Home Instead Bath and West Wilts

Home Instead Senior Care Bath and West Wilts is registered to provide personal care to people in their own homes. There were up to 112 people using the service. 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.

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

Medicine systems were audited regularly, and action plans were developed where gaps were identified. However, there had been a number of medicine errors where staff had not recorded the medicines administered. The providers were taking action to prevent further errors. An electronic system of recording medicines administered was to be introduced.

People’s needs were assessed before the service agreed to deliver personal care. Care plans were individualised with people’s background information and their preferences. Their abilities to manage their care and how staff delivered personal care was part of the care plan. However, the priorities of care and wishes were not consolidated for one person receiving end of life care. We recommend the provider introduce end of life care plans for people receiving palliative care.

People told us they felt safe with the staff. Safeguarding information and procedures were on display in the office and staff room. Safeguarding referrals were made appropriately.

Systems were in place to manage risk. Where risks were identified individual risk assessments action plans were in place on how to minimise the risk. People’s environment was assessed to ensure the safety of people and others.

There was an online system of recording accidents and incident. Reports were reviewed and the follow-up action to prevent any further reoccurrences was detailed They were also analysed to identify patterns and trends such as persistent medicine errors

Staffing levels were determined by the needs of people.

New staff had an induction when they started work for the service. The staff attended the training that ensured people's needs were met and were supported with their performance and development. Performance was monitored through one to one supervision, observations and annual appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way. People had capacity to consent to their care and treatment. Some people had nominated Lasting Power of Attorney and the provider had checked the status of the legal document with the office of the public guardian. Where people had capacity and deferred consent to their relatives this needed to be made clear in the documents.

People managed their healthcare. The staff reported concerns about people’s healthcare. There were electronic records of health care visits which included the nature of the visits and the outcome.

People and relatives were complimentary about the service. They told us the staff were kind, caring and they would recommend them. They told us their personal care was delivered by staff that knew their preferences and the matching of people to staff ensured relationships were built.” We saw photos of when the staff were caring towards people. The staff told us there was always time during their visits to sit and chat with people. The deputy manager told us they ensured the staff employed were caring and compassionate.

Complaints were investigated and resolved. People told us their concerns were resolved whenever they raised concerns.

Quality assurance systems were effective. The national office completed audits of outcomes and the providers developed improvement plans on how to meet shortfalls identified. The views of people and staff about the agency was gathered through questionnaires. Actions were added to the improvement plan from feedback received through surveys.

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 Outstanding (published 7 February 2017) in brackets.

Why we inspected

This was a planned inspection based on the previous rating.

Home Instead Senior Care provides domiciliary care and support to around 100 people living in Bath and Wiltshire and the surrounding area. There were around 30 people receiving personal care when we carried out the inspection. Home Instead Senior Care is part of a franchise that delivers care to people in many areas of the United Kingdom. The services provided included support with personal care such as assistance with bathing and dressing. It also included support with eating and drinking, medicines and home help covering all aspects of day to day housework.

There was a registered manager for the service. 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 who needed support with their medicines were supported by staff to receive them safely. This was because the staff had completed in depth training in safe handling and administration of medicines. There were safe systems and processes in place to help to protect people from the risk of harm. For example, new staff were only recruited after a robust recruitment procedure was undertaken. When selecting new staff the agency placed a strong emphasis on the candidates caring approach and life history so far as well as previous experience in the care industry. This was to help them recruit staff that were suitable to work with the people who used the service. For example staff who were very extrovert or introvert were matched with people who wanted support from staff who matched their own personality.

People felt safe and staff knew what the different types of abuse were and what constituted poor practice. Staff knew the correct action to take if abuse was suspected. Risks to people were well managed. Care records contained up to date guidance as well as detailed risk assessments. These were updated regularly when people's needs changed. Accidents and incidents were closely monitored. If actions were required after an incident these were discussed with staff and the people involved.

People received a consistently high standard of care and support. The staff were led by an experienced and proactive registered manager and provider. The team were very motivated and committed to ensuring each person had a good quality of life and were able to stay independent.

People told us staff were very kind and caring and knew how to provide the care and support they needed. People and their relatives were all very positive about the caring attitude and approach of the staff. People repeatedly told us that the agency was “The best in the area.” Staff demonstrated that they knew each person they visited as a unique individual. Staff told us, people mattered to them and every staff member told us that they loved their work.

The staff knew the people they supported very well. They knew each person's personal life histories and were matched with people according to their needs, wishes and interest’s .People were fully involved in planning how they were cared for and supported. Care records were person centred and written to meet people's individual needs. Care plans were reviewed regularly with the involvement of the person concerned.

The staff felt they always had access to the information they needed to meet people's needs, including receiving regular up to date information. Changes in people's needs were identified and their care packages were updated to meet their changing needs. The service was flexible and responded in a positive way to people's requests when it could.

The provider used up to date technology to help them provide a service that was highly responsive to the needs of the people who used it. This meant it was easier to respond swiftly to any changes when they happened, during the day and night. For example, if a staff member was sick at the last minute.

People and their relatives were actively encouraged to make their views known and were involved in making decisions about their care. People knew how to make a complaint and were encouraged to share their views and opinions about the service they received. There were also independent surveys in place to allow people and their relatives the opportunity to feedback about the care and treatment they received.

There were effective quality assurance systems in place to monitor the quality of the service provided. The experiences of people who used the service were at the centre of how the service was checked and monitored.

The providers were very enthusiastic about how they wished the service to be provided through best practice and continuous improvement. These values were strongly shared by the staff team. There was a very positive and open culture within the service.

We visited the agency's office and spoke with the providers, the registered manager and three care givers. We spoke with three people who used the agency and received comments that included 'I have no query about them. I have the same girl for five days every week. They are very kind and thoughtful' and 'No concerns they are lovely. They look after me as much as possible'.

Care documentation provided care givers with detailed information about how people should be supported with their care. Risk assessments had been completed to ensure care givers knew how to support people through safe methods.

There were enough qualified, skilled and experienced care givers to meet people's needs. Those spoken with demonstrated a good understanding of how to recognise abuse so that people using the service were protected from harm. The provider had responded to any allegations of abuse appropriately.

There were systems in place to monitor the quality of the service included seeking the views of the people who used the agency and reviewing their care on a regular basis.

People told us that they received their support from the same care giver or a small team of care givers. The manager told us that they matched their staff to the person being supported and always introduced the care giver to the person before a service commenced.

The agency referred to their staff as care givers therefore we have used this term throughout our report. Care givers we spoke with talked confidently about the people they supported and demonstrated their competency in the role. They told us they received training and were well supported to do their job.

People were asked to provide feedback about the service they received.