Home Instead

Home Instead is a domiciliary care service providing personal care to people in their own homes. It provides a service to older people and younger adults as well as people who may be living with a learning disability or autistic spectrum disorder, dementia, mental health needs, a physical disability or a sensory impairment. At the time of our inspection there were 110 people receiving support from this service. Sixty-nine people were receiving a regulated activity.

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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Right Support:

People were supported by a service which promoted choice, control and independence. Staffing levels ensured people’s needs were met and staff told us they received regular training. People who were supported with their medicines received these as they should. However, care plans did not always contain the most up-to-date information about people’s medicines and appropriate information about the application of topical creams was not in place.

We have made a recommendation about the management of some medicines.

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.

Right Care:

Risk assessments were in place. However, control measures had not been regularly reviewed. People received person-centred care which met their individual needs and preferences. People were always treated with dignity and respect. Staff understood their responsibility to protect people from abuse and were clear about how to report concerns. Staff were confident these would be acted upon.

Right Culture:

The service did not have a scheduled approach to audits and governance checks. Care plan reviews had not been undertaken regularly as planned. There was no clarity about whether staff had received checks on their competency, although we observed some of these checks had been undertaken.

We have made a recommendation about how the provider ensures good governance and oversight of the service.

The service had an empowering culture with clearly defined outcomes for people. People and their relatives were communicated with regularly. People and relatives were involved in developing people’s care plans.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 January 2018).

Why we inspected

This inspection was part of CQC’s scheduled inspection approach.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Home Instead on our website at www.cqc.org.uk.

Recommendations

We have made recommendations to the provider about medicines and governance. We will review these recommendations at the next inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This inspection took place on 1 and 8 November 2017 and was announced. The provider was given 48 hours’ notice of our inspection, because we needed to make sure someone would be in the location office when we visited. At the time of our inspection, the service supported approximately 90 mainly older people who lived in Harrogate, Ripon, Thirsk and the surrounding villages.

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 Regulations about how the service is run.

At the last inspection in July 2015, the service was rated ‘Good’. At this inspection, we found the service remained ‘Good’.

People told us they felt safe with the support staff provided. Systems were in place to ensure sufficient numbers of suitable staff were deployed to meet people’s needs. Risks were identified and assessed. Care plans and risk assessments provided guidance to staff on how to safely meet people’s needs. People were supported to take their prescribed medicines. More robust audits had been introduced to monitor and address shortfalls in the records relating to the support provided with people’s medicines.

Staff received on-going training and support to enable them to provide effective care in line with evidenced based guidance. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff supported people to ensure they ate and drank enough and, where necessary, to access healthcare services.

Staff were kind, caring and compassionate. Staff supported people to have choice and control over how their care and support was provided. People told us staff were good at maintaining their privacy and dignity and treated them with respect.

Care was person-centred and tailored to meet people’s needs in line with their individual preferences. People told us they felt able to raise any issues or concerns and we saw action was taken in response to feedback to improve the service provided.

The service was well-led. People told us management were approachable and supportive. We found the provider and registered manager were committed to providing high quality care and support and to continually improving the service. The provider was proactive in sharing their knowledge and expertise with those in the wider community.

Further information is in the detailed findings below.

People expressed a high level of satisfaction with the care provided. We were told that care staff turned up at the correct time and stayed for the time allocated to them. The majority of records showed and people confirmed that they had a regular group of care staff that looked after them. People said this was important to them. Comments from people included 'I think it is very good", "The staff fill you with confidence" and "I am very satisfied." We were told that the care delivered was in line with the agreed care plan. This helped to ensure that people's needs were being met.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. All the people we spoke with told us they felt safe when the care staff went into their or their relatives home.

We saw appropriate checks were undertaken before staff began work.

Records showed that complaints were appropriately recorded and investigated. People were provided with information on how to complain when they first started to receive support.

All of the people we spoke with said they were satisfied with the care they received. Comments they made included, 'They (the care staff) are polite and helpful.' Another person said, 'They always ask me before they do anything.' We saw evidence of the care packages being reviewed and these was signed by the person who received care or their representative. This showed that people were central to care delivery.

People told us the care staff always had enough time to support them and this helped them to feel safe. In addition we were told that they always had the same carer and at holiday times one person said,' It is negotiated with me who will be coming to help me.'

We found that the provider had systems in place to assess and monitor the quality of the service provided. This included an annual 'satisfaction survey' which was sent to the people who used the service and their relatives. This was to gain information about how they see the service and what, if any changes they would like to see.