Pathways to Opportunities

Pathways to Opportunities is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older people and younger adults with various needs, including people with learning disabilities. At the time of this inspection 12 people were 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

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.

Right Support:

People received good quality care. 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. Care plans were detailed and person-centred. The care plans provided guidance for staff about how best to support people's needs and preferences, and the outcomes to be achieved. People and relatives were involved in the care planning and regular reviews. Staff knew and understood people extremely well which led to good outcomes for people.

Right Care:

People received person-centred care of a high standard. People received kind and compassionate care. Everyone we spoke to as part of the inspection praised the service. Staff were kind, caring and understanding. Staff treated people with dignity and respect. Staff understood and responded to people’s individual needs. People's care needs were risk assessed and care plans provided staff with the information they needed to manage identified risks. People were protected from the risks of abuse and staff were trusted to keep them safe. Staff had received training in how to safeguard people. Medicines were managed safely, however, we have made recommendations about the provider reviewing their ‘as required’ (PRN) medicines systems and reviewing the frequency of staff medicine competency assessments.

Right Culture:

The culture of the service was friendly, open and transparent. The registered manager had clear values which included a passion for providing a high standard of care to people. These values were embedded into the service and staff members we spoke with. The registered manager and staff demonstrated a commitment to people, and they displayed person-centred values. People's choices were respected, and staff supported them to achieve good outcomes. The culture was open and inclusive. Staff said they enjoyed their roles and the relationships between staff and people was positive. Auditing systems were in place that enabled the registered managers to have effective oversight of the service and identify and respond to any improvements needed. People told us they felt safe and knew how to raise concerns.

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 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Recommendations

We have made recommendations about the provider reviewing their ‘as required’ (PRN) medicines systems and reviewing the frequency of staff medicine competency assessments.

Follow up

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

At the last inspection, which took place in December 2015. The service was given a rating of 'Good'. At that time we also found one breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. This related to the lack of appropriate systems to record and respond to complaints. At this inspection we saw improvements had been made and the service was meeting all regulations at this time.

This inspection took place on 8 March 2018 and was announced.

At this inspection we found the service remained 'Good'. We found that these standards had been maintained and improved further. The service was very well-led. Skilled and caring staff supported people in a person centred way. Staff embraced people's diversity and this was reflected in the care plans we saw.

There was a registered manager at the time of the inspection. 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 registered manager was based at the office five days per week supported by a team of management personnel. There was a manager available by telephone at all times.

During this inspection we reviewed a range of care records. Care plans were detailed, consistent and contained up to date information. Risk assessments were regularly reviewed and were updated accordingly.

Medicine management systems were in place. Medicine was only administered by staff who had received the appropriate training. Regular medicine audits were taking place and people received all medicines which were prescribed for them.

People were protected from abuse and supported to make their own choices. Risks were identified and managed effectively to protect people from avoidable harm. Recruitment processes were in place to make sure that people were protected from staff being employed that were not suitable.

People received support from a staff team that was well trained and supervised. Staff had the skills and support needed to deliver care to a good standard.

People benefitted from a staff team that was caring and respectful. Staff knew each person well and worked with them in a calm, caring and professional way. People's rights to confidentiality, dignity and privacy were respected. They were enabled and encouraged to develop and maintain their independence wherever possible.

Staff told us they enjoyed working at the service and felt supported by the registered manager.

Quality assurance systems were in place and regularly carried out by both the provider and registered manager. Feedback was sought from people who used the service, staff and relatives, this information was analysed, and action plans produced when needed.

The provider continues to work in partnership with other organisations and has taken part in good practice initiatives, designed to further develop the service and support other providers to develop their services.

People had their care needs assessed regularly. They had been asked about their preferred routines and their likes and dislikes. People told us they were treated respectfully by care workers. Their comments included 'Staff are prompt; they listen and don't rush me' and 'I would recommend the service and already have'.

Care workers understood the process for making a safeguarding referral if they thought a person was being abused. Safeguarding training was provided for staff during their induction process.

The provider had an in-depth recruitment process to help confirm staff members were of good character and had the required skills to perform their work.

The provider had a quality assurance and risk assessment system in place to protect people from the risk of inappropriate or unsafe care.