Archived: Age UK Kent Rivers

Age UK Medway is a domiciliary care service registered to provide personal care for older people. At this inspection the service was providing personal care for 95 people. It also provided footcare for 265 people.

Personal care was provided by the main team of care staff completing care calls to people in their own homes. These care calls were usually completed each day. The footcare service was provided by a separate smaller team of care staff who visited people at home every two months.

The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, where they do we also take into account any wider social care provided.

In this report we refer to the two parts of the service as being ‘the homecare service’ and ‘the footcare service’ when our conclusions are not applicable to the whole service.

People's experience of using the service and what we found

People and their relatives were positive about the service. A person using the homecare service said, “The staff are friendly and the place is fine for me.” In a thank-you card a relative praised the homecare service for the “first class care” provided for their family member.

People were safeguarded from the risk of abuse. They received safe care and treatment in line with national guidance. There were enough care staff to reliably complete care calls on time and safe recruitment practices were in place. People were supported to safely manage medicines, lessons had been learned when things had gone wrong and good standards of hygiene were promoted. People had been helped to quickly receive medical attention when necessary.

Care staff received training and guidance so they had the knowledge and skills they needed. When necessary, people had been helped to obtain medical attention and to receive consistent care when they moved between service.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

People received compassionate care promoting their dignity and respecting their right to privacy. They were also supported to express their views about things important to them.

People were consulted about their care, given accessible information and supported to pursue their hobbies and interests. There was a procedure for quickly resolving complaints and people were treated with compassion at the end of their lives so they had a dignified death.

Quality checks had been completed. People had been consulted about the development of the service and their suggestions had been implemented. Good team work was promoted, regulatory requirements had been met and joint working was promoted.

For more details, please read 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 4 February 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.

Age UK Medway provides personal care to 112 people in their own homes and visits another 111 people every six to eight weeks to provide a nail cutting service. The care was managed from an office in Chatham. The personal care provided to the 112 people was tailored to their needs so that people could maintain their health, wellbeing and independence and remain living at home. The care was delivered to adults, some of whom may be living with dementia, long-term health conditions or physical disabilities.

At the previous inspection on 7 and 10 December 2015, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to the recording of detailed information on risk assessments, ensuring that staff did not have gaps in their employment records when recruited and the effectiveness of auditing systems. The provider sent us an action plan telling us what steps they would be taking to remedy the breaches in Regulations we had identified. At this inspection we checked they had implemented the changes.

At the previous inspection on 7 and 10 December 2015 we also made two recommendations to assist the provider to make improvements to the service provided. These recommendations were in relation to the recording of topical medicines (creams and lotions) when administered and the effective communication of changes in staff deployment at weekends. At this inspection we found improvements had been made.

There was a registered manager employed at the service. 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. The registered manager was also the provider.

People spoke about the staff in a positive light regarding their feelings of being safe and well cared for. People told us that they felt safe when receiving their care. They told us that having continuity in staff attending helped them have confidence and feel safe.

Risks were assessed by staff to protect people. There were systems in place to monitor incidents and accidents. The registered manager had improved the way risk assessments were written so that they gave staff more detailed information about minimising risk.

Staff were recruited safely and had been through a selection process that ensured they were fit to work with people who needed safeguarding. Recruitment policies were in place that had been followed. Safe recruitment practices included background and criminal records checks and now also included a record of explanation for any gaps in employment, prior to staff starting work.

People were happy with the leadership and approachability of the service’s registered manager and the management team. Staff felt well supported by registered manager. Audits were now more effective and risks were monitored by the registered manager to keep people safe.

Staff had been trained to administer medicines safely and staff spoke confidently about their skills and abilities to do this well. Records showed and staff confirmed they were now keeping proper records of the administration of topical creams and lotions.

The registered manager ensured that they could provide a workforce who could adapt and be flexible to meet people’s needs and when more staff were needed to deliver care, they were provided. Some people needed more than one member of staff to provide support to them. People were now made aware of which staff were providing weekend care.

Staff had received training about protecting people from abuse and showed a good understanding of what their responsibilities were in preventing abuse. Procedures for reporting any concerns were in place. The registered manager knew how and when they should escalate concerns following the local authorities safeguarding protocols. People were given information about how to report abuse.

Staff training covered both core training like first aid and more specialised training in dementia. We could see that the management and staff culture was grounded in recognised good practice in providing care to older people. For example, the service also provided older people with advice about keeping warm, community meal services and where they could access community day services.

The registered manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support people’s best interest if they lacked capacity to make certain decisions about their care.

Working in community settings staff often had to work on their own, but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people. The service could continue to run in the event of emergencies arising so that people’s care would continue. For example, when there was heavy snow or if there was a power failure at the main office.

People said that staff were well trained and understood their needs. They told us that staff looked at their care plans and followed the care as required. People told us that staff discussed their care with them so that they could decide how it would be delivered.

Most people made their own arrangement around food and drink. However, the registered manager gave staff guidance about encouraging people to eat and drink enough. When needed staff assisted people to make sandwiches, hot drinks and other foods. Care plans were kept reviewed and updated.

There were policies in place that ensured people would be listened to and treated fairly if they complained. The registered manager ensured that people’s care was individualised to them.

Age UK Medway is part of the Age UK National Group. A national provider of support services for people with diverse needs in community settings. The management team and staff were committed to the values of the organisation and ensured they took these into account when delivering care and support. The provider and management team wanted to continually improve and had development plans in place that were being implemented to further enhance the quality of the service.

People said that they had been involved in developing their plans of care and that they were consulted with all aspects of their care and treatment. Care plans were detailed so that staff had clear guidance to follow to meet people's individual needs.

People were very complimentary about the skills of the staff team. Comments included, 'I'm really satisfied with the way they look after my wife.'; 'The carer does everything I want and beyond, she's very good.'; 'It's what my mother needs and it suits her very well'; and, 'Very, very fond of my carer ' look forward to her coming.'

Staff had been trained in how to give people medicines safely. Records did not always clearly show if people had taken their 'as required' medication (PRN).

Effective measures were in place to safeguard people when new staff were recruited to the agency.

Most people told us that they had never had the need to make a complaint about the agency. People who had made a compliant said that it had been resolved to their satisfaction.

The agency had comprehensive systems in place for monitoring the quality of service that it provided, which included regularly asking people who used the service for their views.

There was good communication between people who used the service, relatives and office staff. "They have never let us down", exclaimed one relative.

Care staff did not rush and had time to sit down and talk to people who used the service. One person told us, "The staff are superb. They chat to Mum and ask how she is when they visit". People said that staff taking time to talk to their relative was a very important part of their relatives care.

Relatives said that they felt confident in leaving their relative to the care of the care staff team. The care staff team knew what to do if they had any concerns about the people in their care.

Care staff had the necessary skills and experience to support people. Care staff were described as, "superb" and "human". Relatives said that the people who use the service were "fond" of specific care staff.

The agency asked the views of people who used the service on a regular basis and took action to make any changes to the service as necessary. Although care staff knew how to support people, care plans records did not always accurately reflect people's changing care needs.