The inspection took place on 19 July and was announced. The inspection continued on 25 July 2016 and was again announced.All Time Care delivers domiciliary personal care to people with learning disabilities and autism. Personal care was provided to 16 people at separate locations. These locations were a mix of shared living and private homes. There was a central office base which had an open plan working area, two separate offices, a toilet and a small kitchenette facility.
The service had a registered manager in place. 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 staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training.
Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they chose to live their lives. Each person had a care file which also included outcomes and guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.
Medicines were managed safely, securely stored in people’s homes, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines.
Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, autism, epilepsy, diabetes and learning disability.
Staff told us they received regular supervisions which were carried out senior management. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions and find them useful”. We saw that supervisions had recently started to be themed around policies or topics such as person centred care or diversity. This demonstrated an innovative approach which managers used to assess staffs knowledge and provide additional support where necessary.
Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. The service completed capacity assessments and recorded best interest decisions. This ensured that people were not at risk of decisions being made which may not be in their best interest.
People were supported with cooking and preparation of meals in their home. People were supported to choose meals through weekly menu planning meetings. The training record showed that staff had attended food hygiene training.
People were supported to access healthcare appointments as and when required and staff followed GP and District Nurses advice when supporting people with ongoing care needs. A community professional told us that the service works well with them.
People told us that staff were caring. During home visits we observed positive interactions between staff and people. This showed us that people felt comfortable with staff supporting them.
Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available in various easy read and pictorial formats. This meant that people were supported by staff who knew them well.
People had their care and support needs assessed before using the service and care packages reflected needs identified in these. Outcomes were set by people and outcome focused reviews took place. These evidenced that people were actively supported to work towards their outcome areas and that achievements were recorded. Additional support was highlighted and provided. We saw that these were regularly reviewed by the service with people, families and health professionals when available.
People, staff and relatives were encouraged to feedback. We reviewed the findings from quality feedback questionnaires which had been sent to people and stakeholders and noted that it contained mainly positive feedback. The results had been analysed and actions were set for the management team to follow up. We saw that the actions identified from this were being addressed.
There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints in place. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.
Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.
People and staff felt that the service was well led. The registered manager and others in the management team all encouraged an open working environment. All the management had good relationships with people and delivered support hours to them as and when necessary.
The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.
Quality monitoring visits and audits were completed by the management team. The quality manager logged data from incident reports monthly which included medication errors, incidents, complaints and falls to name a few. This data was then recorded and analysed to identify trends and learning which was then shared. This showed that there were good monitoring systems in place to ensure safe quality care and support was provided to people.