. These needs were recorded in care plans and all staff we spoke with knew the needs of each person well.

The provider operated a bespoke training programme developed and adapted to provide staff with in-depth knowledge about legislation, approved best practice guidelines and health conditions people using the service lived with. The training programme focused on practical face to face training in an environment specially adapted by the provider to resemble to the type of environment their client group lived in.

The provider and staff were passionate in enabling people to live independently in their own homes for as long as possible and they used assistive technology to promote safety. The effective use of innovative technology had measurable impact on vulnerable people at risk of dehydration and those at risk of getting lost when leaving their home.

People received personalised care and support, and this was flexible to fully meet their needs. The provider yearly budgeted a large sum to enable them throughout the year to provide free of charge bespoke services, equipment and often household goods to people who could not continue live at home without this.

The provider developed services for people who were at risk of social isolation. They commenced pet therapy support and offered this service free of charge to people who missed having pets to stroke and talk to and these had many positive benefits for people. They also looked after people’s pets when they were no longer able to so that people continued to enjoy the company of their animals.

People told us they were supported by a stable staff team who they developed good relationships with. They told us staff were extremely caring and often they went over and above their professional duties. This made people feel valued and safe living in their own homes.

The provider developed a close working relationship with commissioners and local authorities from their catchment area to develop new services in response to the needs of people in the community. Commissioners and representatives from the local authority’s social work team told us the support they received from the provider was invaluable. In their recent contract monitoring visit the provider achieved an ‘Excellent’ overall rating.

The provider’s quality assurance systems were self-developed and tested all aspects of the service they provided. The systems were highly effective in identifying any issues or areas where improvement was needed to the quality of the service provided. The effectiveness of the monitoring systems were constantly tested and improved. This led to effective deployment and management of staffing resources across all their services with only 20 missed visits recorded in a year out of 1.2 million. The visits were marked as missed because staff were more than two hour late arriving at people’s homes.

The providers were involved in developing and sharing best practise in their areas of expertise often mentoring and supporting other providers of similar services. They were nominated and won several awards to recognise their contribution of improving people’s life in the community. The provider ran several well-being programmes for their employees. The award schemes and development opportunities offered to their staff contributed to the development of a strong, dedicated and motivated staff team who adhered to the vision and the values promoted by the provider.

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 09 September 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Care by Us is a large organisation which offers personal care and other related services in East, West and North Hertfordshire, Essex and North London. This inspection covered the services provided in East and North Hertfordshire and West Essex reaching out to approximately 1200 people.

The services provided included, domiciliary care; flexi care scheme; live in services; specialist care from home services; respite care; parent support and supported living. The provider also provided a free of charge charity service which offered specialised transport with staff support for people with mobility difficulties to access the community.

The provider had specialist staff teams trained to offer a wide range of excellent care and support tailored to the individual needs of people with complex health and social care needs. These included end of life care; people with behaviours other may find challenging; people living with learning difficulties, dementia and other illnesses which required staff to have specific knowledge such as epilepsy, diabetes and eating disorders.

There was a long standing registered manager in post who was also one of the owners of the company. 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 were supported to have control and choice over their care and to develop their own care plan with staff assistance based on their needs, wishes and what was important for them. Staff recorded people`s wishes, what dignity and respect meant for people and gave people choices and control over the support they required and wanted. The care and support people received was effective and enabled them to remain in their own homes and live independently.

Staff were knowledgeable in what constituted abuse and their responsibilities in reporting any concerns they had internally and externally to local safeguarding authorities. Staff were aware of the whistleblowing policy and how to report their concerns about the service if they felt there was a need for it.

People told us staff were very kind and caring towards them and offered support which met their needs and made them feel safe. Staff showed a caring attitude when talking about people and were able to tell us how they delivered individualised care which met people`s needs.

The provider delivered care and support to people against the seven outcomes of the `Ageing Well in Hertfordshire` strategy. People were enabled to live well, independently and safely, for as long as possible in their own homes, people were treated with dignity and respect. Support was offered at the right time, people had choice and control over their lives, people were helped to make informed choices about their end of life care.

The provider placed a strong emphasis on the importance of people eating and drinking well. Staff attended cookery lessons part of their induction training where they learned basic cooking skills and how to promote healthy eating for people they were supporting. Staff were knowledgeable about people`s nutritional needs and different types of diets people had.

People told us they felt staff were knowledgeable and knew how to deliver care and support in an effective and safe way. There were staff designated ‘champions’ in the service who actively supported staff to make sure people experienced good outcomes to remain longer in their own homes. In addition staff had their competencies in the areas of their responsibilities regularly checked by their managers and they worked towards a personal development plan which was reviewed in regular supervision sessions and yearly appraisal meetings.

The provider had developed a close working relationship with commissioners and local authorities from their catchment area to develop new services in response to the needs of people in the community. This had a positive impact by helping people remain in their own home as long as possible with the support from Care by Us staff and in preventing unnecessary hospital admissions. This was of benefit to people receiving a service from Care By Us and also to the other related services within the community.

The provider actively sought feedback from people and took prompt action to resolve any concerns. When people started using the service or if they were any experiencing problems with their care and support the provider arranged weekly well-being visits from a senior staff member. This was provided for every person who needed it free of charge and it was used by the provider as an opportunity to monitor the service provision and enable people to easily feedback their experience about the service and identify ways to improve. The provider offered this service until people were happy with the support they received.

People received comprehensive information in a service user guide that explained how to complain and who to complain to and offered an overview of the services provided, offices opening hours and responsible staff contact details for each department within the service. The provider appropriately logged and responded to complaints. They investigated each complaint and if improvements were needed these were implemented and shared with the staff team to ensure there was learning by all.

Due to their commitment to deliver a highly effective service responsive to people`s needs the provider was chosen by two local county councils to develop and implement their accelerated hospital discharge projects across Hertfordshire and West Essex. They were the only provider working on these projects and successfully built and facilitated safe discharges from hospitals for people back to their own homes. They also provided enabling care and support for these people until assessments were carried out by social care professionals to establish the type of support people needed until they regained independence and were able to stay safe in their own homes.

The provider developed a recruitment strategy and aimed to recruit staff living within the area of the people they were supporting. In areas where they were short of care staff the provider offered relocation packages to their existing staff to ensure they were able to deliver a continuous quality care service to people. This was particularly important in the more rural areas of the counties they operated in. Care by Us were considered by the local authority in Hertfordshire a reliable and high performing partner in offering care and support to people living in remote rural areas.

We saw that either people who used the service or a close relative had signed to state that they were in agreement with and had understood the care plan. We spoke with eight care workers. They told us that they always explained to people what they needed to do and asked if they gave their consent to receive care.

People were happy with the service that they received and felt safe with the care workers. One person stated: "I have been very pleased with the care workers. They are always very helpful."

We saw that the staff had annual appraisal meetings basis when care workers had been encouraged to identify their specific training and development needs.

Quality assurance reviews were completed at the same time as the review of the care plans and were monitored to ensure that they were undertaken. We saw that the service had an up to date policy on how to handle complaints and that care workers were given advice on what to do if they received a complaint.

We saw that records for people who used the service were maintained as both electronic and paper files and were up to date.

A person who used the service said, "Always before they leave they say, 'is there any more I can do for you?' "

All of the people who we spoke with said that staff stayed for the allotted time and completed all of the tasks required. A relative said that staff did generally arrive on time, albeit they may be, "A couple of minutes late here and there. They explain why."

Some relatives did raise concerns regarding the arrival of the care workers. One relative said, "They don't call to say they are going to be late." They went on to explain that they had been having a regular care worker for the last two months and that this had resolved the problem.

People explained that the service provided a rota a week in advance which detailed which staff would be attending and at what time. One relative commented, "They turn up either very early or very late and they seem to change the preferred times. If [my relative] wants to go bed at 9am, they turn up at 10.10pm. They're not good at phoning to say they're going to be late." The relative went on to say, "As a general rule they're very good with [my relative] and know what they're doing."