St Micheal Care Limited t/a HomeInstead Senior Care Also known as St Micheal Care Limited (Home Instead Senior Care)

St Micheal Care Limited t/a Home Instead Senior Care is a care agency providing personal care and support to people living in their own homes, mainly in the London borough of Hammersmith and Fulham. They provide care to a small number of people living in the neighbouring boroughs.

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.

At the time of our inspection, the agency was providing personal care to 31 older people. Some people had live-in care workers. This meant they had a care worker who stayed with them during the day and night. Other people had regular visits throughout the day. The minimum visit was for 1 hour.

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

People received extremely good quality care which met their needs and reflected their preferences. The agency worked with others to help develop best practice. Their work had a significant impact for people and their overall experience. For example, work to improve people's diet and mental stimulation.

The agency took a holistic approach to care. They worked with families and health professionals to understand people's needs and suggest ways to improve people's lives and wellbeing. They used technology in innovative ways to help keep people safe and to educate staff to help them understand about people's sensory experiences.

The agency was an important contributor to the local community, providing opportunities for people to socialise. These events were open to all people living locally and not just those paying for their care. They worked with charities and universities to research and implement new ways of supporting people by learning about dementia, and other conditions associated with older age.

The staff were exceptionally well trained. Their training included immersive experiences, group analysis of their experiences as care professionals and learning from professionals.

The provider was forward thinking and had plans to develop the service in response to the needs of people and the local community. For example, they were in the process of recruiting a specialist dementia nurse to provide bespoke guidance and training for groups of staff working with individual people and they had already employed a nutritionist who was helping to improve people's diet and attitude towards food.

There were systems to monitoring and audit the service. These included asking others for feedback, responding to, and learning from adverse events. The registered manager was well known by people using the service, their relatives, staff and the local community. They all found the registered manager approachable and valued their views and input.

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.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 20 August 2019).

Why we inspected

We undertook this inspection based on the date of the last inspection.

Follow up

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

St. Michael Care Limited t/a Home instead Senior is a domically care agency (DCA) registered to provide personal care and support to people living in their own homes. It provides a service to people living with dementia, older people and people with learning disabilities. They also provide other services that are not registered or regulated by the Care Quality Commission, such as offering companionship and preparing meals.

Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of our inspection 24 people were receiving personal care. The staff who provided personal care were called care givers.

People's experience of using the service

People and their relatives were very happy with the service. They told us that care givers came on time. They spoke of care givers being kind, caring and thoughtful. They told us that their needs were being met in a personalised way which reflected their preferences. They were involved in planning and reviewing their care and were able to contribute their ideas to improving the service.

The registered manager had developed good connections with other health care professionals and community-based organisations. This helped to achieve positive outcomes for people. People received their medicines in a safe way and as prescribed.

Care givers recognised the importance of providing company and social contact for people, while also meeting all their care needs. People were involved in all aspects of their care. Care givers supported people to participate in activities that were important to them.

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.

The care givers told us they liked working at the service. They felt well supported and had the training they needed. They told us they felt listened to and valued. There were systems to make sure only suitable staff were employed to care for people and that they received an induction into the service. The registered manager carried out regular assessments to make sure care givers had the skills and knowledge to care for people in a safe way.

People knew how to make a complaint and felt that these would be responded to. The care givers and registered manager were aware of their responsibilities to keep people safe, address any concerns and learn from incidents and accidents to help prevent reoccurrence.

The registered manager and management team were well respected by people using the service and other stakeholders. There were appropriate systems to monitor and improve the quality of the service.

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

Rating at the last inspection

The last rating for this service was Good (published 20 December 2016).

Why we inspected

This was a planned inspection based on the previous rating of the service at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St. Michael Care Limited t/a Home instead Senior Care provides personal care support to people in their own homes. They also provide other services that are not registered or regulated by the Care Quality Commission, such as offering companionship and preparing meals.

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 and associated Regulations about how the service is run.

This is the first inspection under the new methodology. In February 2014, our inspection found that the service met the regulation we inspected against.

People said they were pleased with the service provided and were notified of any changes to staff and the timing of their care. The designated tasks were carried out to their satisfaction and the staff team really cared. They thought the service provided was safe, effective, caring, responsive and well led.

People’s, staff and other records were kept up to date and covered all aspects of the care and support people received, their choices and identified and met their needs. They contained clearly recorded, fully completed, and regularly reviewed information that enabled staff to perform their duties well.

Staff where knowledgeable about the people they gave support to and the way people liked to be supported. They also worked well as a team when required, such as calls that may require two staff members. Staff provided care and support in a professional, friendly and supportive way that was focussed on the individual and they had appropriate skills to do so. Staff were well trained, knowledgeable and accessible to people using the service and their relatives. Staff said the organisation was a good one to work for and they enjoyed their work. They had access to good training, support and there were opportunities for career advancement.

People and their relatives were encouraged to discuss health and other needs with staff and had agreed information shared with GP’s and other community based health professionals, as appropriate. Staff protected people from nutrition and hydration associated risks by giving advice about healthy food options and balanced diets whilst still making sure people’s meal likes, dislikes and preferences were met.

The agency staff knew about the Mental Capacity Act and their responsibilities regarding it.

People told us the office, management team and organisation were approachable, responsive, encouraged feedback and frequently monitored and assessed the quality of the service provided.

At this inspection we found improvements in the recording and monitoring of people's medicines. We viewed the revised medicines policy and procedure dated January 2014. This outlined the roles and responsibilities of the staff who supported people using the service. We looked at the care records for three people using the service. We found detailed information recorded about people's support needs in relation to the medicines they were prescribed. We saw that identified risks in relation to medicines had been assessed and there was clear guidance for staff in relation to managing these risks. For example, in one person's records we read that they sometimes forgot to take their morning medicines. There was an expectation that staff monitored this and recorded and reported if the person had not taken their medicines.

Furthermore the manager told us that she had started completing medicine audits to ensure that staff were following the revised medicine policy and procedures for the service. We saw two audits that had been completed in January 2014. We saw that any gaps in the records had been identified and addressed with staff.

People were involved in the support and help they required from the service. Where possible they were asked and encouraged to give consent about how they wanted to be cared for. Relatives were also involved and included in planning the support needed. One relative confirmed they had seen and signed their family member's care plan.

People were supported effectively and had visits from a regular member of staff. People who use the service confirmed they knew who was coming to their home and that they had developed positive relationships with staff. One person told us 'I am clear what I want' and said the service responded quickly if they had a concern or wanted a different member of staff to visit them.

Staff received training on medicines management. However we found there were shortfalls in this area. There was limited information in people's care plans regarding the support people needed, such as prompting to take their prescribed medicines or if staff had to administer the medicine to the person. There were no records to show that any risks had been assessed with regard to medicines and if so how these would be managed. Therefore people using the service could be placed at risk of unsafe help and support.

There were systems in place to monitor the service. The manager and care manager contacted people on a regular basis and visited them to ensure they were happy with the service they received. Those people we spoke with confirmed they received phone calls and visits and were able to talk about any issues they might have with the service.

The service had a complaints procedure in place and responded to any comments or complaints made. People and the relative we talked with said they would be happy to talk to the service if they had a complaint.

People said they were satisfied with the care provided. We were informed that carer's monitored the person they were caring for and if there were any concerns or changes required communication was good.

Information was available on the services being offered by St. Michael Home Instead to assist people in making a decision about their care. The agency assessed people's personal care and social needs and aimed to provide a care worker who would understand their preferences and lifestyle.

People have a care plan which reflects their physical, emotional and social needs and ensures care is delivered safely.

The agency had policies and procedures in place to protect people from the risk of abuse.

The agency had a robust recruitment procedure in place for the selection of care staff. Staff received appropriate training, and regular planned supervision with their manager.

The agency had a system in place for auditing standards and asking people for their views on the service.