We carried out this inspection on 31 May 2016 and the inspection announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service who are often out during the day; we needed to be sure that someone would be in.
Home Instead Senior Care Greenwich and Bexley provides care and support including personal care to people in their own homes. At the time of our inspection there were 20 people using the service.
The service had 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 regulation about how the service is run.
People received their medicines safely. The service had systems in place to ensure people’s medicines were administered in line with their prescriptions. People who required prompting with their medicines had their needs clearly documented in their care plans. Staff received training in safe medicines management.
People’s health care needs were documented and updated to reflect any changes. Care plans were person centred and detailed peoples health needs, preferences, history and mobility needs. Where possible people were encouraged to participate in the development of their care plans.
People were protected against the risk of abuse. Staff were aware of the different types and signs of abuse and demonstrated sufficient knowledge on how to report any concerns of harm and abuse. Staff received training in safeguarding adults. People were protected against identified risks. Risk assessments were in place that documented the identified risk, level of risk and the support method to minimise the risk.
Staff had adequate knowledge of the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty Safeguards [DoLS] and their legal responsibility in supporting someone whose capacity was fluctuating. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When people lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.
People were encouraged to make decisions about the care they received. Staff were aware of the importance of ensuring people’s consent was sought and respected prior to care being delivered. People were offered choices in a manner they understood.
The service had robust procedures in place to ensure suitable staff were employed. Staff personnel records contained, Disclosure and Barring Services [DBS] checks, three references, proof of address and photographic identification. Staff received a comprehensive three day induction process that set out their roles and responsibilities. Staff received on-going support through shadowing experienced staff and were required to complete a set of work based competencies, prior to working unsupported. There were adequate numbers of staff available to meet people’s needs.
People received care and support from skilled and knowledgeable staff. Staff underwent training to ensure they had the knowledge to support people effectively. Training included, safe medicine management, MCA, DoLS, safeguarding and first aid. Staff were able to request additional training should they feel it was needed.
People received support from staff that reflected on their working practices. Staff received supervisions from the registered manager. Supervisions looked at what staff did well and any areas required for improvement. Staff felt they were able to speak with the registered manager at any time and not just during scheduled supervisions, if they required support and guidance.
People were protected against social isolation. Staff were aware of the impact social isolation could have on people and how to recognise the signs. Staff could identify the appropriate action to be taken should they suspect someone was at risk of social isolation. People attended activities which reduced this risk.
The registered manager operated an open-door policy. People, their relatives and staff could meet with the registered manager at any time. People found the registered manager approachable and available.
The registered manager and provider carried out audits of the service to ensure people, staff and the environment was safe. Quality assurance questionnaires were sent to people and their relatives to gather feedback on the service and drive improvement. People were aware of the correct action to take should they wish to raise a concern or make complaint. The service had systems in place to manage complaints to ensure positive outcomes for the complainant.
People had access to sufficient amounts of food and drink. Staff were aware of the signs of malnutrition and dehydration and how to effectively respond should they suspect someone was at risk.