Archived: Saltimmary Homecare Professionals

This inspection took place on 8 January 2019 and was announced.

Saltimmary Homecare Professionals is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and people living with dementia.

Not everyone using Saltimmary Homecare Professionals 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 the time of the inspection the service was providing the regulated activity of personal care support to 9 people.

The service did not have a registered manager. The service is not required to have registered manager as the provider is registered as an individual. The provider retains the responsibility to be the manager as well, being a ‘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.

Following the last inspection, on 26 September 2017, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well-led to at least good. At this inspection we found that improvements had been made and the provider was meeting the regulations. Recruitment practices had been reviewed and improved. The training completed by staff had been reviewed, to ensure staff had practical instruction with moving and handing, before supporting people. Practices when staff were supporting people with medicines had been reviewed to ensure the provider had oversight and had taken action when recording was not consistent. Quality assurance and monitoring systems had been put in place to support the provider to have oversight and understanding of the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the practices and systems in the service did not always support this practice.

We have made a recommendation about knowledge and understanding of the Mental Capacity Act.

People felt safe. Staff knew how to report any concerns about people’s safety. Lessons were learnt when things went wrong. The provider understood their duties to report and share information.

People were treated with kindness, respect and compassion. The provider supported staff to develop relationships with people, giving them time to provide care in a personal and compassionate way. People were supported by staff with shared interests. One person told us, “They [staff] are all caring and kind to me.” Another said, “They are always caring and listen to me. I couldn’t be more pleased with them all.”

People’s independence was promoted. People’s privacy and dignity were respected. Confidentiality was protected, with staff’s understanding and records kept securely.

People knew how to raise complaints, and were confident to do so. People and staff were involved in evaluating the service. The provider took action when opportunities for improvement were highlighted.

There were enough staff to meet people’s needs. People were visited by the same staff, wherever possible, to give them continuity. Staff were trained to give them the right skills to support people. The provider met with staff regularly, for staff meetings or individual supervision. Safe recruitment practices were followed when taking on new staff. Staff new to the service were supported with induction which included shadowing established staff.

Risks to people were assessed and individually planned for. Risks about infection control and lone working were assessed and mitigated. People were supported to take their prescribed medicines safely, as required. Some people had assistance with preparing food and drink.

People’s needs were assessed and planned for. People and their relatives were involved in the assessment and planning so that their care was provided in a personalised way. People were supported at the end of their lives. Staff worked with other agencies to ensure people had the right support.

Staff worked well together, with regular communication. Staff also worked in partnership with healthcare professionals and other agencies. There were links between the service and the local community.

Quality assurance systems ensured that the provider had oversight of the service provided. Learning from these checks were shared with the staff team to improve the service.

Saltimmary Homecare Professionals is a domiciliary care agency and provides personal care and support for people living in their own home in the area of Horsham and surrounding villages. Care is provided to adults but predominantly older people, including people living with dementia and people with a sensory loss, for example, hearing or sight loss and people with a physical disability. At the time of our inspection 18 people were receiving a service, all of whom were over 65 years old.

The service did not have a registered manager as the service is not required to have registered manager as the provider registered as an individual and retains the responsibility to be the manager as well. 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.

Feedback from people and their relatives was positive about the care provided. However, despite the positive comments, we found areas in need of improvement. Staff told us there had been a number of challenges since the service had first registered in 2016. This included an office move and the taking over of another home care service which was closing. This involved the transfer of their care staff and people who used the service. The manager told us about the difficulties in the recruitment of new care staff which had led to the manager regularly covering a number of care calls each week. This had impacted on the time available for them to undertake their management role. Feedback and observations during the inspection demonstrated the current management arrangements did not fully support the operation of the service. Procedures such as the development of care and support plans and the reviews, quality assurance audits, spot checks of care staff at work, staff competency checks, supervision, team meetings and staff appraisal, staff training had not been fully embedded into practice. Policies and procedures had not been customised to the working of the service. Local policies and procedures, for example, the Pan-Sussex Safeguarding Adults procedures had not been used to inform the services own policy and procedure. Procedures were in place to ensure the safe administration of medicines. However, records of when medicines had been administered had not always been completed as needed. There was no auditing process in place to highlight this omission or rectify it. Staff had not always been recruited using robust recruitment procedures. Moving and handling risk assessments had not been completed by staff trained to undertake this assessment. The Care Quality Commission had not been informed about important events which the service is required to send us by law. We have asked the provider to make improvements in all these areas.

People and their relatives told us they felt safe with the care provided. One person told us, “I am grateful for the support and feel so lucky and always safe.” Care staff were kind and caring. Comments received included, “As a family we have all benefited and the carers have enhanced all our lives,” “I feel my carers are an extension to my family they are that good,” and “I think the carers and agency are exceptional.”

Consent was sought from people with regard to the care that was delivered. All staff understood about people’s capacity to consent to care and had an understanding of the Mental Capacity Act 2005 (MCA) and associated legislation.

People and their relatives told us there was good continuity of care staff providing their care calls. People told us they always got their care call and they were happy with the care and the care staff that supported them.

Where required, care staff supported people to eat and drink and maintain a healthy diet. People were supported with their healthcare needs.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.