7 December 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 20 October 2017. The provider was given 48 hours notice of our visit because we wanted to ensure the manager and Nominated Individual were available to support the inspection process. One inspector undertook the inspection.
Before the inspection we reviewed records held by CQC which included notifications, complaints and any safeguarding concerns. A notification is information about important events which the registered person is required to send us by law. This enabled us to ensure we were addressing potential areas of concern at the inspection.
During the inspection we visited the agency’s office and spoke with the managing director, care manager, compliance manager, recruitment and training manager, care co-ordinator and four care workers. We checked care records for four people, including their assessments, care plans and risk assessments. We checked four staff files, including recruitment checks, the complaints and compliments log, the most recent satisfaction surveys and the provider’s quality monitoring audits.
After the inspection we received feedback about the agency from five people who used the service, eight relatives and two social care professionals.
This was the first inspection of the agency at its current location. We had previously inspected the agency when it was registered at a different address on 22 August 2013, where we found no concerns.
7 December 2017
The inspection took place on 20 October 2017 and was announced.
Home Instead Senior Care provides care and support to people in their own homes in the Guildford and Woking areas. The agency provides a range of services to people, including companionship, home help and personal care. This report focuses on the experiences of people who received personal care as part of their support package. Most of the people who use the service are older people, some of whom are living with dementia. The agency also provides services to younger adults who may have learning disabilities, mental health issues, sensory impairment or physical disability. The agency provided services to 102 people at the time of our inspection, 48 of whom received personal care.
There was no registered manager in place at the time of our inspection. Like registered providers, registered managers 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. The agency’s care manager had submitted an application for registration with the Care Quality Commission which was being processed at the time of our inspection. Sarah Daly is the agency’s managing director and the Nominated Individual for the provision of personal care.
The agency adopted a proactive approach to keeping people safe. Staff had implemented measures to reduce not only any risks involved in providing people’s care but also to improve their general safety and security. The measures that had been put in place ensured people were as safe as they could be in their own homes. In several instances staff had taken swift action to protect people from financial abuse or fraud. As a result of the risk many older people faced from financial abuse, the managing director had introduced advice sessions for people about how to avoid becoming a victim of fraud.
People told us they trusted their care workers and felt reassured by their presence. They said they could rely on their care workers and felt safe when staff provided their care. Relatives told us care workers consistently considered how best to keep their family members safe when receiving their care and in their day to day lives.
The agency employed enough staff to ensure that all care visits were covered. People said their care workers had never missed a visit. The managing director told us that the availability of staff to cover visits was always considered before a new care package was agreed. The management team had developed plans to ensure people’s care would not be interrupted in the event of an emergency.
People were protected by the agency’s recruitment procedures. Prospective staff were required to submit an application form and to attend an interview where their suitability for the role was assessed. Applicants also had to provide details of four referees and to produce proof of identity, proof of address and eligibility to work in the UK. The agency had obtained satisfactory references and a Disclosure and Barring Service (DBS) certificate for all staff employed.
Staff understood the responsibility they had to keep people safe. They had attended safeguarding training during their induction and were knowledgeable about the potential signs of abuse. Staff knew how to report any concerns they had about people’s safety or well-being, including outside the agency if necessary.
If an incident or accident occurred, staff recorded the event and the action they had taken in detail. Accident and incident records were reviewed by the management team to ensure that the actions taken were appropriate and to identify any learning points from the event.
Where people’s care involved support with medicines, this was managed safely. Staff had been trained in the safe management of medicines and their competency in this area had been assessed. Staff maintained medicines administration records in people’s homes, which were audited regularly to ensure people were receiving their medicines safely.
People received their care from staff who were well trained and supported. All staff attended a comprehensive induction and had access to the training and support they needed to do their jobs to a high standard. Staff met regularly with their managers for one-to-one supervision and were encouraged to achieve additional qualifications relevant to their role. Staff provided very positive feedback about the training the agency provided and the support they received from their managers. They said the training equipped them well to do their jobs and they were encouraged to identify any additional training they needed.
All the people we spoke with said their care workers were extremely competent and provided care to a consistently high standard. Some of the people who used the agency had complex needs which required staff to work collaboratively with relatives and professionals involved in providing their care. Relatives and professionals who worked with the agency in these circumstances said care workers possessed the knowledge and skills they needed to provide excellent care.
People received their care from a consistent team of care workers, which they said was important to them. They were always informed if their regular care worker would not be attending and told us the agency always arranged a suitable replacement care worker. New care workers were always introduced to people before providing their care.
People’s care was provided in accordance with the Mental Capacity Act 2005 (MCA). People told us staff always asked for their consent before providing their care. If people lacked the capacity to make decisions, relevant people had been consulted to ensure any decisions were made in the person’s best interests. Staff had received training on the principles of the MCA and how these principles applied in their work.
People who received support with meals enjoyed the food their care workers prepared. They told us their care workers knew their dietary needs and preferences. Relatives said care workers put time and effort into providing meals their family members enjoyed. People’s nutritional needs were assessed during their initial assessment and any dietary needs recorded in their care plans. Where people needed assistance with eating and drinking there was a care plan in place to outline the support they required.
Care workers supported people to stay healthy and to obtain treatment when they needed it. Care workers liaised with healthcare professionals involved in people’s care and accompanied them to appointments where necessary. People and their relatives valued this support because they found it difficult to manage transport to appointments and communication with healthcare professionals. Care workers were quick to identify any changes in people’s health. Relatives said care workers’ vigilance and advice had been valuable in enabling their family members to obtain treatment when needed.
People were supported by staff who were extremely kind, caring and compassionate. Care workers were passionate about their work and wanted to make a positive difference to people’s lives. They frequently gave up their own time to spend time with people, particularly if they lived alone or had limited family contact. Many people had established close relationships with their care workers and regarded them as good friends. Relatives said their family members benefited greatly from the kindness and companionship of their care workers and the relationships they had formed with them. Several relatives said staff had also provided valuable emotional support to people’s families when they experienced difficult times.
Staff supported people to be as independent as possible. People told us staff had emphasised the benefits of independence and encouraged them to do things for themselves where they could. One of the agency’s stated aims was to enable people to stay in their own homes and there were many examples of staff enabling people to achieve this when they would have been unable to do so without support. We also heard examples of how staff had supported people to remain involved in their local communities, which increased their independence and prevented social isolation.
The agency organised events that were available to people receiving care but also benefited people in the local community. The agency ran a dementia café and a choir for people living with dementia and the managing director had established a regular dementia-friendly church service. Relatives were able to attend the agency’s dementia training at no cost, which helped them to understand the condition and ways in which they could support their family members.
Dignity and respect underpinned the agency’s approach to providing people’s care. These values were emphasised in the induction attended by all staff and the agency had appointed a dignity champion to ensure dignity and respect were at the forefront of the agency’s work. People told us their care workers always treated them in a respectful way and provided care in a way that maintained their dignity.
The agency was exceptionally responsive to people’s individual needs, including when their needs changed. We heard many examples of care staff and managers supporting people and their families at short notice, often in their own time and with tasks unrelated to their agreed care package. People and their relatives told us they valued this responsiveness highly. Some people said the flexible support provided by they agency enabled them to live independently when they would not otherwise be able to do so. Relatives said this flexibility enabled them to make sure their family members received the care they needed when their own commitments changed.
The agency ensured that people were assigned care workers who were not only able to meet their care needs but whose interests they shared and whose co