Background to this inspection
Updated
22 April 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was completed by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
The manager of the service had recently changed. Following our inspection, the new manager became registered with the Care Quality Commission. This meant that at the time of our inspection the provider was legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 30 January 2020 and ended on 5 February 2020. We visited the office location on 30 January 2020.
What we did before the inspection
Before the inspection we reviewed information we held about the service. This included any statutory notifications sent to us by the registered provider about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We also contacted the commissioners of the service to gain their views.
The provider was also asked to complete a 'provider information return' prior to this inspection. This gives some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and used all of this information to plan our inspection.
During the inspection we spoke with ten members of staff including the nominated individual, business manager and service manager. We spoke with five people who received personal care and six friends and relatives. We also looked at care records belonging to six people receiving support, recruitment records for two members of staff and other records relating to the management and quality monitoring of the service.
Updated
22 April 2020
About the service
Home Instead UK is a care service providing personal care and support for people living in their own homes. At the time of inspection, the service provided support for 96 people.
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. At the time of this inspection, 32 people received personal care.
People’s experience of using this service and what we found
Feedback from people, their relatives and friends were that staff members genuinely cared about people, were exceptionally compassionate and put themselves out to ensure people received the care and support they needed. People and their family members told us about, and we saw examples of, how this approach had led staff to provide support that at times exceeded people’s expectations. People’s relatives told us that they felt included and supported emotionally by the approach from staff and the quality of the care provided for their family members. They praised the kindness and creativeness of the staff team.
People told us that all staff were respectful of them, their family life and their home. They adapted their approach in each person’s home, to ensure that they met the person’s preferences and actively searched for opportunities to promote people’s dignity. People’s autonomy was promoted and respected and they were supported to remain as independent as possible. The service provided for people was adapted as much as possible to meet people’s needs, often in a creative and insightful way. A culture of flexibility was embedded within the service.
People and their relatives told us that staff were not only respectful of their physical home; but also, of their privacy and family dynamics. One family member told us about the staff who visit their home, “He helps us feel comfortable; he always comes in with a smile… a breath of fresh air.” Another family member told us, “They are very thorough and perceptive… [they] analyse our needs at the time… I feel comfortable with them in my house.”
The culture within the service was progressive, dynamic, open and reflective. Every area of people’s care and support showed evidence of thoughtfulness, kindness, learning and ongoing improvements. There was a clear focus on providing the best possible support for people, that was absolutely reliable, safe and centred on their choices and preferences. Everybody’s feedback reflected this.
The service was safe. People told us that the calls they received were extremely reliable. The service had enough staff, and the schedules of people’s visits were planned so they had sufficient travel time between visits to ensure that they were not rushed. There was a series of audits and unannounced spot checks. These ensured that the support people received was in accordance with what they needed and had been agreed. Staff also received training and regular refreshers on safeguarding; and there were effective systems in place to help senior staff identify and reduce any risks in people’s support.
People and their family members told us that staff were very skilled and competent. Staff told us that they received exceptional support that enabled and inspired them to be effective in their role. One staff member told us, “I’m encouraged to grow. I feel supported in my role and this has promoted my confidence.” The effectiveness of staff training was constantly assessed.
Everybody we spoke with told us that all staff were excellent at listening to their views and ensuring that they were supported to make their own decisions. One person told us, “I felt listened to and respected and [after speaking up] everything ended up fine.”
The principles of the MCA were applied in a meaningful way within every aspect of people’s care and support. 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. We saw that on occasions staff had provided exceptional support when acting in a person’s best interests.
Each person had an individual care plan that contained all the details that the person wished to share about their care and support needs, daily routines and information about them as a person. People and their relatives told us that they were involved in or consulted about their care plans and reviewing the effectiveness of their care and support. Supporting people to maintain important relationships was a central part of people’s support. Some people told us that they had been supported to reengage in their local community. Staff were matched with people who they supported. The matching was based on the person’s wishes, staff personalities and what had worked previously.
People were supported to remain as healthy as possible. Any guidance and advice from healthcare professionals was recorded as part of people’s care plans. Family members told us that staff are very observant and vigilant in identifying any changes that may indicate a person may need to see a medical professional. One person’s family told us, “The carers see her every day; they are perceptive and know her well, we rely on them to spot things and we go to them for advice.”
The service was well led. The process for supporting people with complaints or concerns was open, honest and responsive. People told us they felt comfortable raising a concern. The manager had oversight of a system that recorded and acted upon any accident, incident or near miss; and any actions identified to prevent further occurrences were acted upon. They also set a positive example and showed a genuine interest in people, their family and friends; and they had a detailed plan of ongoing improvements of the service.
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 good (published 5 July 2017).
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.