Archived: Independent Care

We last inspected the service in May 2016 when we rated the service as requires improvement. At that time we found the service was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these related to safe care and treatment, governance and staffing.

Following that inspection the provider sent us an action plan which detailed the improvements they planned to make. This inspection was to check improvements had been made following the last inspection and to review the ratings.

At this inspection we found that improvements had been made and the requirement actions had all been met.

Independent Care is registered with the Care Quality Commission (CQC) to provide personal care and support to people living in their own home. At the time of our inspection 48 people were using the service and being supported in meeting their care needs.

The service had a registered manager. 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 and their relatives spoke highly about the service and said their experiences had been positive. The management team and staff were described as, “Really caring”, “Very professional” and “Very loving, sensitive and thoughtful.”

Care workers were aware of their responsibilities in protecting people from abuse and knew the procedure to follow so that people were kept safe.

The management and administration of people’s medicines was safe and demonstrated people received their medicines as prescribed.

Recruitment procedures were in place ensuring only those applicants suitable to work with vulnerable people were appointed. Sufficient numbers of staff were available to support the individual needs of people.

The registered manager was aware of their responsibilities under the Mental Capacity Act and knew who to liaise with so that people’s rights were protected. People told us they were actively involved and consulted with in planning their care and support.

Appropriate staff training and development was provided enabling staff to develop their knowledge and skills. This helped to ensure people were supported safely and effectively so their individual needs were met.

Where necessary people were supported in meeting their nutritional and hydration needs. Advice and support was sought from the speech and language therapists (SALT) or dieticians where potential risks had been identified.

People's care records showed that thorough assessments had been completed prior to the service commencing. Once agreed a detailed person centred plan was implemented providing good information about people’s wishes and preferences and clearly guided staff in the support people wanted and needed.

Systems were in place for the reporting and responding to any complaints brought to the attention of the service. People said they had no issues or concerns and felt they could discuss anything with the management team or care workers if they needed to. People were confident they were listened to.

The registered manager was aware of events such as accidents or incidents, which should be notified to CQC. This information helps us check the service is taking action to ensure people are kept safe.

Opportunities were provided for people and their relatives to be involved with the service to comment on their experiences and the quality of service provided, so that any improvements needed could be identified and acted upon.

The provider was displaying the rating from the last inspection in May 2016 on site and on their website.

The service was previously inspected in June 2013 when we found that the service was meeting all of the regulations we assessed.

When we visited the service there was a registered manager 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.

Independent care is registered to provide personal care and support to people living in their own home. At the time of our inspection there were 62 people using the service.

During this inspection we identified four breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staff training, staff supervision, medicine management and the lack of systems to assess and monitor the service delivered to people; you can see what action we told the provider to take at the back of the full version of this report.

There was a risk that people may not receive their medication as prescribed by their GP because there were not accurate recordings of the medication administration and adequate checking processes had not been implemented by the registered provider.

From speaking with the registered manager we found there were gaps in staff training for 2015. This meant some staff may not be appropriately trained and skilled to meet the needs of the people receiving a service.

Not all staff during 2015 had received regular supervisions and an annual appraisal.

Due to the shortfalls found during this inspection process the quality assurance processes need to be more robust.

Some parts of the support plans looked at did not contain enough detailed information to direct staff members on how to provide care and support for people taking into account the person’s personal preferences and encouraging independence. We recommend that the service considers current best practice in relation to implementing and reviewing the plans of care that are designed to meet the individual needs and personal preferences needs of people who use the service.

We saw that call times were monitored on an informal basis. We recommended that the registered provider implements a formal recording system for call times.

People said they knew who to contact if they wanted to make a complaint and felt they would be listened to and action would be taken. However we recommended that all concerns/issues raised with the service are formally recorded, investigated and proportionate action taken in response and a system to review and learn from issues raised to continually improve the service is implemented.

The service had good recruitment processes to ensure only suitable staff were employed.

We were told by a person receiving a service, relatives of people receiving a service and staff that there was a relaxed and friendly atmosphere between staff, people receiving a service and their relatives.

We were told by the person we spoke with who was receiving a service and relatives we spoke with that staff were kind and respectful to people when attending to their needs.

The person receiving a service, who we asked, told us they felt safe and comfortable when being supported by the care staff.

Those staff we spoke with understood their responsibilities to protect the wellbeing of the people who used the service and were clear about the action they would take if an allegation of abuse was made to them or if they suspected that abuse had occurred.

At the time of our inspection Independent Care were providing a service to approximately 75 people and employed approximately 45 staff including office based staff. Following our visit we made telephone contact with people who used the service or their relatives.

We asked the people we spoke with what were their views on the quality of the service provided by the agency. People using the service or their relatives told us that they were very happy with the quality of care and support provided. One person said the care was exceptional. They told us that they had excellent relationships with care staff and described them as kind, caring and respectful. Some of the comments we received were: 'I would recommend them to anybody,' 'I am very happy and I can't fault them in any way,' 'I would give them a gold star' 'They are kind, compassionate and professional,' 'I have total peace of mind' and 'I have no complaints about them at all.' Several relatives told us that in their opinion the care staff go above and beyond the call of duty.

During this inspection we spoke with five members of staff. All the comments we received were positive about the high standard of care delivered to people and about the support given to them by the manager of this service. We were told that they were encouraged to call the office if they had any concerns or worries about any of the service users. We were told that somebody could be contacted 24 hours a day for advice or support. One comment was 'This agency really cares about people. 'Another comment was 'The manager genuinely cares about all of the service users and the staff.'

Following our inspection visit to the office we made telephone contact with three people receiving a service, three relatives, a health care professional and three members of staff.

Everyone we spoke with spoke highly of the service provided and said they had no complaints.

Some comments we received from family members of people who used the service were: 'We can't praise them enough.', 'They are outstanding and they enabled' X' to be cared for at home.', 'They give very good, high quality, individualised care.', They are very responsive and immediately dealt with an issue I raised.' and 'We were heavily involved in discussing care plans and spent a lot of time discussing the expectations of the service.'

Some comments from staff were: 'Privacy and dignity is always respected.', 'The manager has very high standards and really cares about the service users.' and 'A high standard of care is always given.'