Home Instead

About the service:

Home Instead Senior Care is a domiciliary care agency which is registered to provide personal care and support to adults. It provides a range of services, including personal care, companionship, medication support, meal preparation and light housekeeping. The service operates in Saddleworth, Oldham and Tameside.

People’s experience of using this service:

Everyone we talked to, without exception, spoke very highly of the service, its staff and how it was managed. People told us staff were extremely caring and kind, and talked about having close relationships and friendships with them. People told us their privacy and dignity were always respected and that staff helped and encouraged them keep their independence.

People's needs and wishes were met by staff who knew them very well. There was a consistent staff team with people supported regularly by the same care giver. This ensured continuity of care. All the staff we spoke with showed a great commitment to supporting people in a person-centred and individualised way. Care plans were highly detailed and gave clear guidance on how each person wished to be supported in a manner that was unique to them. These were reviewed regularly.

Staff told us they loved their job and were proud to work for the organisation. They said they felt listened to and supported by the management team, who cared for them and their wellbeing. There was a positive workplace culture, as the organisation valued, encouraged and praised its staff.

Staff and management were well trained and had the support and supervision they needed to carry out their roles effectively. Both the registered manager and managing director were a visible presence within the service and led by example.

Staff were aware of how to report any concerns about neglect or abuse and were confident they would be addressed. There were systems in place to ensure only staff who were suitable to work with vulnerable people were recruited. The management team were committed to employing people who shared the values of the organisation. Where possible they ‘matched’ staff to people, so that they were supported by staff who shared the same interests. The registered manager told us, "We are quite specific about the people we employ."

People were supported safely and risks regarding their care were assessed and met. Staff took measures to prevent and control the spread of infection. There were systems in place for the safe management of medicines so that people received their medicines as prescribed.

The service had recently introduced electronic medicines records. The service was innovative and forward thinking. There were quality assurance processes in place and information from accidents, incidents, complaints, audits and feedback was used to deliver a high quality service and drive improvement.

People felt very involved in their care and were regularly contacted by the management team to check that the care they were receiving was as they wished and of a high standard.

The service had a strong community involvement, including an advice column in a local magazine, sponsoring a local café, speaking at dementia workshops and charity work. Staff told us they were proud to work for an organisation that promoted and encouraged work within its local community.

Rating at last inspection: Outstanding (report published November 2016).

Why we inspected:

This was a scheduled inspection, based upon the last rating.

Follow up:

We will continue to monitor the service through information we receive and future inspections.

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

The service was registered with CQC on 21 December 2012 and was last inspected on 11 July 2014, at which time the service was compliant with all regulatory standards.

Home Instead Senior Care is a domiciliary care provider based in Uppermill, Oldham, providing personal care and support to people in their own homes in the Oldham and Saddleworth area. There were 110 people using the service at the time of our inspection.

The service had a registered manager in place. 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.

We found the provider delivered outstanding levels of care that put the person’s needs at the forefront of care planning and decision making, and ensured extremely high levels of continuity and familiarity. People who used the service, relatives and healthcare professionals were unanimous in their descriptions of staff who went out of their way to ensure people were cared for well.

Staff were consistently described as compassionate, caring and having built positive relationships with the people they cared for and we found a range of evidence to support these opinions. People who used the service, relatives and staff felt having care calls of a minimum of one hour enabled these relationships to develop.

Staff were consistent in their extremely positive feedback about the levels of support they received from the registered manager and provider, both of whom were regularly on site. The registered manager displayed a sound understanding of the service and the needs of people who used the service, whilst the registered provider demonstrated both effective leadership of the service, as well as a passionate, innovative and varied approach to community engagement and involvement.

People who used the service, relatives and healthcare professionals we spoke with were consistent in their praise of the leadership of the service. The provider, registered manager and all staff we spoke with were consistent in their understanding of the principles of the service, as set out in the Statement of Purpose, and were passionate about caring for people.

The provider, registered manager and other staff developed and maintained a range of excellent community links to raise awareness of dementia, the risks to vulnerable adults, but also to celebrate and support people’s independence.

Recent responses from annual surveys demonstrated improvements against already extremely positive scores from the previous year. We found staff at all levels were aware of, and contributed to, a culture focussed on meeting people’s individual needs.

We saw that sufficient numbers of staff were on duty to meet the needs of people who used the service. Staff underwent a range of pre-employment checks to ensure they were suitable for the role.

We saw that no medicines errors had been made on the Medication Administration Records (MAR) we sampled and that the provider regularly checked staff competence to administer medicines.

We saw evidence that concerns regarding people’s safety had been appropriately managed and staff displayed a good knowledge of safeguarding principles. We found that risks were managed and reduced through pre-assessment and ongoing assessment of individual needs. People using the service felt safe and there was an out-of-hours phone line for people who used the service and staff in case of unforeseen circumstances.

We found evidence of consistent and prompt liaison with external healthcare professionals and other agencies in order to ensure people’s healthcare needs were met.

Induction training was comprehensive and in line with established national best practice, whilst ongoing refresher training and access to vocational qualifications was welcomed by all staff we spoke with. Training incorporated the latest National Institute for Health and Care Excellence (NICE) guidelines regarding care provided in people’s homes and Care Certificate standards. Training included safeguarding awareness, moving and handling, infection control, health and safety, first aid and handling medication.

Staff supervisions, appraisals and staff meetings all happened regularly. Staff told us they were well supported.

We saw that people were supported to contribute to their own care planning and review, whilst family members confirmed they were invited to take part in reviews and were regularly consulted and updated.

Where people’s needs changed, reviews were brought forward and care provision amended accordingly. People who used the service told us office staff were accommodating to changing needs.

Peoples' hobbies and interests were encouraged, with people supported to pursue their preferred activities as independently as practicable. The engagement officer had developed and was in the process of sharing a ‘What’s On’ guide, which gave people who used the service and the wider community information about local activities.

The provider had a complaints policy in place. People who used the service were made aware of the complaints procedure and told us they knew how to make a complaint and who to make it to, should the need arise.

An efficient auditing and quality assurance regime had been established and positive changes had been made to the management structure when an internal audit identified gaps.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

The summary is based on a visit to the service's office where we looked at records and talked to the registered manager, the assistant care manager and the training manager. We also spoke to the service provider. Following the visit we contacted, by telephone, a sample of people who used the service and relatives of people using the service. We also talked to some care staff.

The full report contains the evidence to support this summary.

Is the service safe?

Staff had received training in safeguarding which meant they understood what to look out for and what they should do if they had any concerns about poor practice or people's safety. Members of the management team maintained regular contact with the people who used the service to monitor the quality of the service and help ensure the people using the service were safe.

Health and safety assessments were undertaken as part of the care planning process. This helped to ensure the physical safety of people using the service and staff. Personal Protective Equipment was provided to staff.

People who used the service told us they felt safe and had good relationships with the carers who supported them. People knew how to contact office staff if they needed to. Managers were described as approachable and helpful. This means that any concerns about someone could be easily communicated.

Comments about the staff from people who used the service or their relatives included: '[staff are] friendly but don't take advantage' and '[the manager] would not send anyone she didn't trust'.

Staff who we asked, were confident that people who used the service were safe. They also told us they understood the need to report any poor or concerning practice and their responsibility to 'blow the whistle' if necessary.

Everybody who we asked were confident that anyone could complain if they were unhappy with any aspect of the service. People also told us they believed any complaint would be listened to and acted on.

Is the service effective?

The service was provided on the basis of an assessment of the individual's needs, undertaken by a senior member of staff and a written plan of care. People using the service, and when appropriate their representatives, were involved in discussing the best way for identified needs to be met.

Care and support plans were regularly reviewed and updated when necessary.

Staff were appropriately trained. They told us that the service provider encouraged them to pursue training opportunities. Staff also told us they were not asked to undertake any tasks which they were not trained to do effectively.

Regular spot checks were undertaken with people using the service to monitor the quality of the service. Other audit processes were in place, including checking on the relevance of the visit records. These actions would help to ensure that any weaknesses in the effectiveness of the service would be identified and rectified.

Is the service caring?

All the people using the service and their relatives who we spoke to were positive about the attitude of the staff and the management. Comments included: 'They {staff] are [like] part of the family and I can turn to them'; 'they have employed thoughtful caring women who have an interest in the job' and '[staff] are very thoughtful and we get on well together'.

Staff spoke positively about the people they supported. One person said 'I am passionate about looking after people how I would want to be looked after.' Another staff member, when asked what the best thing about the service was, said it 'put the patients first'.

Is the service responsive?

Care and support plans were regularly reviewed and updated if necessary. Staff were encouraged to notify managers of any changes to a person's circumstances so that a reassessment could be undertaken.

The service had a written complaints procedure. This included advice about how to pursue a complaint if dissatisfied with the outcome of the initial investigation. Staff, people who used the service and their relatives, who we asked, were confident that any complaint would be dealt with appropriately. One person said 'I could complain. I know the management team'. Other comments included 'they would listen and put it right' and 'I know that if I ring up I would get a response'.

Comprehensive quality monitoring and assurance systems were in place. These would help to enable the identification of any modifications to the service which may be beneficial.

Is the service well led?

There were clear lines of accountability within the service. Managers were described as approachable, supportive and responsive. People using the service and their relatives told us they were listened to and that their opinions were valued.

Communication within the service was good. Staff told us they felt well supported by managers who made themselves available for them. Comments from staff included: 'there is always someone on call. If you ring up they will give you support 24 hours a day': '[the manager and service provider are] the best people I have worked for ' the owner cares about the service' and '[I can] always pop in to the office'.

People told us the service was reliable.

Quality monitoring and assurance was well developed.

People consented to any care or support provided. They were involved in discussion about the nature of the service they required. People were provided with detailed information about their assessment and what support they could expect from the provider.

Some care workers supported people with their medication. There was appropriate training to enable them to do this safely.

Staff were only allowed to support people using the service after they had been rigorously vetted through the recruitment procedure. When talking about the care workers, comments from people using the service included: "I can't speak too highly of the care" and "all [the care workers] have been top-notch".