8 February 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 11 December 2018 and was announced in accordance with our current methodology for home care services. The inspection team consisted of one Adult social care inspector and one expert by experience who had knowledge and experience of this type of service.
The service was previously inspected on 23 June 2016 when it was found to be fully compliant with the regulations and good in all areas. Prior to the inspection we reviewed the Provider Information Record (PIR) and previous inspection reports. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed the information we held about the service and notifications we had received. A notification is information about important events which the service is required to send us by law.
During the inspection we visited one person at home and spoke with six people and six relatives by telephone. We also spoke with six staff, the deputy manager, the registered manager and the provider’s nominated individual. We also inspected a range of records. These included four care plans, three staff files, training records, staff duty rotas, meeting minutes and the service’s policies and procedures.
8 February 2019
We carried out this announced inspection between the 11 December 2018. At the last inspection, in June 2016, the service was rated Good in all areas. At this inspection we again found the service was Good.
Alexandra’s Community Care Penzance is a domiciliary care agency. It provides personal care to predominantly older people living in their own houses in the West of Cornwall. At the time of our inspection the service was providing support to approximately 50 people. The service generally provides short visits at key times of the day to support people with specific tasks to enable people to continue to live in their own homes. The majority of these packages of care were funded privately or via the NHS.
People and their relatives were complimentary of Alexandra’s Community Care Penzance which they would be happy to recommend to others, Comments received included, “I absolutely would recommend them, I think they are excellent”, “They are very kind and helpful” and “They are very gentle with [My relative] and that’s what I like about them, they are very good.”
People felt safe whilst receiving support and relatives told us, “I feel that [my relative] is perfectly safe with the carers.” Staff knew how to respond to and where to report any safeguarding concerns. They told us they were confident any safety concerns they reported to manager would be dealt with appropriately.
Risk assessments had been completed and staff had sufficient guidance available to enable people’s care needs to be met safely. Any accidents or incidents that occurred had been recorded and investigated by the registered manager. This enabled the service to learn from all incident that occurred and prevent similar event from reoccurring. Where people required support to move around their home their care plans included information on how any necessary equipment should be used.
Staff knew people well and people told us they were normally supported by a small group of carers who visited regularly. The service rotas were well organised and included appropriate amounts of travel time between care visits. Records showed carers normally arrived on time and people told us they did not feel rushed whilst receiving support. People’s comments included, “The majority of time they arrive on time. When they’ve been a bit late it is only five or ten minutes” and “They will always stay the correct amount of time and will stay longer if need be.”
The service had appropriate procedures in place for the prioritisation of care visit during periods of adverse weather and we found no evidence of planned care visits having been missed during our inspection. People told us, “They always turn up” and “We’ve never had any missed calls, none at all.” While staff said they were not aware of any care visits having been missed.
Staff were trained and sufficiently skilled to meet people’s needs. All staff initially completed training in a variety of topics considered mandatory by the service and records showed this training had been regularly updated. All staff new to the care sector were supported to complete nationally recognised induction training designed to ensure they understood current good practice in care. Staff told us, “The induction was good”, “The training is fine, all mine is up to date” and “The training was very good it covered everything it needs to.”
The service’s recruitment practices were generally safe. Disclosure and Barring Service checks had been completed for all staff. However, we noted two staff had completed shadowing shifts, as part of their induction, before these checks had been completed. We discussed this with the registered manager and new procedures were introduced immediately to prevent this happening in future.
People’s care plans were detailed and informative and provided staff with sufficient information to enable them to meet people’s needs. People and their relatives had been involved in the process of developing and reviewing these documents. Staff told us people’s care plans were accurate and commented, “The care plans really do have lots of information in them”, and “The care plans are very detailed, they tell you everything you need to know on each visit.”
People’s care plans included guidance for staff on their individual communication needs and how to support people to make decisions. This included guidance on people’s use of hearing aids and information to help staff understand how people’s medical conditions may affect their communication skills. Care plans included guidance on how staff should offer information to enable people to make choices. People’s relative told us and we saw staff always involved people in making decision and choices about how their care was provided.
The service acted within the legal framework of the Mental Capacity Act 2005(MCA). Where people’s capacity to make decisions was known to fluctuate care plans provided staff with guidance on how to present information and support people to make choices independently. Where this was not possible records showed decisions had been consistently made in the person best interests. We identified some potentially restrictive arrangements in the care plan of one person who did not have full capacity. This issue was discussed with the registered manager who subsequently highlighted these arrangements to the local authority for authorisation by the Court of Protection.
The service was led by a registered manager who was also responsible for overseeing the management of two other registered services. The registered manager was routinely based in the service’s office and staff told us, “The registered manager is here two or three days per week” and “The registered manager is very hot on providing support, she probably phones in five times each day when she is not in the office.”
Staff were well motivated and the roles and responsibilities of senior staff were well understood. Records showed all staff had received regular supervision and annual performance appraisals. Team meeting were held regularly and staff suggestions had been listened to and acted upon. Staff told us, “The managers are lovely and all the staff are lovely”, “[The managers] will do everything they can to help you” and “The [Registered] manager is very fair and approachable. She is very switched on.”
The service had effective quality assurance systems in place to drive improvements in performance. The regular audits and spot checks of staff performance were completed to monitor the quality of care provide. In addition the nominated individual visited the service regularly to assess the service’s performance. Any issues identified were promptly resolved. People’s feedback was regularly requested during care plan reviews and consistently positive. People and their relative’s understood how to make complaints and told us, “I would feel confident making a complaint; you don’t like doing it of course, but it’s only done for good reason. I have made a complaint once and it was resolved” and “I made a complaint only once and they sorted it all out for me very quickly.”