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Home Instead Senior Care - Luton & Central Bedfordshire Good

Reports


Inspection carried out on 14 March 2019

During a routine inspection

About the service:

Home Instead Senior Care – Luton and Central Bedfordshire is a domiciliary care agency. It provides personal care to people living in their own houses, flats and specialist housing in the community. It provides a service to adults. At the time of the inspection, 47 people were being supported by the service.

Not everyone using a domiciliary care agency receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

People’s experience of using this service:

People’s comments about the quality of the service varied. Most people were happy with how staff supported them, found staff to be skilled, caring and responsive to their needs. However, some people, relatives and staff did not find the provider to be always responsive to concerns raised about the service. They said their feedback was not always used to make consistent improvements. These comments meant that we rated Well-led ‘requires improvements’, but there were no breaches of regulations.

People were protected from harm by staff who had been trained and confident in recognising and reporting concerns. Potential risks to people health and wellbeing were assessed and minimised. There were enough staff to ensure people’s needs were met safely. People were supported well to manage their medicines because staff had been trained to do so safely. Staff followed effective processes to prevent the spread of infection.

Staff had been trained and had the right skills to meet people's needs effectively. Staff were well supported and had information to meet people’s assessed needs. Where required, staff supported people to have enough to eat and drink. Staff supported people to access healthcare services when required. This helped people to maintain their health and well-being.

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. People were involved in making decisions about their care and support. People and their relatives were involved in planning and reviewing care plans. People told us staff who supported them were caring and friendly. Staff respected and promoted people’s privacy, dignity and independence.

Information in people's care plans supported staff to deliver person-centred care and in a way that met people’s needs. The registered manager worked in partnership with other professionals to ensure that people received care that met their needs. There was a system to ensure people’s complaints were recorded, investigated, and acted upon to reduce the risk of recurrence. The service did not always support people at the end of their lives and therefore this information was not included in people’s care plans. However, the registered manager said they will include people’s wishes in their care plans as soon as possible.

Audits and quality monitoring checks were carried out regularly to make the required improvements quickly. The provider had systems to enable people to provide feedback about their experiences of the service. The registered manager said they will further improve these systems to ensure people had more opportunities to provide feedback.

Rating at last inspection:

The service was rated 'requires improvement' when we last inspected it. That report was published in March 2018.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor all information we receive about the service and schedule the next inspection accordingly.

Inspection carried out on 17 January 2018

During a routine inspection

We inspected Home Instead Luton in July 2015 and rated the home as Good. When we revisited the service in January 2018 we rated the service as Requires Improvement overall. This is the first time Home Instead Luton has been rated as Requires Improvement since the service was registered in 13 December 2012. This inspection was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults.

Not everyone using Home Instead Luton receives the regulated activity; the care quality commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of this inspection Home Instead Luton were supporting 56 people.

There was 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. There was also a day to day manager at the service. For the purpose of the report this person will be referred to as the manager.

People had risk assessments and care plans in place but these did not always capture people’s needs. These plans lacked information to fully guide staff when they supported people. These plans also did not clearly state or had enough information to always help staff understand the risks which people faced. Staff did not always have clear guidance when supporting people who were a risk of falls.

Training which staff received did not always cover areas relevant to the people they were supporting. The management team were not checking if the training had always been effective and did not check staff had retained key information important to their work.

The competency checks completed to see if staff were competent to work independently after their induction and during their time at the service were not robust. They did not evidence that it was a robust competency check or how the assessor reached their decisions.

The services auditing processes were not robust because they had not identified the issues which we had found.

These issues constituted a breach in the legal requirements of the law. There was a breach of Regulation 12, 18, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we asked the provider to take at the back of the full version of the report.

When we spoke with people and the staff we found out that there had been some recent shortfalls in the delivery of care. Some people’s care visits had been cancelled due to staffing levels. This was not everyone’s experience but it had affected some people’s confidence that they would receive their care visits. Some people told us that they had not received rotas and their regular staff had left or had told them they were planning to leave. Some staff felt under pressure to work additional hours. The management team said they were not aware of these issues.

The management team did not have an effective contingency plan in place, to manage situations when there was a reduced number of staff, available to support people.

Staff had a limited understanding about what could constitute a potential safeguarding event. Staff were also not clear about how to protect people from discrimination.

Auditing processes in relation to people receiving their prescribed medicines identified shortfalls in staff practice, but the solution provided was not effective. Nor were these issues identified in a timely way.

People said they were supported by staff who were consistently kind, thoughtful, and caring. Both the people who

Inspection carried out on 30 June 2015

During a routine inspection

We carried out an announced inspection on 30 June 2015. Between this date and 13 July 2015, we spoke with care staff, people who used the service and their relatives or friends by phone.

The service provided care and support to adults in their own homes. People supported by the service were living with a variety of needs including chronic health conditions, physical disabilities and dementia. At the time of the inspection, 32 people were being supported by the service.

The service has a registered manager, who is also the provider. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from the risk of possible harm.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities to seek people’s consent prior to care being provided.

Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff that went over and beyond expectations of their role to ensure that people lived happy and fulfilled lives.

People were supported to pursue their interests and hobbies.

People had been assessed, and care plans took account of their individual needs, preferences, and choices.

People were supported to access other health and social care services when required.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service.

The provider had effective quality monitoring processes in place. They engaged external auditors to assure themselves that their systems were still fit for purpose.

Inspection carried out on 18, 23 July 2013

During a routine inspection

We spoke with 15 people who use the service, five staff and the registered manager. People said that they were happy with the care provided and that staff respected their privacy and dignity. A person using the service said, “They respond to whatever I need they more than do their best to treat me with respect and dignity they are just so polite”. Another person said, “They knock on the door and ask if they can come into the bathroom to help me and shield me when I’m having a wash”.

We found that people’s needs had been assessed to ensure the care they received was safe and effective.

The agency had procedures in place to ensure that people were safeguarded against the risk of abuse and staff had been provided with appropriate training. However, we found that those procedures may not always have been followed.

We found that the agency had effective recruitment procedures to ensure appropriate checks were undertaken before staff commenced work. Staff were appropriately supported and provided with regular supervision and appraisal to enable them to deliver safe and effective care to people who use the service.

We found that the agency had a system in place to assess and monitor the care provided to people. This ensured people's views were listened to, acted on and addressed in a timely manner.