24 April 2015
During a routine inspection
The inspection visit took place at the agency’s domiciliary care office on 24 April 2015. On 29 April 2015 we visited people in their own homes and spoke to relatives and personal assistants (P.A’s). We also contacted relatives and P.A’s by telephone. P.A’s are members of staff providing care and support.
The agency’s office in based in the middle of Deal town centre and the agency offer support and care to people in Deal and the surrounding areas. Your Choice is registered to provide personal care to younger people who had physical and learning disabilities. People lived in their own homes in the community. At the time of the inspection the agency provided personal care for six people. They also provided support for other people with their shopping and activities but this type of support is not regulated by the Care Quality Commission (CQC). The provider and office manager assisted with the inspection. They worked as a team to make sure we had the information we requested.
The majority of the people who used the agency lived with their relatives. The agency provided 19 self-employed P.A’s to support people with their personal care and their social activities. (Because the people who worked at the agency were self-employed they were referred to as personal assistants and not staff). The agency also provided support and respite for relatives throughout the week. The support hours varied from 24 hours a day to an hour or more.
Some people required two P.A’s at each visit. For some people the routine was that the P.A’s would go into their homes in the morning to assist and support them with their personal care and get them ready for the day. P.A’s would them take them out to participate in activities in the community. On other days relatives/parents gave all the support. Each package of care was tailored to meet the personal needs of each person. The agency worked to give people the care and support they wanted and needed to remain at home and to be as independent as possible.
There was no registered manager in post. This was because the agency was registered to one person who is the provider and therefore the agency does not require a registered manager. The provider was the registered person. 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 registered provider had overall responsibility for this agency. The provider was at the agency office every day and there was an office manager in post who gave support with the day to day running of the agency. The registered provider and office manager also provided care and support to people.
Safeguarding procedures were in place to keep people safe from harm. People felt safe using the service; and if they had any concerns, they were confident these would be addressed quickly by the provider. The P.A’s had been trained to understand their responsibility to recognise and report safeguarding concerns and to use the whistle blowing procedures. P.A’s had received training in how to keep people safe and demonstrated a good understanding of what constituted abuse and how to report any concerns.
People received support in line with their assessed personal care needs. Systems were in place to manage risks to people using the agency and P.A’s, including risk assessments. In some cases further detail was needed in the risk assessments so that P.A’s had full written guidance of how to keep risks to a minimum. P.A’s were able to tell they would do if an incident did occur.
People indicated and relatives told us that they were very happy with the service the agency provided. P.A’s knew people’s individual needs and how to meet them. People and their relatives were fully involved in the assessment and the planning their care. The details in the care plans contained the information needed to support people in the way they preferred and suited them best. People were confident that P.A’s provided personalised care and knew their routines well.
People care plans had been reviewed by senior P.A’s and any relevant changes were made when required. P.A’s said the communication between them and the office made sure that they were up to date with people’s changing needs.
People and their family were involved in developing care plans, and they were able to make decisions about their care and support. Although P.A’s had not received formal training in the Mental Capacity Act 2005 they were able to explain current guidance to support people to make decisions. They were able to tell us about the importance that everyone should be deemed to have capacity to make decisions about their lives. They knew what to do if a person did not have capacity to make a decision. They told how they supported people to do this. The Mental Capacity Act 2005 provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. The provider told us that recently a person had been referred to health and social care professionals to make decisions about their care and support. A best interest meeting had been held to collectively decide what action should be taken to act in the person’s best interest.
People received their medicines safely and when they needed them. They were monitored for any side effects. The agency made appropriate referrals and worked jointly with health care professionals, such as community nurses, doctors and specialist services to ensure that people received the support they needed.
P.A’s supported people to prepare meals to make sure they had a range of nutritious food and drink.
There were sufficient numbers of P.A’s available to make sure people’s needs were met. They had permanent regular schedules of calls so that people received care from a consistent team.
People were protected by robust recruitment procedures and new P.A’s had induction training which included shadowing experienced P.A’s, until they were competent to work on their own.
P.A’s received an induction, core training and specialist training, so they had the skills and knowledge to meet people’s needs. They fully understood their roles and responsibilities as well as the values of the agency.
P.A’s were caring and treated people with dignity and respect. People received care from a team of consistent P.A’s who knew their routines well. They were kind, compassionate and polite. Relatives told us that the P.A’s arrived on time and stayed for the duration of their call. P.A’s often took people out during the day to attend various activities in the local community. The activities varied depending on what the person liked and enjoyed.
People and P.A’s were supported by an out of hours on call system. They told us told us that the provider and office manager were always responsive and any queries raised were sorted out promptly.
People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the agency informally and formally. The feedback received had been positive.
The culture within the agency was transparent, personalised and open. People, their relatives and P.A’s could drop in at the office at any time to discuss any issues or concerns. There was a clear management structure in place and P.A’s told us they were all part of the team. They said they felt comfortable talking to the provider about their concerns and ideas for improvements. There were systems in place to monitor the safety and quality of the service being provided. The agency looked at new ways of working to continuously improve the service.