Home Focus

At the time of inspection the regulated activity of personal care was carried out in 13 of the 20 tenancies, with only 24 people receiving support with their personal care requirements out of the 68 people who used the service.

At our last inspection, although we rated the service as good overall, it was rated as requires improvement in the KLOE effective, as we identified a breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff supervision sessions had not always been carried out in a timely way. During this inspection we found improvements had been made and the service was now meeting all requirements of the regulations.

At this inspection we found evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us they felt safe in their own homes. Appropriate safeguarding processes were in place and staff knew how to keep people safe and raise concerns if they suspected someone was at risk of harm or abuse.

Risk assessments were in place and personalised. They highlighted possible risk of harm to a person or staff member around areas such as people's lifestyle choices or behaviours. Care plans were also tailored to people’s individual requirements and updated regularly to reflect people's changing needs.

Staffing levels continued to be appropriate and people received care in line with their preferences.

The service had a training matrix to monitor the training requirements of staff. Staff received appropriate training, supervision and appraisal to support them in their role. Appropriate documentation was maintained to confirm when these sessions had taken place.

The management of medicines was safe. Staff received training in medicines administration and the service had detailed policies to guide staff on how to ensure a person received safe support in this area.

People were supported in line with the Mental Capacity Act 2005 (MCA). 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 support this practice.

People's consent to care and treatment was sought prior to care being delivered and they were encouraged to make decisions and choices about their care and had their choices respected.

The service continued to support people to remain as independent as possible and maintain maximum choice and control over their daily routines. This included accessing the community and employment.

People were encouraged to maintain a nutritionally balanced diet and had access to sufficient amounts to eat and drink, at times that suited them.

Further information is in the detailed findings below.

The service is registered to provide personal care to people within a home environment via supported tenancies. A supported living service is where people live in their own home and receive care and support in order to promote their independence. The support that people receive is often continuous. People who use the service are tenants in their own right and live with support in various types of accommodation provided by a variety of different landlords. The service is currently made up of 16 homes, providing support for 53 people who live in the Salford and Stockport areas. The office is within walking distance of Eccles town centre, which has facilities such as banks, post office and shops. There is a large car park at the front of the office.

There was a registered manager in place at the time of our inspection. 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.

This service was last inspected in December 2013, when we did not identify any concerns with the care and support provided to people who used the service.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We looked at the training and professional development staff received to ensure they were fully supported and qualified to undertake their roles. When we looked at staff personnel files, we found limited evidence of regular supervision including annual appraisals. We looked at the service supervision policy, which stated ‘The care service is committed to providing its care staff with formal supervision at least four times a year.’ We found no supporting evidence that this policy was being adhered to.

Whilst other staff confirmed they received regular supervision, on the whole we found supervision was inconsistent and not in accordance with service policy. The manager told us that they were aware of the inconsistent application of supervision policy, but with the appointment of two locality managers covering each local authority areas, these concerns would be addressed.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, because the provider could not demonstrate the appropriate support and professional development of staff.

People or their relatives told us that they believed they or their loved ones were safe with Home Focus.

We found appropriate criminal records bureau (CRB) disclosures or Disclosure and Barring Service (DBS) checks had been undertaken and suitable references obtained. This meant staff were safe to work with and provide care to vulnerable adults.

We looked at the service ‘safeguarding service users from abuse or harm policy’ and ‘whistleblowing’ policy and found there were suitable safeguarding procedures in place.

We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure the service was safe. In the houses we visited, medication was kept securely in a locked cabinet in the staff bedroom / office. We saw that each house undertook a daily stock count of medicines. We found records supporting and evidencing the safe administration were complete and accurate.

We found all new members of staff underwent an induction programme. Staff told us they received an induction when they started working at the service, which included classroom based training and shadowing more experienced staff.

We found people had access to healthcare professionals to make sure they received effective treatment to meet their specific needs.

During our inspection we observed that care staff had developed caring relationships with the people they supported. Staff were very knowledgeable about people and knew about their likes, dislikes and personal preferences.

People told us care staff respected their or their family member’s dignity and privacy.

People told us that the service actively promoted their independence.

People received care and support which was personalised to their wishes and responsive to their needs.

Each person had support plans in place, which provided guidance for staff about how best to meet each person’s needs. Care files were person centred and provided information on people’s likes and dislikes and the level of support required.

We found the service had systems in place to routinely listen to people’s experiences, concerns and complaints. The service had a complaints and compliments policy and procedure in place. This provided information about how people could inform staff if they were unhappy about any aspects of the service they received.

Both relatives and staff told us the service was well managed.

We found that regular reviews of care plans and risk assessments were undertaken. We found the service undertook a comprehensive range of checks to monitor the quality service delivery. These included auditing of care files, medication, finances, accidents and safeguarding. The service also undertook unannounced spot checks on houses and staff. We looked at the minutes from recent staffing meetings, which included an actions list of issues that needed to be addressed.

Providers are required by law to notify CQC of certain events in the service such as serious injuries and deaths. Records we looked at confirmed that CQC had received all the required notifications in a timely way from the service.

We found the service had been accredited with Investors in People recognition. Investors in People is a management framework for high performance through people.

Support was provided 24 hours a day with staff on site at night either sleeping or awake depending on need. At the time of the inspection the service had within the previous few weeks acquired a number of new tenants and additional properties. The service supported 34 tenants with 47 staff.

During the inspection we visited two locations and spoke with six tenants, one tenant's relative, the manager, deputy manager and four support workers. Staff spoken with told us tenants were given information to enable them to make decisions and choices around their day to day care and tenants confirmed this.

Tenants told us their privacy and dignity was respected and staff asked the tenant's permission before providing support.

People we spoke with expressed confidence that the manager would address any issues and make improvements for tenants who used the service.

We found there was a system in place to ensure staff were recruited safely with appropriate checks made before commencing employment.

We looked at the systems in place to both monitor the quality of service provision effectively. We found there were several methods in place such as regular auditing, staff meetings and the use of a complaints log and policy and procedure.

Support was provided 24 hours a day with staff on site at night either sleeping or awake depending on need. At the time of the inspection the service supported 33 tenants between the ages of 24 and 71 years respectively.

We visited one location and found six people lived there; five from the six had lived there for over three years.

People who used the service assist with household chores and were responsible for the cleaning of their bedrooms.

Tenants we spoke with told us: "I am always helping with washing up and things I like it". "I have a job part time and enjoy it". "I like it here I have been here for years, I have my favourite staff but like them all really". "We go out to lunch sometimes its great". "We make our own sandwiches if we want to otherwise the staff will do it for us".

Staff told us: "We encourage independence and sometimes have to cajole tenants but on the whole they like to be involved". "We know them so well we know if they are not well without them telling us.'It's like having an extended family; they know all my family members by name and ask everyday about them. I try to be a friend to them rather than a carer and it works well". "I really enjoy my job, I don't mind which house I work at but this is my usual one".