Autonomy Care Limited

Autonomy Care Limited is a domiciliary care agency providing personal care to 22 people in their own home, at the time of the inspection. 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

At the last inspection the service was rated as outstanding for caring. At this inspection, we found examples of outstanding care had continued. People had been supported to engage with their family at important events and to make friendships. Staff understood the importance of supporting people to achieve positive outcomes. People spoke of staff as being kind, caring and respectful.

People told us they felt safe. They told us there was usually a regular team of care staff and they mostly knew who to expect. Staff were appointed subject to satisfactory background, employment and character reference checks.

Where there were potential risks to people’s safety and wellbeing, these were assessed, and risk-reducing measures were put in place for staff to follow. Staff understood their responsibility to recognise and report any safeguarding concerns. Staff had received safeguarding training.

Medicines systems were well managed. There were clear protocols in place to guide staff in administering people’s medicines safely. Medicine records reviewed were up to date and accurate.

People’s care plans reflected their needs and choices. There were plans in place for specific healthcare needs such as epilepsy, with clear guidance for staff to follow. There were efficient processes in place to update staff and the person’s care plan in the event of any changes in the person’s support needs.

People told us staff talked through everything they were supporting them with and sought their consent. People told us they felt the care staff were caring and respectful.

Where complaints and concerns had been received, these had been investigated and responded to appropriately.

People were invited to share their feedback with the service through reviews and surveys. The most recent survey results were mostly very positive. Where there were less positive comments, the management team followed up on these to see what could be done to make things better.

Staff received a range of different training. This included mandatory training such as equality and diversity and safeguarding.

Where people lacked the mental capacity to consent to decisions about their care, this was assessed in accordance with the principles of the Mental Capacity Act. People were supported to have choice and control of their lives and staff supported them in their best interests; the policies and systems in the service supported this practice.

The registered manager had plans for the future development of the service. Staff felt supported by the registered manager.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drives of improvement. As part of thematic review, we considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

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 18 January 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.

Autonomy Care Limited provides a range of services to people in their own home including personal care, companionship, and shopping in Devizes and the surrounding areas. The regulated activity for this service was the provision of personal care and at the time of inspection 34 people were using the service under this regulated activity.

A registered manager was in place and available throughout the 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.

Risk assessments had been completed and actions recorded to manage identified hazards and concerns. There was good documentation of some risks and clear documentation which provided guidance to staff on how to mitigate these risks. However, new risk assessments and guidance had not always been documented in people’s care records. The registered manager told us they had recently identified gaps in some care records where risk assessments and necessary supporting guidance required more information. In response to this they had delegated two senior care staff to perform regular quality checks and help to update records where documentation had not been completed.

People were protected from potential harm and abuse by staff who were aware of the different types of abuse and the actions to take if they suspected someone was at risk of harm. Staff were aware of the responsibility to report any concerns they had about people’s safety and welfare and who to report concerns to.

People said they were satisfied with the support they received with regards to their medicines however; medicines were not always managed safely. The recording of information on Medicines Administration Records (MAR) was not always consistent with other care records although in line with their recent identification of some gaps in care records the registered manager had taken action to address this prior to the inspection. In addition, gaps that were seen during the inspection were immediately addressed and current documentation was revised to correct this.

Processes were in place to ensure staff recruitment procedures were followed and staff received training and support from management to ensure they had the right knowledge and skills to meet people’s needs. The service also enabled staff to undertake nationally recognised training to help them progress in their work.

There were enough staff deployed to fully meet people’s health and social care needs. People received their care at the correct time and had support given by the same members of staff to ensure consistency of care.

Staff completed competency assessments as part of their induction followed by regular supervisions and training. Staff were knowledgeable about people’s needs and said they received the necessary training to equip them with the skills they needed to provide the care people required.

People told us staff sought their consent before providing any care or support. Staff had an awareness of the Mental Capacity Act (2005) and knew how to support people to make their own decisions.

People had access to health care professionals to make sure they received appropriate care and treatment. The service maintained accurate and up to date records of people’s healthcare and GP contacts in case they needed to contact them.

People and their relatives spoke highly of the staff and said for the managers, office staff and care staff, no task was too great. People said staff knew how to deliver care in a person centred way and were very flexible according to their changing needs. People told us whenever possible, visit times were arranged to suit people’s needs and when changes to visit times had been requested the service did this “without any fuss being made”.

Staff spoke fondly about the people they supported and gave good examples of how they developed positive relationships with people using the service. People, their relatives and staff gave examples of when staff had gone the ‘extra mile’ to help and support people. People told us that if certain tasks were required which were not part of people’s care packages, staff would willingly help even if this meant doing certain things in their own time.

People’s needs were assessed and care plans developed to identify the care and support people required. There were effective communication systems in place to ensure any changes or updates about people were communicated to staff immediately. Any changes in people’s health or emotional well-being were responded to straight away.

The service actively involved people in assessment of their care requirements which enabled them to make choices about the support they needed to help them to be as independent as possible.

Staff and the registered manager were very responsive to people's individual needs. Staff knew people well and what was important to them. The service actively sought feedback from people, their relatives, community professionals and their staff to monitor and continually improve the quality of the service. One example of this was feedback from staff that during visits to people they had told them they would like to have the opportunity to socialise more outside of their homes. In response to this, the service set up a coffee morning which people said they really enjoyed and was a huge success.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received.

The service had received a large number of compliments from people, their relatives and community professionals stating the care provided was flexible and person centred.

The service promoted an open and honest culture and the registered manager was transparent in their discussions with us. Staff spoke highly of the management team and felt well supported.

Staff were confident they could raise any concerns or issues, knowing they would be listened to. One staff member told us “This is a very nice company to work for. They are very accommodating and always listen. This is the best company I have ever worked for”.

The registered manager spoke passionately about the service and staff. They were very proud of their staff team and believed in valuing their staff as much as the people using their service. The service had an ‘employee of the month’ and staff were also recognised by the management team for ‘going the extra mile’.

As part of this inspection, we spoke with two staff, and shortly after our visit we contacted one person who used the service, and three relatives. Everyone we spoke to was complimentary about the staff and the care and support provided.

We reviewed the care plans for three people and found that they were comprehensive. They contained sections for personal care, continence, skin & physical wellbeing, with sub sections for sight, hearing, oral care, feet, dexterity, BMI (body mass index), pain, sleep, breathing, circulation, nutrition, medication, communication, mobility, syndromes and conditions, mental health and daily routines.

The provider had a medication administration procedure which was reviewed in November 2013. Staff spoken to confirmed how they would provide support to a person with their medication. Staff confirmed their knowledge of medication monitored dosage systems, with dosette boxes, and how they would prompt a person if needed, to take their medication.

We looked at staff recruitment records and found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider demonstrated a commitment to quality assurance and a robust system was in place to effectively monitor the service.

As part of this inspection, shortly after our visit we contacted two people who use the service, one relative and two members of staff. We also spoke with one social care professional. The views of services users and our findings were summed up through what people told us.

Everyone we spoke was complimentary of the staff and were satisfied with the care and support provided. One person told us 'there is consistency in the staff which is very important to me. They recognise if I am not feeling well and take action such as calling my doctor. The staff ensure that I am in total control of my care and support and I have plenty of opportunities to express my views regarding the care or treatment I receive.'

Another person said 'the staff encourage me to do as much for myself as possible and this enables me to stay in my own home, and be as independent as possible. New staff have been introduced gradually and have worked alongside experienced staff until I have felt confident that the new staff know me and my routine, which I value. The staff are well trained and aware of the importance of privacy and dignity, they are polite and respectful.'