2, 3 April 2014
During a routine inspection
Below is a summary of what we found. If you wish to see the detailed evidence supporting our summary please read our full report.
Is the service safe?
At the time of our inspection there were 70 people being supported in their homes by 25 staff. We spoke with seven people who used the service, five relatives, the registered manager, an area manager, a care coordinator and seven care staff.
People told us that they felt safe and trusted the staff. We found that people service were protected from the risk of abuse because the provider had appropriate procedures with respect to safeguarding vulnerable adults. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.
The provider had procedures in place to ensure the safe management of medicines. Staff told that they had received training and been assessed in the administration of medicines. We found that staff had effectively recorded medication prompted and were able to tell us what action to take if there was an error.
There were systems in place which made sure that the provider and staff learned from events such as accidents, incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. For example we saw that alterations had been made to fixtures and fittings within a person's home to ensure that identified risks had been reduced to a minimum.
Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives. One person we visited told us, 'I want to remain independent and stay in my own home as long as I can and they have helped make this possible.' We looked at this person's risk assessments and observed practice delivered in line with their care plan.
The provider had procedures which gave staff clear guidance about what to do if people did not answer the door or if they were found on the floor. Staff we spoke with clearly knew and understood this guidance and the appropriate action to take in such circumstances.
The agency had a thorough recruitment process which ensured people were cared for by reliable trustworthy staff.
The Deprivation of Liberty Safeguards is a code of practice to supplement the Mental Capacity Act 2005. They are designed to ensure that people lacking capacity are not deprived of their liberty, other than in accordance with the law. At the time of our inspection the agency did not provide support to anyone who was subject to Deprivation of Liberty Safeguards. However the manager understood the process and knew how to make an application if this became necessary.
Staff we spoke with told us how important it was to make sure that people had consented before providing their care. Staff told us that they had received training about the Mental Capacity Act during their induction course, which had been linked to their dementia awareness training. We saw certificates to confirm this in the nine staff files we reviewed. We read quarterly quality assurance questionnaires which had confirmed that staff had sought valid consent from people they supported.
Is the service effective?
We looked at nine people's care records and found that they had been reviewed every six months or more frequently if required. We saw that one person had a degenerative condition which meant their care plan was subject to constant review by the area manager. People said that their care plans were up to date and reflected their current needs, which was confirmed by the records we reviewed. This meant that the provider had ensured that people's changing needs had been identified and met.
Is the service caring?
We spoke with 12 people who had been supported by the service who made positive comments about the staff. People told us that they felt their rights and dignity were respected. One person told us 'The staff are wonderful and really care for me. They never rush and make me feel that I am their main priority.' Another person said, 'I look forward to their visits and it is the extra little things they do without asking that mean so much and show they really care.' We spoke with staff who were dedicated and cared for the people they supported. We observed care practices where people were supported in a caring professional manner, with genuine warmth and compassion.
Is the service responsive?
People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary needs had been identified where required. During a home visit we spoke with staff who knew how to support a person eating to minimise the risk of choking whilst consuming a high calorie diet.
People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.
People knew how to make a complaint if they were unhappy but told us that it had not been necessary. They told us that they frequently received visits from the area manager who was 'very friendly and approachable'. One person said, 'If I need anything I just speak with the girls or tell the manager over a cup of tea.' The provider had an appropriate complaints system, although none had been recorded since our last inspection. Staff we spoke with were aware of their responsibility to report and record any complaints.
Is the service well-led?
The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. People who used the service, their relatives and other professionals completed an annual satisfaction survey. This was supplemented by quarterly quality assurance telephone calls and visits made by the area manager. Staff told us they were clear about their roles and had a good understanding of the values of the service. This helped to ensure that people received a good quality service at all times.