The inspection took place on 27 March 2018. We gave the provider 48 hours' notice of the inspection because the service provides care to people in their own homes. The registered manager and office staff spend time visiting people and we wanted to make sure that someone would be available in the office on the day of the inspection.
IDC Care Ltd - Heritage Healthcare Ealing is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The agency also provides support with cleaning and domestic calls. The Care Quality Commission only regulates and inspects support with personal care. At the time of the inspection 34 people were receiving support with personal care. The agency provided a service to older people, including people living with the experience of dementia and people being cared for at the end of their lives. They also provided support to younger adults with learning disabilities and people with physical disabilities. The majority of people funded or partly funded their own care. The London Borough of Ealing commissioned some of the care.
There was a 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.
The agency was a franchise and was owned by the registered manager and their partner through a limited company. The Franchisor offered some support with setting up policies and procedures, although the registered provider was able to make additions and changes to these to reflect their local needs. This location was the only branch for the registered provider. They provided a service for people living in the London Boroughs of Ealing and Richmond upon Thames.
At the last inspection on 10 May 2016 we rated the service Good.
At this inspection on the 27 March 2018 we have rated the service Outstanding in the key questions of Caring, Well-led and overall. We have rated the key questions of Safe, Effective and Responsive as Good.
People using the service and their relatives told us they received a very good service. Alongside the positive feedback as part of the inspection, we saw that people had given extremely positive feedback on independent review websites and the provider had cards, emails and letters praising the service. Some of the comments from people included, ''Absolutely wonderful'', ''Nothing is too much trouble for them'' and ''[The service has] transformed my life.''
The staff working for the agency told us they enjoyed working there, commenting on how well they were supported and how they liked the values of the agency. One care worker told us, ''The best thing about this agency is how client focussed they are.'' The staff also told us they felt valued and listened to. One member of staff explained that the registered manager always asked them if they were happy to undertake a piece of work. They said, ''They never just tell you, they ask you and I like that, it feels like they respect us.''
The values of the agency underpinned the work they carried out and were clearly upheld in the care being provided. The agency's support was tailor made for each person and reflected their individual needs and wishes. Each person was supported by a small team of familiar care workers who were selected because their personalities and way of working matched the person's needs. When people were not happy with a particular worker the agency offered them alternative care workers. The senior staff were able to describe the importance of this and how they recognised that people liked different things about the staff who cared for them, so that someone who wanted a very 'chatty' care worker could have this, where others who wanted someone who was more reserved could be assigned a care worker with this personality.
The registered manager understood that people needed to feel they trusted the agency and staff who cared for them. There were different ways they supported people to feel safe and build up this trust, for example ensuring that people were involved in every aspect of planning and reviewing their care. People confirmed they did feel safe, telling us staff always arrived on time, gave them the support they needed with medicines, followed good hygiene practices and managed risks in a safe and supportive way.
People felt that the staff were skilled and competent. There were examples where the staff had undertaken specialist training specifically to meet a person's needs, for example when they were discharged from hospital or when they used sign language for communication. The provider had not been restricted in the way they provided care, making sure they made changes within their service to meet people's needs. For example, helping to enable a person who wanted to die at home to return there from hospital, supporting one person to take a business trip abroad, enabling people to travel to see families and providing emergency care and support outside their normal working hours when people needed care, food, shopping or following an emergency.
The care workers were exceptionally thoughtful and caring. Many of them displayed innovative practices that enabled people to have more control to live the lives they wanted. There were numerous examples of this, including the observations of one care worker that the person they were supporting could not open and close their blind independently because they could not reach the cord. The care worker lengthened the cord and positioned this close to the person to enable them to have control over their blind. Another example was where the care worker for a person was concerned that they were not eating breakfast and this was affecting their wellbeing. The care worker helped support the person to understand the importance of this meal and encouraged them to try to eat.
Not only did the agency put the people they supported at the centre of their work but also provided comfort and support to families. For example, one person using the service became ill when their next of kin was abroad. The agency provided support for the person, liaised with the hospital where the person was admitted and provided regular updates and information for the person's next of kin so they felt reassured.
The agency had very effective systems for monitoring the quality of the service and making improvements. They used an electronic monitoring system which allowed them to view live information about the care being provided, such as when medicines were administered. They could update this system with immediate effect so that any changes to care plans could be viewed by care workers, the person using the service and their representatives as soon as the changes were made. People had access to their electronic records, as did their representatives (with the person's consent) so they could view when and how care was being provided. The provider was very responsive to changes in people's care and needs and had taken action to adjust the service when needed. The agency had systems for receiving feedback and comments from stakeholders and we saw that they had acted on this so that they could improve the service.
The registered manager had worked with other community groups to better understand and meet the needs of people using the service and others. For example, they had provided information about what to expect from care services and where to go for help for a group of people living in a local extra care scheme. The provider had plans for continuous improvements such as further developing the way in which medicines were managed electronically by linking their records with pharmacy records. They also had plans for further work with the community providing support and information to other community groups. There was a continuous improvement approach where the provider recorded feedback, information about things that went wrong and things that went well. They used this to help plan for the future so that the service evolved in the way which best reflected people's needs and wishes.