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Inspection carried out on 18 October 2016

During a routine inspection

The inspection took place on 18 and 19 October 2016 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

We last inspected Care Direct Salford on 29 July 2014, at which time it was meeting all our regulatory standards.

Care Direct Salford is a domiciliary care provider based in the Eccles area of Manchester, providing personal care to people in their own homes in the local area. At the time of our inspection the service provided personal care to 60 people, the majority of whom required help to maintain their independence at home.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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 registered manager had extensive experience of working in the social care sector. They demonstrated a strong awareness of areas of best practice and a good knowledge of the individual needs of people who used the service.

There were effective pre-employment checks of staff in place to ensure the risk of unsuitable people working with vulnerable people was reduced. Lone worker policies and procedures were in place with all staff receiving a first aid kit.

People who used the service expressed confidence in the ability of staff to keep them safe. No concerns were raised from local authority commissioning professionals or other sources and all relatives and external healthcare professionals we spoke with expressed similar confidence of the ability of staff to care for people safely.

We saw risk assessments were in place to ensure people were protected against a range of risks. These were regularly reviewed and staff displayed a good knowledge of the risks people faced. One risk assessment required improvement and the registered manager rectified this during the inspection. Staff had received safeguarding training and were confident in this area.

Medicines administration was regularly audited and we found no evidence of medication errors.

There were sufficient staff to meet people’s needs safely, with travel time included in the planning of care calls and spot checks undertaken to ensure staff arrived and left at the agreed times.

Staff were trained in core areas such as first aid, person-centred care, moving and handling, safeguarding and dementia and training needs were well monitored and refreshed.

We found staff had a good knowledge of people’s likes, dislikes, preferences, mobility and communicative needs.

People who used the service were supported to maintain their independence in their own homes, in line with the service user guide.

We found care plans generally to be sufficiently detailed and person-centred so as to give members of staff relevant information when providing care to people who used the service. Some care plans contained more background information about people who used the service and the registered manager agreed to review these sections of care plans to ensure new staff would have a better understanding of each person’s background.

Care plans were reviewed regularly and with the involvement of people who used the service and their relatives.

The registered manager displayed a good understanding of capacity and the need for consent on a decision-specific basis.

People’s changing needs were monitored, identified and met through liaison with a range of external health and social care professionals.

People we spoke with and relatives told us they had received positive outcomes when suggesting changes or raising queries. People told us they knew who to contact if they had concerns. Whilst the service user guide contained contact information, it did not make it explicitly clear how people could make a complaint and this needed to be rectified.

Staff, people who used the service, relatives and other professionals were generally in agreement that the registered manager led the service well and was accountable and approachable. We found them to have a good knowledge of the needs of people who used the service, and how the service could make improvements in the future.

We saw there were a range of audits and other quality checks to identify errors, inconsistencies, or scope for improvement.

The registered manager and staff had successfully established a caring culture and a service that met people’s needs, particularly with regard to provide a stable continuity of care from staff who people had grown to know and trust.

Inspection carried out on 29 July 2014

During a routine inspection

Care Direct Salford is a domiciliary care agency registered to provide personal care. The services provided by the agency include personal care, community support, meal preparation, shopping and domestic help.

At the time of our inspection there were 34 people who used the service. As part of the inspection we spoke to five people who used the service, nine relatives and friends and five members of staff.

Our inspection was co-ordinated and carried out by an inspector, who addressed our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People told us they had no concerns about their personal security and safety.

We found safeguarding procedures were robust and staff understood how to safeguard people they supported.

People told us that they felt their privacy and dignity was respected by staff.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and whistleblowing. This reduced the risks to people and helped the service to continually improve.

We found people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people are protected.

Is the service effective?

People’s health and care needs were assessed with them. People said that their care plans were up to date and reflected their current needs.

We found that when reviews of care were undertaken by the service, people were fully consulted about their changing needs.

Is the service caring?

People who used the service and relatives told us they or their loved ones were supported by kind and dedicated staff. Comments included; “They will do their best to accommodate you. X really gets on well with her carers.” “X my carer is very kind and caring.” “Very good, they cooperate with everything we ask for.”

When speaking with staff it was clear that they knew the needs of each person they supported.

People who used the service completed a satisfaction questionnaire. Where shortfalls or concerns were raised these were addressed by the service.

We found care and support had been provided in accordance with people’s wishes and consent.

Is the service responsive?

People knew how to make a complaint if they were unhappy. There were no recorded complaints against the service at the time of our visit.

People told us the service was very responsive to changes in need. One relative told us; “They are very responsive to any changes in X’s requirements. We have over a period of time refined services to meet X’s needs. They are very good.”

Is the service well-led?

The service had quality assurance systems to ensure high standards of care were maintained. Problems and concerns were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they felt supported by the service and were clear about their roles and responsibilities.

Inspection carried out on 1 July 2013

During a routine inspection

A relative of a person who used the service told us; “We have only had them a short time. My X has dementia. We sat down and discussed my X’s care needs. They have a good attitude and are very responsive.”

One relative of a person who used the service told us; “Their carers are all considerate and careful. As a small company we have had the same carer all the time who was able to build an excellent relationship with my X”. Another relative we spoke with said “I find Care Direct very good. The carers are very good and consistent and are excellent with my X. They are very reliable.”

We found that medicines were safely administered and that people who used the service received their medicines in the way that had been prescribed for them.

We saw that criminal records bureau (CRB) disclosures had been obtained and at least two references had been obtained prior to commencing employment.

One member of staff told us: “We have unannounced spot checks by managers to ensure we are following the support plans and that the clients wishes are being met.”

Inspection carried out on 15 May 2012

During a routine inspection

We spoke with people using the service who told us: "I am more than happy with the care I recieve it is excellent", "They look at the book and write in it every time they visit", "The lady who comes to me is great", "They do whatever I want", "I have been with them 6 or 7 years and I have never had a problem", "They do more than is expected" and "They are very good indeed."

We spoke with two relatives of people using the service who told us: "'x' receives consistent care by a few support workers they know well", "Excellent I would have no qualms in referring other people to them", "They are very good, very approachable and very helpful", "Staff respect 'x's privacy and maintaining dignity is a priority", "I cannot speak highly enough about the care they are incredibly organised", "They are all totally and utterly dedicated" and "I never had any doubts that someone would be there for 'z'."