Care By Us - North London & West Hertfordshire

The service provided a wide range of services which included, domiciliary care, 24-hour live-in care, enablement services, prevention of hospital admission, ‘Front of House’ service that turned around people at A&E to get them home and prevent hospital admission, delirium recovery pathway, early stroke discharge service and extra care schemes.

The diverse services meant that a large number of people were supported with the regulated activity of personal care. For example, at the time of the inspection, there were around 600 people who received personal care. The number of people receiving support varied significantly in numbers from day to day due to the short term support some people received. In one year, there were approximately 2000 people who received care and support from the service.

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

People and their relatives gave us extremely positive feedback about the service they received. They told us the care and support they received was not just safe, but effective in enabling them to live in their own homes. People told us they were involved in their care, had become more independent and their health was promoted.

People were supported to learn how to take risks safely and protect themselves from the risk of abuse. This was in addition to staff being well trained and knowledgeable about safeguarding procedures and how to report their concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us how grateful they were for staff supporting them to live in their homes. Staff were trained and supported to meet the diverse needs of people including those related to disability, gender, ethnicity, faith and sexual orientation. These needs were recorded in care plans and all staff we spoke with knew the needs of each person well.

The provider operated a bespoke training programme developed and adapted to provide staff with in-depth knowledge about legislation, approved best practice guidelines and health conditions people using the service lived with. The training programme focused on practical face to face training in an environment specially adapted by the provider to resemble the type of environment people they supported lived in.

The provider and staff were passionate in enabling people to live independently in their own homes for as long as possible and they used assistive technology to promote safety. The effective use of innovative technology had measurable impact on vulnerable people at risk of dehydration and those at risk of getting lost when leaving their home.

People received personalised care and support, and this was flexible to fully meet their needs. The provider yearly budgeted a large sum to enable them throughout the year to provide free of charge bespoke services, equipment and often, household goods to people who could not continue to live at home without this.

The provider developed services for people who were at risk of social isolation. They commenced pet therapy support and offered this service free of charge to people who missed having pets to stroke and talk to and these had many positive benefits for people. They also looked after people’s pets when they were no longer able to so that people continued to enjoy the company of their animals.

People told us they were supported by a stable staff team who they developed good relationships with. They told us staff were extremely caring and often they went over and above their professional duties. This made people feel valued and safe living in their own homes.

The provider effectively planned and tested their ability to provide an undisrupted service to people in case of extreme weather conditions or other unforeseen events. They purchased special vehicles they could drive staff around in case of floods or snow. They also worked closely with the local fire service to ensure people’s homes were equipped with fire detection for early warning in case of a fire.

People had access to a 24/7 helpline which they could call for any emergencies they had. This gave reassurance to people who had no close relatives to deal with any household emergencies.

The provider developed a close working relationship with commissioners and local authorities from their catchment area to develop new services in response to the needs of people in the community. Commissioners and representatives from the local authority’s social work team told us the support they received from the provider was invaluable. In their recent contract monitoring visit the provider achieved an ‘Excellent’ overall rating.

The provider’s quality assurance systems were self-developed and tested all aspects of the service they provided. The systems were highly effective in identifying any issues or areas where improvement was needed to the quality of the service provided. The effectiveness of the monitoring systems were constantly tested and improved. This led to effective deployment and management of staffing resources across all their services with only 20 missed visits recorded in a year out of 1.2 million. The visits were marked as missed because staff were more than two hours late arriving at people’s homes.

The provider was involved in developing and sharing best practise in their areas of expertise, often mentoring and supporting other providers of similar services. They were nominated and won several awards to recognise their contribution to improving people’s life in the community. The provider ran several well-being programmes for their employees. The award schemes and development opportunities offered to their staff contributed to the development of a strong, dedicated and motivated staff team who adhered to the vision and the values promoted by the provider.

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 Outstanding (published 29 October 2016).

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.

Care by Us is a large organisation which offers different types of services in East, West and North Hertfordshire, Essex and North London operated from two main locations. This inspection covered the services provided in West Hertfordshire and North London reaching out to approximately 600 people.

The services the provider offered to people included, domiciliary care, flexi care scheme, live in type of services, specialist care from home services, respite care, parent support and supported living. The provider also provided a `Local Links` service which offered specialised transport with staff support for people with mobility difficulties to access the community. This service was free of charge and run through the provider`s own charity organisation.

The provider had specialist staff teams trained to offer a wide range of care and support for people with complex health and social care needs. These included, end of life care, people with behaviour which could challenge other, people living with learning disabilities, dementia and other illnesses which required staff to be knowledgeable about, such as epilepsy, diabetes and eating disorders.

There was a long standing registered manager in post who was also one of the owners of the company. 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 involved in developing their own care plan based on their needs and wishes. Before people started using the service staff met them for an initial personal and risk assessment where they decided and agreed their care and support plan. Staff captured in care plan people`s wishes, what dignity and respect meant for people and gave people choices and control over the support they required and wanted. People gave their written consent to the care and support delivered by staff and participated in regular reviews about their care needs.

People told us staff were respectful and offered care and support in a caring and compassionate way. The care and support offered to people met their needs and made people feel safe. Staff showed a caring attitude when talking about people and were able to tell us how they delivered individualised care which met people`s needs.

People told us they felt staff were knowledgeable and knew how to deliver care and support in an effective and safe way. They praised staff responsiveness to their needs and the provider`s approach to provide equipment, mobility aids and specialist support to enable them to live independently in their own homes for as long as possible.

Staff had comprehensive induction training when they started working for the provider and they attended regular refresher training sessions. The registered manager identified and offered specialist training for staff to develop and take on the roles of champions in the areas of their interest. The champions held the highest qualification in their subject areas and actively trained and coached staff. As a result staff acquired knowledge and skills to meet people`s needs effectively.

The provider created opportunities for staff to progress in their career within the company which led to a high retention of permanently employed staff group. People benefitted from consistent care and support from staff who were long standing and knowledgeable in how to meet peoples` needs effectively. The provider had a robust call monitoring system in place which they checked daily and implemented measures to improve call response times when they identified late or very occasionally missed calls.

We found that the provider acted as a role model for staff in creating a caring culture throughout the service by putting people first. People relied on their services and trusted that they could turn to the staff for any help they needed even outside their agreed care contract. The provider understood how much people wished to be cared for in their own homes and they went over and beyond their lines of duty to help people achieve this

The provider successfully supported people to overcome the risk of social isolation. They organised regular events at their own cost to bring people together and encouraged social interaction.

The provider worked closely with commissioners and local authorities from their catchment area to develop new services in response to the needs of people in the community. This had a positive impact by helping people remain in their own home as long as possible with the support from Care by Us staff and in preventing unnecessary hospital admissions.

When people started using the service and were experiencing problems or were unhappy with the care and support received from staff, had weekly well-being visits from a senior staff member. This was provided free of charge and was used by the provider as an opportunity to monitor the service provision and enable people to easily feedback their experience about the service and identify ways to improve. The provider offered this service until people were happy with the support they received.

People received comprehensive information in a service user guide that explained how to complain and who to complain to and offered an overview of the services provided, offices opening hours and responsible staff contact details for each department within the service. The provider appropriately logged and responded to complaints. They investigated each complaint and if improvements were needed these were implemented and shared with the staff team.

The provider developed a recruitment strategy and aimed to recruit staff living within the area of the people they were supporting. In areas where they were short of care staff the provider offered relocation packages to their existing staff to ensure they were able to deliver a continuous quality care service to people. This was particularly important in the more rural areas of the counties they operated in. Care by Us were considered by the local authority in Hertfordshire a reliable and well performing partner the lead provider in offering care and support to people living in remote rural areas.

The provider mentored and shared best practice ideas with other providers of similar services in their catchment area. They were dedicated to improve the quality of care people received in their own homes in the counties they operated in often offering training for staff working for other providers.