03 March 2015
During a routine inspection
The inspection was carried out on 03 March 2015, and was an announced inspection. The manager was given 48 hours’ notice of the inspection as we needed to be sure that the office was open and staff would be available to speak with us.
Mears Care - Ashford is a domiciliary care agency which provides personal care and support for older people and younger adults who are living in their own homes. At the time of the inspection, the service was providing support to 83 people, in the areas of Ashford, Tenterden, Brabourne, Charing, Chilham, Challock and surrounding areas. Most people were funding their own care through direct payments. Some people were funded through NHS continuing care services.
The service is run by a registered manager, who was present throughout the day of the inspection visit. 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 and associated Regulations about how the service is run.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005.
The agency had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, the director, or the local authority safeguarding team. Staff were trained in how to respond in an emergency (such as a fire, or if the person collapsed) to protect people from harm.
The agency provided sufficient numbers of staff to meet people’s needs and provide a flexible service. Staff were able to accommodate last minute changes due to people’s appointments or other staff sickness. Staff were allocated to people within a close range of each other, so that they would not have long distances to travel between attending to people. This ensured that they would not be delayed from attending to people at the correct appointment times.
The agency had robust recruitment practices in place. Applicants were assessed as suitable for their job roles, and new staff were provided with a detailed induction programme, which included training in essential subjects. Refresher training was provided at regular intervals. No staff commenced any duties until a satisfactory Disclosure and Barring Service (DBS) check had been received. (DBS checks identify if prospective staff have had a criminal record or have been barred from working with children or vulnerable people).
All staff received induction training which included essential subjects such as maintaining confidentiality, moving and handling, safeguarding adults and infection control. They carried out shadow shifts and had their competency assessed before they were allowed to work on their own. The registered manager ensured that staff had the right training and experience to support people with specific needs, such as dementia care, or end of life care. Other staff training included assisting people with managing their medicines. Some calls were specifically to visit people to prompt them to take their medicines, or to check they had taken them.
The senior agency staff (known as ‘visiting officers’) carried out extensive risk assessments when they visited people for the first time. This was to assess that the home was safe for providing their care, and for staff’s safety. Other assessments identified people’s specific health and care needs, their mental health, medicines management, and any equipment needed. A care plan was drawn up and agreed between the agency and the individual people concerned. Some people were supported by their family members to discuss their care needs, if this was their choice to do so.
People were supported with meal planning, preparation and eating and drinking. Staff also supported people by contacting the office to alert the manager to any identified health needs so that their doctor or nurse could be informed.
People all spoke positively about their care staff and had no negative comments about their work. They gave examples of how care staff went beyond their required duties, and offered to do extra things. People said that they knew they could contact the registered manager or their visiting officer at any time. The visiting officers carried out frequent spot checks to assess care staff’s work and procedures, with people’s prior agreement. This enabled people to get to know the visiting officer so that they felt confident about raising any concerns or other issues.
The agency had processes in place to monitor the delivery of the service. As well as talking to visiting officers at spot checks, people could phone the office staff at any time, or speak to the senior person on duty for out of hours calls. Care plan reviews were carried out with people after 28 days, and then every six months, or sooner if needed. Changes were made to their care plans as they were needed. People’s views were also obtained through annual surveys. These could be completed anonymously if people wished. The agency’s head office analysed these and checked how well people felt the agency was meeting their needs.
The registered manager sent out monthly newsletters to staff to keep them informed about events, changes, ideas, training dates and meetings. The agency staff provided events together for the benefit of people receiving support. These had included a full Christmas dinner and entertainment in 2014, as well as a Summer Fair, and a Macmillan coffee morning. This was an innovative way to assist people to feel included as part of the agency, and to give people a focus and prevent loneliness. Staff also provided items to put into Christmas hampers for people who did not have anyone else to support them or care for them, showing that their care and compassion extended beyond their own job roles.