Carers at Home Limited

Carers at Home is a domiciliary care agency. It provides a service to older adults, some of whom are living with dementia. Not everyone using Carers at Home receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection, it was providing the regulated activity of personal care to 115 people living in their own houses and flats

People’s experience of using this service and what we found

Staff had a hugely positive impact on people’s lives, such as improving their wellbeing and supporting people in their own time in a crisis. People felt that staff were like friends or family rather than carers and felt that staff knew them very well and that they could approach them with any requests. Although people we spoke to had never had to complain to the service, they felt comfortable to do so if needed. Staff knew people well and delivered care that was personalised to their needs. People were encouraged to make decisions around their day to day care and be as independent as possible where safe to do so.

People received safe and good quality care. Risks to people were appropriately recorded and managed by staff who were aware of their responsibility to safeguard people from abuse. There were sufficient numbers of staff and people told us they had never missed a call. People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff attended thorough training sessions which put them in the position of the people they supported so they understood how it felt to receive care. Staff were safely recruited and received regular supervision and appraisals.

Care plans were personalised to reflect the individualised care that people received, including information around their health conditions. Medicines were administered and recorded safely, with any errors being addressed immediately. Complaints were dealt with in a timely manner and good outcomes reached to prevent any reoccurrence. The service was not delivering end of life care to anyone at the time of the inspection, but this topic had been discussed and recorded in people’s care files, with staff offering emotional support to families during this time. The service had strong partnership working links with other agencies to ensure people received care in adverse weather conditions. Checks on the quality of the service were thorough which meant any shortfalls found were resolved immediately. This has been reinforced through the use of a new electronic care planning system which alerted staff to any concerns.

People, relatives and staff were complimentary on the running of the service and felt that the management team were approachable. Staff felt their ideas were listened to and implemented where possible, and people and their relatives were given the opportunity to give feedback each year through a questionnaire. Staff were also able to give feedback and were kept up to date with the latest care guidance and important information through weekly newsletters. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection (and update)

At the last inspection the service was rated Good (1 March 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.

Bramley is a domiciliary care agency providing personal care for people in their own homes. There were 140 people using the service at the time of the inspection. Half of the people receiving the service were living with dementia. Services are provided from their main office in Bramley and a satellite office in Chertsey.

There was a registered manager in post. 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 had up to date risk assessments for fire, the environment, medication and moving and handling. However, we found some people did not have risk assessments for identified risks of malnutrition, dehydration or pressure sores. However the registered manager took immediate action to improve this and make sure these were in place to guide staff.

There was a risk that people’s rights would not be protected because not all staff had good knowledge of the Mental Capacity Act 2005 (MCA) and MCA assessments were not decision specific. However the registered manager took immediate action to improve the form that was used and to arrange further staff training.

People and their relatives told us that they felt safe and staff had a good understanding of how to keep people safe.

There were sufficient staff to meet people’s needs. The service used an electronic business management system that records and monitors staffing availability, consistency of carer, travel time and the service being provided to people. The service followed safe recruitment practices.

People benefited from a safe service where staff understood their safeguarding responsibilities. The provider who was the safeguarding lead for the agency.

The provider had developed plans to help ensure that people’s care would not be interrupted in the event of an emergency, such as loss of utilities or severe weather.

People’s medicines were managed and administered safely. Staff received training every year and a competency check every six months to ensure they were able to support people to take their medicines safely.

People received individualised care from staff who had the skills, knowledge and understanding needed to carry out their roles. Staff had received induction training which included completing the care certificate and shadowing more experienced staff. Staff received refresher training to help ensure they remained up to date with best practice and training to enable them to meet people’s specific needs.

People were supported by staff who had supervisions (one to one meetings) and an annual appraisal with their line manager.

The staff met people's dietary needs and preferences and people’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

People and their relatives told us that staff were caring and they were happy with the care they received, and staff told us they really cared about people and what was important to them.

Staff treated people with dignity and respect, and people were encouraged to be as independent as possible.

When people first received a service they were always introduced to the care staff who were going to support them. People knew which staff were going to provide them with support and when, and the same care workers were provided consistently.

People’s views were sought through care reviews and customer surveys.

Care, treatment and support plans were personalised and detailed. People and their relatives were involved in developing them and were in control of their care.

Assessments covered people’s needs and captured important person centred information and people’s needs were reviewed regularly and as required.

There was a complaints policy in place and people’s concerns and complaints responded to in good time

Staff were aware of the visions and values of the agency and were proud to work for the agency.

People and their relatives had opportunities to feedback their views about the quality of the service they received and spot checks were carried out on staff.

Staff were well supported by the management of the service and had regular team meetings.

The provider and registered manager carry out a number of audits. These include audits of medication administration, outcomes of reviews, staff timesheet analysis and training and supervision. All of these were used for monitoring quality and identified shortfalls with action taken.

The registered manager, provider and other staff members were actively involved in key local organisations and promoted awareness of dementia in the local community.