One to One Homecare Limited

One to One Homecare Limited provides personal care and support to people living in their own homes. Some people who received a service lived in supported living houses which they shared with other people. The service provides support to people who have a learning disability and/or mental health needs. At the time of our inspection there were seven people receiving the regulated activity of personal care.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of key questions safe and well led The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

People were supported to have maximum choice, control and independence. People and/or their representatives were involved in decisions about their care and support.

Staff supported people in their own homes to continue to be in control of their day to day lives. Care provided was flexible to fit in with people’s wishes.

People were supported by small staff teams who knew them well. People had trust in the staff who supported them.

Right Care

People received kind and compassionate care. Staff knew people well which enabled them to provide person-centred care in accordance with people’s wishes and preferences.

People received care which met their individual needs. Staff worked with other professionals to make sure people received the right care and treatment.

People were supported to follow their own interests and hobbies.

Right Culture

People were supported by a management team who worked hard to promote a culture where people were valued and respected as individuals. This culture enabled people to live the lives they chose. Staff spoken with treated everyone as an individual.

People were cared for by staff who felt valued by the organisation and supported by the management team.

Communication between staff was good which meant people received care and support in accordance with their up to date wishes and needs.

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 (report published 19 February 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has not changed from good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for One to One Homecare Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

One to One Homecare Limited provides personal care and support to people living in their own homes. Some people who receive the service live in supported living houses which they share with other people. The service specialises in providing support to people with learning disabilities or mental health needs. At the time of the inspection there were six people receiving personal care from the service.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. e.g. People’s support focussed on them having as many opportunities as possible to gain new skills and become more independent.

People and their representatives were very happy with the service they received from One to One Homecare Limited. One relative told us, “You can’t fault it in any way.” Another said, “The service is superb. The staff really know what they are doing.”

People received their care from a small consistent staff team who they were able to build trusting relationships with. Everyone told us staff were caring and patient.

There were systems in place which made sure people received their allocated hours but staff were flexible to fit around people’s changing needs or wishes. One relative told us, “Their dedication is outstanding and their time keeping is exceptional.”

People received a safe service because the provider had systems and processes which helped to minimise risks. This included a robust recruitment procedure and training for staff about how to recognise and report suspicions of abuse. One person told us, “I feel safe because staff are always kind.”

People were involved in decisions about the care they received and staff knew how to communicate with each person to help them to make choices. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

People were supported by staff who had the skills and experience to help them to maintain and develop their independence. Staff treated people as individuals and respected their privacy and lifestyle choices.

The provider was open and approachable which enabled people to share their views and raise concerns. People told us if they were worried about anything they would be comfortable to talk with a member of staff or the provider.

The management structure in the service ensured people and staff had access to, and support from, a competent management team. The provider monitored quality, sought people’s views and planned on-going improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good. (The last inspection report was published in August 2016.)

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

One to One Homecare Limited provides personal care to people living in two supported living houses with shared occupancy and to people living in their own home. They provide care and support in the counties of Somerset and Devon. People who live in the shared supported living properties have individual tenancy agreements. At the time of the inspection they were providing personal care and support to six people. We visited two supported living properties to meet people and to discuss the care they received. One person agreed to talk with us about their experience of the care they received. Another person agreed to meet us although they had limited communication. Other people living in the shared accommodation chose not to talk with us whilst others were not receiving personal care. We observed how people interacted with staff and whether they were relaxed and happy.

The last full inspection of One to One Homecare Limited was October 2013. At that inspection there were concerns around the safeguarding processes for a specific person receiving care and we issued a Warning Notice. We checked on the provider’s progress with the warning notice in January 2014 and they were compliant with this area. At the October 2013 inspection we also found the provider had not ensured people’s safety as they had not obtained a criminal record check for staff before they started work. They also did not have sufficient staff to ensure the care hours were covered safely without staff working long hours. The provider had also failed to forward statutory notifications to the CQC when an incident occurred These are notifications providers must make when anything significant occurs within the service. These failures to comply were not followed up at the January 2014 inspection. The provider sent us an action plan telling us when they would be compliant. At this inspection we found the provider had improved and all areas were now compliant and being managed appropriately.

At the time of this inspection the registered provider was also 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.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed the deputy manager and staff took the time to talk with people during visits to their flats and homes. One person said, “I know who is coming and there are never any surprises. If they say it is [staff member’s name] I know they will be here.” Another person said, “We have regular staff so it is good to get to know who is coming.”

People who received care and support from One to One Homecare told us they were happy with the service provided. They said the registered manager and staff were open and approachable and cared about their personal preferences and maintaining their independence. One person said, “I have been in the care system for years and I am really happy here, the support is brilliant and I like all my staff.”

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Care workers had access to training specific to their roles and the needs of people, For example they had attended training in the use of alternative communication aids such as Makaton. Staff told us the training they received was good one staff member said, “I had previous care experience but the training with One to One was good and is on-going.”

People said they were cared for and supported by care workers who were polite, compassionate and caring. One person said, “[Staff member’s name] is always polite and caring, they understand me.” We observed they had a very relaxed and cheerful relationship with the care worker supporting them during our visit.

People were protected from abuse because the provider had systems in place to ensure checks of new staffs characters and suitability to work with vulnerable adults were carried out. Staff had also received training in protecting vulnerable people from abuse.

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care. All care plans included written consent to care if people agreed to sign. Care workers had comprehensive information and guidance in care plans to deliver consistent care the way people preferred.

The registered manager had a clear vision for the service. Their statement of purpose said, They would, “Support individuals to live fulfilling lives, reach their full potential and achieve their goals.” This approach to the care a support provided for people could be seen throughout the inspection. People were encouraged and supported to attain goals through regular activities agreed and planned with them. Whilst at the same time promoting independence.

The service had a complaints policy and procedure that was included in people’s care plans. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

There were systems in place to monitor the care provided and people’s views and opinions were sought on a daily basis. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

We had identified other concerns during the visit in October 2013 which were in regard to how recruitment was carried out for new staff, whether there were sufficient staff on duty and that the provider had not reported serious incidents to the CQC when serious incidents had occurred. However, we plan to revisit and check compliance for these other areas at a later date.

During this inspection we spoke with one member of staff, the registered/managing director was not available. We did not speak to any people who used the service. However, they were asked if they did wish to speak with us, but they declined. We looked at the care records for three people in the registered office. We also looked at other records in regard to the management of the service.

We found the provider had taken reasonable steps to identify and reduce the risks of abuse occurring. This was through changing the system of how they supported people with their monies and ensuring checks were in place to monitor the potential risks if assistance was required as part of their planned care. The provider had reviewed and updated procedures to ensure staff had the systems in place to respond and act accordingly when significant events, concerns or people's behaviour put themselves or others at risk of harm.

During this inspection we spoke with five staff, the registered manager and a managing director. We met and spoke with three people who used the service. We looked at records in the registered office and in people's own homes. These included records for three people who currently used the service and one person who had recently left the service. We also obtained information from the social work teams supporting people who used the service. We obtained information from the local police force.

When we spoke with three people who used the service, two people clearly expressed that they felt safe and supported by the service. Whilst we were speaking with one person who used the service they disclosed information that indicated there was a possibility of risk of harm to them. The provider referred this disclosure on prompting to the local authority safeguarding team for investigation.

We found practices at the agency did mirror the concerns we had received, for which compliance actions have been made for the service to rectify. The provider had not taken reasonable steps to identify or prevent the risk of abuse occurring. For example, the manager had not acted on safeguarding information in a timely way or kept people's personal information secure. We also found that a police check had not been carried out on a new member of staff before they had started working with vulnerable people. At times there were not enough staff for people to have one to one support they needed.

We obtained feedback from health and social care professionals who came into contact with the service. They told us people had voiced their opinion that the service met their needs and they were happy with what they received. We heard from another social care professional that the provider had worked well together with social services to support a person through difficult circumstances. We were told that they had provided a responsive service that adapted to the person's needs and staff were very supportive to the person concerned and their family.

We found that there had been improvements in all five areas of the essential standards and the service was overall compliance to the regulations. However, we have not been able to test that compliance was sustained and we will continue to monitor the service.

People told us about their experiences with staff. They said, "friendly and sociable,""sort problems out," and "very helpful." One person described the staff as "happy bubbly people."

We found One to One Homecare Ltd non compliant for five of the six areas that were reviewed. This was in regard to the care and welfare of people, safeguarding people who use the service, requirements for and supporting workers and assessing and monitoring the quality of the service.