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Inspection carried out on 3 August 2018

During a routine inspection

This inspection took place on 3 and 6 August 2018. This was an announced inspection as Chrome Tree Ltd is a Domiciliary Care Agency (DCA) and we needed to be sure someone would be at the office. A DCA is a provision that offers specific hours of care and support to a person in their own home. The service currently supported 72 people with the regulated activity of personal care, and employed 32 staff on a zero hours contract.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information 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.

At the time of the inspection a registered manager was 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.

The service remained safe. Sufficient staff were employed to manage people’s needs, and enable them to engage in activities of their choice, through appropriate risk management. Staff knew how to safeguard people from abuse and were aware of the protocols to follow should they have concerns. Staff reported that they would not hesitate to whistle-blow if the need arose. Where staff were involved in medicine management, these were managed safely. Staff were competency checked annually and audits were completed to ensure people were kept safe.

The service had improved in the domain of effective. Systems were now in place to ensure records were maintained for any best interest decisions made by the service. Support continued to be delivered by a trained staff team, who were able to respond appropriately to people’s changing needs. Staff were supervised and supported by an effective management team, who made certain they were available to staff at all times. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The service remained caring. Staff were reported to be polite, respectful and ensured they maintained people’s dignity when supporting them. They encouraged open communication and worked on motivating people to increase their independence. Evidence of using systems of communication that reflected the person’s choice was evident. Where concerns had been identified of staff proficiency in English, the service considered ways to make improvements.

The service remained responsive. Care plans were individualised, focusing on people’s specific needs. The service took necessary action to prevent and minimise the potential of social isolation. People and staff were protected from discrimination. Measures were in place to allow people to be treated equally. Systems to monitor and investigate complaints were in place, with detailed records maintained.

The service had developed methods of good governance, that provided real time evaluation of practice. A thorough quality assurance audit was completed annually with an action plan being generated, and followed up on. Feedback was encouraged from people, visitors and stakeholders and used to improve and make changes to the service. We found evidence of compliments and complaints that illustrated transparency in management . The service was well-led.

Inspection carried out on 30 November, 2 & 3 December 2015

During a routine inspection

Chrome Tree Limited is registered to provide domiciliary care to people who require support and assistance in their homes in the Slough area. On the day of our visit there were 67 people using the service.

The registered manager has been in post since March 2012. 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.

People and their relatives felt the service was caring and talked about how staff showed this in the way the care was provided. One relative commented, “When giving X a bath, they (staff) do this is a thoughtful and sensitive way.”

People said staff promoted their independence and supported them to exercise choice. Staff had established good working relationships with the people they supported and had a good understanding of their care needs.

People and their relatives felt staff were experienced and skilled to provide care to them. Comments included, “Yes, X (staff) does all we need”, “They know what they’re doing“, “Basically, they do what is needed” and “Some don’t know what they’re doing but are paired up with experienced staff.”

People and their relatives said the care provided was centred on their wishes. They were able to express their views on the care delivered and were able to give input on the changes that were required. We noted care plans were reviewed and changed to ensure they fully met people’s needs and was provided for in the way that people preferred.

People said they felt safe and knew who to speak with if they felt unsafe. Staff knew how to protect people from abuse, and how to respond if they had concerns. For instance, one staff member commented, “We look for signs of abuse or neglect and report it to the office. We have to take full details from people who report abuse to our manager.” We found this to be in line with the service’s safeguarding policy and procedure.

Safe recruitment processes and checks were in place and being followed. Risk assessments were undertaken and in place to ensure people’s safety. Care records showed where people had identified at risks appropriate measures were put in place.

People who received support from staff with their medicines said their medicines were managed safely. Staff described what they did to ensure medicines were administered safely. This was in line with the service’s medicine policy.

Staff received appropriate induction, training and supervision.

Staff was aware of the implication for their care practice in regards to the Mental Capacity Act 2005 (MCA). Where people did not have capacity to make specific decisions, the service did not carry out mental capacity assessments. Care records did not show who had legal powers to make important decisions on their behalf. We have made a recommendation for the service to seek guidance on undertaking mental capacity assessments and obtaining legal powers of attorney, based upon the Mental Capacity Act 2005.

People said they knew how to make a complaint and were given information on how to do this. Staff knew how to handle complaints and confidently spoke about the procedures they would follow. We found this was in line with the service’s complaints policy.

People were supported to maintain good health and had access to healthcare services.

The service had effective quality assurance monitoring systems in place to improve the quality and safety of people who used the service.

Inspection carried out on 27 February 2014

During a routine inspection

We found that staff consulted with people who used the service or their advocates in order to gain their consent.

People's health and welfare needs were being met and they told us that they were happy with the support provided.

We found the management of medicines to be safe and appropriate to people's needs.

Staff were trained to ensure they were competent and they were well supported by the manager.

The quality of the service was being monitored and systems were in place to manage risks to people's health, welfare and safety.

Inspection carried out on 21 February 2013

During a routine inspection

We spoke with or received feedback from five people who received care and support from Chrome Tree Limited including one person who had only recently started to receive care. They told us they had a very thorough assessment carried out. This had identified their needs and enabled them to discuss with the provider how they would like them to be met.The person told us the care experience so far had been "very satisfactory". We saw recorded reviews of care plans and risk assessments. We saw evidence of monitoring calls and interaction between the manager and people who used the service in order to review how care was progressing.

People told us they felt safe and had no concerns about the competence or care practice of staff. We spoke with a local authority commissioner of care. They confirmed they had not received any information of concern about the provider or the safety or quality of service provided. We spoke with one member of the staff team who provided care to people. They confirmed they had received safeguarding of adults training. This showed people were supported and protected through training provided for staff.

When we looked at the recruitment record for staff we found appropriate checks were undertaken before staff began work to protect people who received care.

People told us they felt very confident in the willingness of the provider to listen to any concerns and take action to deal with them where it was possible to do so.