Agrade Community Care Services Limited

Agrade Community Care Services Limited is a domiciliary service providing care for people within their own homes. At the time of our inspection there were 39 people using the service.

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

People felt safe when staff supported them in their homes. The provider acted on concerns raised and informed other agencies where required. The risks to people’s health and safety were assessed, monitored and reviewed to ensure people continued to receive safe care. There were enough staff in place to meet people’s care needs. People’s medicines were managed safely. Robust infection control and Covid-19 policies meant the risk of the spread of infection was reduced. The provider ensured staff learned from mistakes with increased training and supervision where needed.

People’s needs were assessed prior to them receiving care to ensure their needs could be met. Staff were well trained and received supervision of their role and assessment of their competency. People were supported to maintain a healthy lifestyle and balanced diet. Staff worked in partnership with other health and social care professionals to provide timely and effective care.

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 felt staff were kind and caring and they were treated with respect and dignity. People’s choices about their care were respected and acted on.

People received care that was personalised to their needs, choices and preferences. The provider ensured all documentation was provided in a format people could understand. People felt their complaints were handled appropriately. The provider responded to formal complaints in accordance with their complaints policy, although one formal complaint did not have a final written conclusion provided for the complainant.

Robust quality assurance processes were in place. These were monitored by the registered manager and made available to senior management to ensure that quality of care provision met the required standards. The registered manager was knowledgeable about the regulatory requirements of their role and they were supported by senior management to carry out their role effectively. People’s feedback was used to drive continuous improvement.

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

Rating at last inspection and update

The last rating for this service was good (published 11 April 2019).

Why we inspected

The inspection was prompted in part due to a safeguarding concern. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the ‘Safe’ section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Agrade Community Care Services Limited 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.

Agrade Community Care Services is a domiciliary care service providing personal care to people in their own homes in and around the Chesterfield area. The service is registered to provide personal care. Not all people who used the service received personal care. At the time of the inspection the service was providing personal care to 28 people.

People’s experience of using this service:

Feedback about the service from people and their relatives was positive. People received support which was tailored to their needs, delivered by staff who treated them with respect and understood their goals and aspirations. People and their relatives told us they felt the care staff were gentle and caring. People received care and support in a way which suited them. Staff we spoke with were passionate about this work.

The provider ensured care was delivered in a safe way. People were protected against the risk of abuse. Risks were assessed and well managed. Staff had received appropriate training in relation to health and safety and the prevention and control of infection. Staff followed protocols for the safe management of medicines. Staff underwent pre-employment checks to make sure they were of good character and suitable to work with adults and children.

Where part of their care package, people were supported in eating a healthy diet and maintaining good health. 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. Staff told us they received training and support to make sure they had the skills and knowledge to carry out their role effectively. Staff received training and support that was effective and equipped them for their roles.

People’s feedback was sought, so that they could contribute to ongoing improvements within the service. The registered manager fostered a culture of openness and continuous improvement. There was effective communication between staff and managers. Feedback from other professionals, such as social workers and health care professionals was positive.

More information is in the full version of the report

Rating at last inspection:

At the last inspection the service was rated Good (29 June 2016).

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

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

We carried out this inspection on 29 June 2016. It was an announced inspection, which meant the provider knew we would be visiting. This was because we wanted to make sure that the registered manager, or someone who could act on their behalf, would be available to talk with us.

At our last inspection on 25 April 2014, we found that the service was meeting all standards assessed. It was compliant with the regulations and no concerns were identified.

A registered manager was in post. 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.

Staff were appropriately recruited, trained and supported. They had undergone a comprehensive induction programme and, where necessary, had received additional training specific to the needs of the people they were supporting. Communication was effective and regular meetings were held to discuss issues and share best practice. Staff understood their roles and responsibilities and spoke enthusiastically about the work they did and the people they cared for.

The provider had detailed policies and procedures relating to medicine management. Staff understanding and competency regarding the management of medicines was subject to regular monitoring checks and medicine training was updated appropriately.

Staff knew the people they were supporting and provided a personalised service and used effective systems for gaining consent. Individual care plans, based on a full assessment of need, were in place detailing how people wished to be supported. This helped ensure that personal care was provided in a structured and consistent manner. Risk assessments were also in place to effectively identify and manage potential risks.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Systems were in place to effectively monitor the safety and quality of the service and to gather the views and experiences of people and their relatives. The service was flexible and responded positively to people’s changing needs and any issues or concerns raised. People and their relatives told us they were confident that any concerns they might have would be listened to, taken seriously and acted upon.

Is the service safe?

Families we spoke with told us that any new staff had been introduced to their relative before they started working with them. They told us this made their relative feel secure as they would not have to open the door to someone they did not know. One person had commented on a customer survey, 'You meet carers before the service starts so you are not opening your door to a stranger.' These procedures helped to ensure people were guarded against the risk of abuse.

On the day of the inspection we checked six staff recruitment files. We found evidence the provider had checked people's identity, employment history, obtained character references and satisfied themselves of the person's suitability for the job. The provider had also obtained relevant information from the Disclosure and Barring Service (DBS). The Disclosure and Barring Service helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups, including children. It replaces the Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA).

Four recent recruitment files showed staff did not start work until after the provider had received a satisfactory DBS check. However, we discussed two older recruitment files where staff had started their induction period before satisfactory CRB checks had been received. The manager told us they had recently changed the way they obtained DBS checks and staff now only started work after satisfactory clearance from the DBS. It is important that staff are not allowed to work before a satisfactory DBS check confirms they are suitable to work with vulnerable people.

Is the service effective?

We saw that people using the service had been involved in planning their own care. We found that people had been asked what they liked and disliked. When we spoke with people using the service and families of people using the service they told us staff always asked for their choices and preferences when supporting and caring for them. One person using the service said, 'Staff always make sure I'm ok with things,' another person told us, 'I feel listened to.' A family member told us, 'My relative doesn't feel under any pressure and staff always check things are ok before doing them.' When we read the daily notes staff made we found that staff had recorded people's choices for meals and activities. This meant that people using the service were asked for their consent and the provider acted in accordance with their wishes.

Is the service caring?

All of the staff we spoke with told us they had enough information to support people using the service. We found evidence of other relevant professionals involved in the assessment and care planning process. The manager showed us evidence of additional advice and training which had been arranged for staff working to support one service user with specific needs. This had included advice and guidance from speech and language therapists and physiotherapists. This meant that care was being planned to include professional advice and was being developed with the person using the service.

Is the service responsive?

There were arrangements in place to deal with foreseeable emergencies. The provider had a business continuity plan in place to deal with any foreseeable emergencies. This included plans for adverse weather conditions, staff illness and damage to people's homes through fire, floods or damage. When we read people's care plan's we found that staff had confirmed working smoke alarms were in people's homes and any identified escape routes were clear. This meant that arrangements were in place to deal with foreseeable emergencies.

Is the service well led?

Staff working directly with people using the service told us that their managers had visited them to observe their work directly. We read the written records of these observations and found that managers had checked staff arrived on time, knocked before entering the person's house, wore their uniform and ID badge and observed how well staff communicated with their client. We found daily records made by staff were audited by managers. The audit checked records had been made correctly and included appropriate information. The manager confirmed any areas identified for improvements were communicated to staff in their supervision so they could improve. These processes reduce risks to people and help the service to continually improve.

We looked at the care plans for six people and found that they considered whether other providers were involved in that persons care, such speech and language therapists (SALT), physiotherapists and stroke support groups. We found that the provider worked in co-operation with others in order to protect people's health, safety and wellbeing.

We found that staff received regular supervision with a senior member of staff and an annual appraisal. Staff told us that their colleagues were approachable and that they felt comfortable asking questions if they were unsure of anything.

We found that people's complaints were fully investigated and resolved, where possible, to their satisfaction. People we spoke with were aware of how to make a complaint and told us that they would feel comfortable in raising any concerns with their care staff or the senior management team.

We looked at the care plans for four people and they all showed input by the people themselves and / or their relatives. There were specific risk assessments in place to support people with different aspects of their care including medication, manual handing and transport. We saw that care plans included guidance for staff on promoting people's independence and allowing risk taking.

People told us that they felt safe with the carers; they said 'I absolutely trust them, I've no concerns' and 'I definitely feel safe with them in the house, I trust them completely.'

There were effective recruitment and selection processes in place and the provider had introduced the Skills for Care 12 week induction programme for staff it had employed in the six months prior to our visit.

The provider was in the process of completing a survey which involved people receiving care and their relatives, at the time of our visit. We found that there was regular quality monitoring of documentation completed by the care staff including the call logs and medication charts from people's homes.