MHA Care at Home - Rosetti Branch

Methodist Homes Associate Care at Home – Rosetti branch is a domiciliary care agency and extra care housing service. It provides personal care to people living in specialist ‘extra care’ housing. Extra care housing is purpose built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements.

The Care Quality Commission does not regulate premises used for extra care housing; this inspection looked at people who received a ‘personal care’ service only at Norah Bellot Court. There were 17 people receiving this regulated activity on the days of inspection and this totalled a number of 107 care hours per week.

At our last inspection, we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

People spoke highly of Norah Bellot Court and enjoyed living there. One person likened it to winning the lottery.

There were sufficient staff available to meet people’s care, support, security and wellbeing. A robust recruitment and selection process ensured only staff who had the right skills and were suitable to work with people living at the home. Staff underwent a thorough induction process and received regular training and updating in their job roles. Their practice was regularly checked and staff supervisions carried out.

Staff were kind, caring and liked by people. People spoke fondly of them and were comfortable in the presence of staff. Meaningful interactions and relationships had developed. People were supported to maintain their independence and help themselves as much as they could.

Staff spoke unanimously about Norah Bellot Court being a good place to work and that they were proud to work there. All staff spoke well of the registered manager and felt included, supported and valued by them. Staff worked well as a team and cared for each other as well as the people they looked after. There were incentives in place and recognition for staff for good practice.

Each person had a care plan in place which reflected their care needs and had any risks identified and managed. People’s medicines were managed safely and staff ensured people’s health and social care needs were met.

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 had a good working knowledge of the Mental Capacity Act 2005 and how it was embedded in their practice.

A variety of activities took place and people were encouraged and welcomed to join others in the communal areas to prevent social isolation and build relationships with each other.

People were supported to maintain a healthy balanced and nutritious diet and took advantage of the restaurant on site.

There was a variety of continuous monitoring of the service with a variety of systems in place to do this. Complaints were dealt with swiftly and resolved before they became an issue.

Further information is in the detailed findings below.

Norah Bellot Court is an ‘extra care housing’ scheme run by the charitable organisation Methodist Homes Association (MHA). ‘Extra care housing’ is a scheme where people can buy or rent their own homes, which means they have choice and control over who can enter their premises. Not everyone who lives in these types of schemes receive regulated care. People have separate contractual agreements for their accommodation and their care. This means people can choose whether they wish to receive their planned care and support by, either staff based at the site, or by an external agency.

At Norah Bellot Court, there were 46 flats available for people to rent. Each person had their own front door. The registered manager promoted community living and recognised the importance of social contact and friendship. People were able to meet and spend time with others in the communal areas on the ground floor. People received their core package of care during the day but staff also responded to an emergency call service. There was one care worker on duty at the scheme during the night to respond to urgent calls.

At the time of the inspection, 33 people were receiving care or support from MHA staff. Approximately 23 care staff were employed. As support was a non-regulated activity, we only looked at those people who received a personal care service. The times of care visits ranged from 15 minutes to 45 minutes. The frequency of care visits ranged from once a week to 28 visits a week.

There was a registered manager in post. 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 received care suitable for their needs. Staff knew people well, understood them and cared for them as individuals. People were relaxed and comfortable with the care staff who supported them. There was a low staff turnover which meant people received care from care staff they were familiar with. Care staff spoke to people in a respectful and kind way. They promoted choice and encouraged people to remain independent. Two people said, “The staff are very kind … they are very, very respectful” and “They are kind … I just have to ask if I want anything … very nice … I’m very happy.”

Care staff were safely recruited. They were well trained, motivated and enjoyed their work. They felt involved in people’s care. They received regular supervision and felt supported by the registered manager. One care worker said, “She gives the best support and the team is involved in people’s care.” Care staff had a good understanding of safeguarding and knew how to recognise the different types of abuse. They knew the correct action to take and who to report any concerns to.

Each person had a care file and suitable risk assessments in place. Although people’s needs were being met, the care files did not always contain the information required. Health and social care professionals were included in people’s care and their advice acted upon.

People were assisted to take their prescribed medicines. These were kept secure in their own flats. Although people received their medicines and creams on time, it was not always recorded to say they had been given. Accidents and incidents were monitored, analysed and reported upon if necessary.

People were encouraged to eat a well-balanced diet and make healthy eating choices.

There was a complaints policy and procedure in place with information about how to raise concerns or complaints.

The culture at the service was open and welcoming. People and their relatives were very complimentary of the scheme, the registered manager and care staff. One relative said, “The whole set up here is a blue print of how things should be run … the staff are absolutely wonderful … there is always laughter.”

There was a range of quality monitoring arrangements in place which the provider used to improve the service. However, these had not picked up the shortfalls in some of the record keeping.

MHA had clear values about the service which the registered manager and care staff promoted.

We met and spoke with the registered manager and four members of staff. We visited and spoke with five people who were receiving care from the service and one person who had recently used the service.

The focus of the inspection was to answer five key questions;

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found the service was safe. This was because people, who received support from the service, told us staff looked after them and met their needs in a caring and helpful way. One person said "they are all polite, kind and helpful". Another person said "very efficient, first class" and "some staff are really very good, but some staff are just excellent".

There was an open and inclusive culture at the service. People told us they could bring up any concerns with the registered manager and they would be acted upon.

Recruitment practices were safe and thorough. Policies and procedures were in place to ensure that unsafe practice was identified and people were protected.

Staff were well trained and supported to do their jobs properly. They told us they had "lots of training" and "we are always asked what training we need". They told us they felt "valued" and that senior staff were approachable for advice if needed.

The registered manager closely monitored the dependency of the people who used the service. This ensured that there was enough staff on duty at all times.

Safeguarding procedures were robust and staff understood how to protect the people they supported. One person told us "I feel very safe with them (the staff)".

People told us they had choices in their everyday lives and staff supported them to stay as independent as possible. We saw people were involved in the planning of their care. Care and support was planned and delivered in a way that met their needs. Within each person's care file, we saw that comprehensive assessments, plans of care and risks had been identified so that staff could give care in a consistent way.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. However, this does not apply to this domiciliary care agency.

Is the service effective?

We found the service was effective because people told us that the service supported them to live their lives in the way they wanted.

Staff showed a good understanding of people's care and they knew them well. People were very complimentary of the staff. Comments included "they (the staff) are very efficient, kind and sweet", "very nice - all of them really" and "very efficient, first class". One person told us "it's the best place I have ever been".

Is the service caring?

We found the service was caring because staff listened to people's requests about how they wanted their care to be delivered, treated people with respect and dignity and maintained people's independence as much as possible. People told us that staff always asked permission before carrying out any care and gained their consent. One person told us "they are polite and respectful" and another said "they are polite and always ask if there is anything else they can do".

Is the service responsive?

We found the service was responsive because systems were in place for ensuring people's views were listened to. The registered manager ensured that people's 'niggles' were resolved before they became a major concern. Staff told us they felt comfortable approaching senior staff with any concerns and their opinions would be listened to.

Where people's needs had changed, staff made sure this was reported to senior staff. Care plans and risk assessments were reviewed and staff made aware of the changes.

Is the service well-led?

We found the service was well-led by the registered manager and senior care assistant. There was an on-call system in place. This ensured a senior member of staff was always contactable for advice or guidance.

There was a staffing structure in place with clear lines of reporting and accountability. Staff told us they felt part of a team and were supported by other staff and the provider's management.

The service had systems in place to review and monitor the quality of the care and support being provided. This included reviews of care, audits, review of records, staff supervision, observations of staff practice, meetings and quality assurance surveys.

During this inspection we looked at the care files for four people, spoke with five staff including the manager and also spent time talking with eight people who used the service. We looked at recruitment files and records relating to management of people's medicines as well as training records and the medicines management policy.

People we spoke with about the service were very positive. Comments included ''The carers here are all very good '' and ''They do everything I ask of them, all the care staff are very good, very caring and very nice.'' We saw care and support was being well planned and delivered by a staff team who knew people's needs and understood their wishes and preferences.

Where people were being assisted with their medications, staff had received training and support to complete this task and their practice was reviewed and monitored. There was clear medications policy for staff to follow. We heard from one person receiving the service ''They make sure I am taking my medications, they don't leave the flat until they have seen me swallow my tablets''.

We found the recruitment process was robust and helped to protect people from being cared for by staff who may not be suitable to work with vulnerable people.

The service had a complaints process and everyone we spoke with said they would be confident to make any concerns known to staff or the manager. Where complaints had been made, the service had recorded what they had done to investigate and what had been identified to resolve and prevent further issues arising. This showed they listened to concerns and acted upon them.

We looked at three care plans in detail, which showed us that care and support was well planned and in line with people's needs, wishes and preferences.

We saw that there were good systems in place for ensuring people's views, concerns and opinions were listened to.

People using this agency were supported by a team of staff that understood their needs and had received training to do their job effectively. The service had ensured that staff had support and training to understand abuse and safeguard vulnerable people.