G&M Senior Care Limited t/a Home Instead Ruislip & Harrow

G&M Senior Care Limited t/a Home Instead Senior Care is a domiciliary care agency providing personal care and support to people living in their own homes. They are registered to provide care to older and younger adults some of whom are living with dementia, disabilities, mental health conditions, and sensory impairments.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection they were offering personal care to 43 people.

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

The provider had strong leadership and managers led by example to provide a quality service for people that met their needs. The culture within the service was enabling and care givers went above and beyond to help meet people’s needs. The provider had robust quality assurance processes and a range of methods to get feedback from people, their relatives and others that they valued and considered in developing and improving their service.

The feedback from people and their relatives was overwhelmingly positive and demonstrated that a caring and empowering culture was well embedded across the organisation. Staff knew the people they were supporting well and understood how best to support them. There was an emphasis on respecting people's individuality and providing care according to their preferences.

The service was led by two directors who were also the owners of the company. They and their management team demonstrated a strong level of engagement with people, relatives and their staff. The provider had demonstrated their aim to be to be proactive and innovative. They put people at the centre of their service delivery.

The provider ensured they supported staff and people using the service well throughout the COVID-19 pandemic. They had introduced initiatives to keep people and staff safe. They had supported staff to create alternative activities whilst people were locked down to maintain peoples’ well-being. The provider had arrangements to ensure people received responsive end of life care, if this is required.

The provider had invested in training their work force. The management team had specific roles and areas of interests and kept their learning updated. It was a strength of the service they could train, advise and support care givers to learn the skills and knowledge they required to give quality care to people.

The providers were well supported by the brand Home Instead and they welcomed both external and internal auditing. Feedback received was treated as an opportunity to reflect and further improve the quality of the service for people.

The provider had systems and processes to identify and mitigate the risk of abuse to people using their service. People told us they felt safe with their consistent individual teams of staff who were familiar, friendly and respectful visitors to their homes. Staff understood people’s care needs well and people were very pleased about the care they received.

The provider had a safe recruitment processes which checked staff suitability to provide care to people. There was considered careful matching of the staff with people they supported. They took into account their mutual interests and individual personalities to make sure that appropriate and caring relationship could be built between care givers and people using the service.

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.

Rating at last inspection

The last rating for this service was good (published 29 June 2018).

Why we inspected

We undertook this announced focused inspection due to the length of time since our last inspection. The report only covers our findings in relation to the key questions of safe, responsive and well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed and remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for G&M Senior Care Limited t/a Home Instead Senior Care on our website at www.cqc.org.uk.

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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The service offers care and support to people living with dementia, learning disabilities and mental health conditions, as well as older people and young adults with physical disabilities or sensory impairments.

Not everyone using G&M Senior Care Limited t/a Home Instead Senior Care receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At this inspection the provider was offering support to 60 people, 39 of whom were receiving personal care. This inspection was done to check that improvements to meet legal requirements planned by the provider after our inspection on 9 August 2017 had been made. The team inspected the service against three of the five questions we ask about services: “Is the service well led”, “Is this service safe”, “Is this service effective.” This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-led to at least good. The provider sent us an action plan on the 3 November 2017 and agreed to have all actions in place by 14 February 2018. At this inspection we found that actions in the plan had been carried out by the provider.

At our inspection in August 2017 we found one breach of the Regulations in Safe care and treatment in the Safe key question. This was because the provider did not assess all the risks to people’s welfare and there was not sufficient staff guidance to mitigate those risks. We found the provider had undertaken assessments of the risks and staff had guidance to support them to work with people in a safe manner.

The provider also did not have safe processes for the administration and recording of medicines. At this inspection we found that the provider had ensured all care staff who administered medicines received training to do so and checked and audited to ensure care staff were adhering to the medicines management procedures. Where mistakes were found these were addressed with the individual care worker and common errors were addressed with the care staff team.

In the Effective domain we made a recommendation about working within the principles of the Mental Capacity Act 2005. and a second recommendation relating to obtain training for staff who worked with people who behaved in a way that challenged the service. We found that staff had received training in both these areas and the provider was ensuring that people’s permission was sought prior to offering care.

In the Well-led domain, we had found in August 2017 that the provider did not have sufficient auditing, checking and tracking processes in place to ensure the service being offered was effective and of a good quality. During this inspection we found the provider now had an oversight of safeguarding concerns, accidents and incidents and near misses. In additions checks and audits identified errors and omissions and addressed these concerns with the care staff.

There was a registered manager in post, however we were informed the week of the inspection that the registered manager had resigned but was still available to speak with and would continue working for the agency in a different capacity. 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 and their relatives told us staff arrived on time and there were no missed calls. The provider assessed people’s needs to ensure there were enough skilled and competent staff to meet people’s support needs before offering a service.

The registered manager had reported safeguarding adult concerns and care staff demonstrated they could recognise signs of abuse and would report concerns appropriately.

The provider ensured staff received supervision and training to equip them to undertake their caring role.

People were supported to remain healthy and staff monitored people’s oral intake where indicated, to ensure they ate well and drank enough to remain hydrated. Care staff liaised with health professionals to ensure they had access to appropriate health care. Relatives told us care staff kept them informed of any changes in people’s health.

Initial assessments were undertaken prior to a service commencing to ensure that people had the right support to meet their needs. Reviews took place on a regular basis and in response to changing circumstances.

The service had a clear company ethos and vision that they shared with staff.

This was the first inspection for this service following initial registration with CQC on 8 February 2016 and later organisational changes. There was not a registered manager in post and the previous registered manager left the service in March 2017. 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. A manager had been appointed and they told us they were in the process of applying to be registered.

G&M Senior Care Limited t/a Home Instead Senior Care is a domiciliary care agency that provides personal care and support to people living with dementia, learning disabilities and mental health conditions, as well as older people and young adults with physical disabilities or sensory impairments. On the day of our inspection, the agency provided support to 68 people out of which 42 were receiving personal care.

Although we found positive aspects to the care provided we identified some areas that require improvement. The agency had not always assessed and managed risks to care and treatment of people who used the service. There was a policy in place for the management of medicines but staff were not always recording the administration of medicines as instructed in this policy.

The agency had not always sought people’s consent to their care and treatment and did not always work within the principles of the Mental Capacity Act 2005 MCA, therefore there was increased risk of people’s rights not being protected.

There were methods to monitor and audit the quality of the service, however, they were not always effective and the agency’s auditors had not always identified and acted on the gaps in the service provision.

The staff were supervised, supported and given regular training, however, we found that staff required additional training on how to work with people who displayed behaviours that challenged the service.

The positive aspects about the agency we identified included the following. The agency helped to protect people from harm and abuse and people told us they felt safe with staff who supported them. Staff were recruited in the safe way as the agency followed an appropriate recruitment procedure and relevant checks had been completed before staff started working with people unsupervised.

There was sufficient staffing capacity and most people had their usual team of allocated care staff for consistency.

People were provided with the necessary assistance to meet their health care and nutritional needs.

Staff felt supported by their managers and could approach them with any issues regarding their professional role and personal matters.

People and their relatives spoke very positively about relationships with their care staff and their kind approach. They said staff always treated them respectfully and with dignity.

People had care plans that were individualised and had detailed information about people’s care and support needs as well as their personal preferences. Where possible the staff supported people to take part in social activities and access the community.

People and their relatives were satisfied with how the agency was run and it was evident complaints were taken seriously and acted on. All of the people we spoke with told us they would recommend the agency to others.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, the need for consent and good governance. We made two recommendations, which related to additional training for staff around working with people who displayed behaviours that challenged the service and working with principles of the Mental Capacity Act 2005.