This comprehensive inspection took place on 1 November 2017 and was announced. Candlelight Homecare Service Limited (East Sussex) was registered with the Care Quality Commission (CQC) in April 2014 as a domiciliary care agency. It provides personal care to a range of older and younger adults living in their own houses and flats in the community. These included people living with dementia, a mental health illness, a physical disability, a learning disability, people with substance misuse, sensory impairment or an eating disorder. The service was also registered to provide care for children from 0-18 years; although at the time of inspection no children were receiving a service.
At the time of inspection, there were 82 people receiving a service from the agency with 450 care hours carried out each week. Although the majority of people using the agency received a regulated activity, approximately 25 per cent did not; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. The time of visits ranged from 15 minutes to one hour and the frequency ranged from once every two weeks to four times a day. There were 22 staff employed.
There was no registered manager in post. The acting manager was in the process of applying to the CQC to be the registered manager for the service. They had undertaken a formal interview on 27 October 2017 and were waiting the outcome. Following the inspection, we were informed their application had been successful and they were now the registered manager for the agency. 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.
People were happy with the service they received. People had built up meaningful relationships with the care workers who supported them and felt comfortable with them in their homes. Comments included, “The service is excellent … I have the best carer I have ever had … she is very good indeed … I have the same carer all the time”, “The carers do what they need to do and chat and make me laugh while they are doing it” and “They’re all really nice young girls with a ‘can do’ attitude … they whizz round in the time that they’re allowed.” However, people did not always know who was coming in to their home as they did not receive a staff rota.
People were kept safe and cared for by care workers who were aware of their safeguarding responsibilities. Staff had received training in how to safeguard people from potential abuse and knew how to identify the risks associated with abuse. Care workers were safely recruited, trained and supervised in their work. Care workers enjoyed their jobs and felt included and listened to in the running of the agency. Comments included, “I’ve been here a while and feel I’m well trained and respected” and “I feel they know I can do my job well and they ask me to attend training when it’s due.”
People were supported to have maximum choice and control of their lives and staff supported them in the least restrive way possible; the policies and systems in the service supported this practice. Care workers had received training on the Mental Capacity Act 2005. They ensured people were asked for their consent before they carried out any care or support. However, mental capacity assessments were not always carried out. We have made a recommendation about following the guidance on the Mental Capacity Act 2005.
Each person had risk assessments and a care plan in place. People were involved in the planning of their care and were regularly reviewed. One person commented, “I was consulted about everything, what time I wanted them to come and what I wanted them to do … they wrote the care plan and I was asked to look at it to be sure it was what I wanted.”
Care workers had been trained to give people their medicines safely and ensured medication administration records were kept up to date.
People were supported to eat a nutritious diet and food and drink of their choice. In between care visits, care workers always made sure people had snacks and drinks available.
People were encouraged to maintain their independence as much as possible and care workers encouraged them to maintain their health and well being.
Regular social activities and networks were planned by the agency throughout the year and people were encouraged to attend and enjoyed community links.
People and relatives were overwhelmingly positive about the staff and management of the service. They felt listened to and confident any concerns they had would be addressed and resolved.
There were some quality monitoring systems and processes in place. However, these needed to be more regularly carried out to ensure continuous development of the agency. We made a recommendation about regular quality monitoring of the service to ensure the service continually improved.