Background to this inspection
Updated
3 February 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 19 December 2016 and was announced. We gave the service short notice because we wanted to meet the manager and needed to be certain they would be available during the inspection. This also gave the manager sufficient time to ask some people if they would be willing for us to visit and speak with them in their homes. The inspection was carried out by one inspector.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information in the PIR and also looked at other information we held about the service before the inspection visit.
During this inspection we went to the provider’s office and spoke to staff including the manager, deputy manager, provider, recruiter and client co-ordinator. We also spoke to five caregivers on the telephone. We looked at a range of records the provider is required to maintain. These included four service user support plans, medicine administration records, staff rotas, four staff recruitment files, staff training records and quality monitoring records. We visited three people with their permission in their own homes, and spoke with another four people on the telephone.
Updated
3 February 2017
The inspection took place on 19 December 2016 and was announced. The service was previously inspected on 8 September 2013 when we found the service was fully compliant with all regulations covered in the inspection. During this inspection we found no breaches of regulations and we found people received a good service.
Home Instead Senior Care is a domiciliary care provider based in North Somerset, providing personal care and support to people in their own homes. Home Instead Senior Care is part of a franchise that delivers care to people in many areas of the United Kingdom. This service supports 100 people in Bristol and North Somerset. The service offered includes personal care, such as assistance with bathing, dressing, eating and medicines. The service also offered home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties; and companionship services such as escorting people on visits or appointments, simple conversation and company. We only looked at the service for people receiving personal care as this is the activity that is registered with Care Quality Commission (CQC). The staff who support people are known as ‘caregivers,’ and we have called them this in the report.
The person managing the service had been in post since August 2016 and had sent their application to the Care Quality Commission to become the 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.’
Staff told us there had been a lot of changes in office staff, and a period of ‘disorganisation’. The manager had been proactive in identifying areas for improvement, including the quality of the care plans, the completion of regular spot checks and the provision of consistent support for caregivers, and was taking action to address any failings. Staff commented; “The team has really pulled together in the last three months”, “[Manager’s name] is really good. It’s an enormous responsibility. We are getting there. [Manager’s name] has worked really hard with the team”.
The manager and provider were ‘hands on’ and approachable. Caregivers and people who used the service told us how accessible and supportive they were. There were systems in place to monitor the quality of the service, including regular checks, audits and quality assurance surveys completed with people every three months.
The service had an ethos of providing continuity and person centred support to people. People received visits of at least an hour from a staff team of no more than three caregivers, with whom they had been carefully matched. People confirmed staff had a good understanding of their needs and were well informed about the care to be provided. Comments included, “They provide very good support. I have two visits a day. I couldn’t manage without them.” and, “All the staff are well trained. They have a good understanding of my family member’s needs”.
People’s legal rights were protected. People who used the service and others involved in their care were fully involved and consulted. People were always asked for their consent before caregivers assisted them with any tasks. Caregivers respected people’s privacy and people were treated with respect and dignity.
Comprehensive risk assessments had been carried out, in liaison with people, relatives and health and social care professionals where appropriate. This meant that caregivers were well informed about any risks and the action needed to keep people safe, while minimising restrictions on freedom, choice and control. Care plans were reviewed at least every three months and people were fully involved in this process.
People were kept safe and free from harm. Their small, consistent staff team were able to quickly recognise any changes in their physical or emotional presentation, and take any action necessary to safeguard them. The service had policies and procedures in place about working with and protecting vulnerable people and staff received regular training on this issue. In addition recruitment processes meant staff were thoroughly checked to ensure they were safe to work with vulnerable people. People were assured they would receive their care because there were systems in place to minimise any risks caused by late or missed visits.
There were systems in place to ensure people received their medicines safely from staff who were trained and competent to carry out the task. Regular auditing ensured these systems were maintained and action taken to minimise the risk of errors, for example additional training for staff.
Where required people were supported, as part of their care package, to access food and drink and maintain their nutrition and hydration according to their needs and preferences.
People were supported by a well-trained team of staff with the knowledge and skills required to meet their individual needs. The majority of staff, including the manager, told us they were well supported. They were enabled to keep up to date with best practice through a range of forums including an annual Home Instead conference and the Home Instead website, where current policies and procedures, a weekly newsletter and practice updates were posted.