Jewel Home Support Ltd

Jewel Home Support is a domiciliary care agency providing personal care to people living in their own homes in the community. At the time of our inspection there were 126 people receiving a regulated activity from this 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

Systems in place helped safeguard people from the risk of abuse. Assessments of risk and safety and supporting measures in place helped minimise risks. Staff managed people’s medicines safely. Staff followed infection prevention and control guidance to minimise risks related to the spread of infection. Staffing levels were sufficient to meet people’s needs and managers recruited staff safely. Staff followed an induction programme, and training was on-going throughout employment.

The registered manager responded to complaints appropriately and used these to improve care provision. The provider was open and honest, in dealing with concerns raised. We have made a recommendation about reviewing how staff respond to calls made to the office.

Care plans included information about support required in areas such as nutrition, mobility, and personal care to help inform care provision. Staff made appropriate referrals to other agencies and professionals when required.

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.

People told us their equality and diversity respected. People felt staff respected their privacy and dignity and took into account their views when agreeing on the support required. Staff identified people’s communication needs and addressed these with appropriate actions.

The provider and registered manager followed governance systems which provided oversight and monitoring of the service. These governance systems and processes ensured the service provided to people was safe.

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

Rating at last inspection and update

The last rating for this service was good (published 28 September 2018).

Why we inspected

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jewel Home Support Ltd. on our website at www.cqc.org.uk.

Follow up

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

Jewel Home Support is a domiciliary care agency. They provide personal care to people living in their own homes in the community for; older adults, including people with dementia, people with physical disabilities, people with learning disabilities and people with autism. At the time of our inspection there were 140 people receiving a regulated activity from this service. The number of people receiving a regulated activity had increased from 40 since our last inspection.

At our last inspection, published in April 2016, we rated the service as good. At this inspection we found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager 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 registered manager was supported by a team of managers and senior staff which included a compliance manager, training manager and care coordinators, who planned and arranged visits and managed the staff rotas.

The service continued to meet people's needs safely. Staff were knowledgeable about how to protect people from the risk of harm and abuse and how to raise any safeguarding concerns. Risk assessments had been completed in people's care plans and had been reviewed and updated regularly. Staff had signed the risk assessments to indicate they had read them.

The service had sufficient staff to support people safely. Staff we spoke with confirmed this. Medicines continued to be managed safely and records were maintained properly. Staff had received training in infection control and could describe the steps they took to minimise the risks of infection.

Accidents and incidents had been recorded and actions taken to ensure the risk of reoccurrence was managed.

People's needs continued to be assessed prior to their care package starting. Some people received fast track care which had been commissioned by health providers. There was an effective system in place to ensure enough information about people's needs had been captured. There was evidence of the service working with other organisations and families to ensure people's needs were assessed consistently and support provided to achieve optimum outcomes.

Staff received induction training and ongoing training to ensure they had the skills and knowledge they needed to support people. Staff commented on the quality of the training. People we spoke with, who used the service, said they felt the staff were knowledgeable.

The service continued to work within the principles of the Mental Capacity Act 2005 (MCA). People's capacity to make specific decisions had been assessed. Staff understood the importance of ensuring people consented to care and support provided. At the time of this inspection no one was subject to restrictive practices amounting to a deprivation of liberty.

People were supported with meal preparation and to maintain their nutrition and hydration. Records of food and drink prepared and consumed had been completed.

People had access to health services, with support when required. Some people had equipment in their homes to support them with the activities of daily living, and mobility. There was information about how this was to be used for support staff. Staff received practical training on the use of hoists and other mobility aids, prior to supporting people with this.

Staff understood the importance of getting people's consent to receive care and support. People's ability to make decisions had been assessed and, when required, decisions made on people's behalf had been taken in line with best interest principles.

Staff described to us how they supported people kindly and in ways that upheld their dignity. Staff were aware of the importance of reassuring people and chatting when providing personal care, they described the different ways they protected people's privacy.

Both the people who used the service and the staff supporting them came from a wide range of cultural and religious backgrounds. We could see how people's needs and preferences in relation to their identity had been recorded to ensure they were supported appropriately. This included, preferences on gender and language spoken. Staff reported feeling they were respected by the management team and felt able to raise any issues they may have in relation to their identity needs.

People were encouraged to share their views and raise their concerns. People we spoke with told us they were always listened to and their concerns had been addressed quickly.

People received care that was personalised and responsive to their needs. Care plans had been developed which reflected the individual person's needs and preferences. Staff we spoke with described how they worked with people in individual ways that reflected what worked best for the person. Any changes to needs and preferences had been identified and reviews arranged. The service ensured through regular reviews that care provided was at the most effective level.

There was a complaints policy, where complaints had been made we could see these had been fully responded to. A log of complaints had not been fully maintained which made it a little difficult to identify how many complaints had been received. People we spoke with said they knew how to raise any concerns they might have. Everyone who said they had raised a concern said it had been responded to straight away to their satisfaction.

People could be supported at the end of their lives to have a dignified and pain free death. The agency did not routinely provide this type of support but when they had done this recently they had worked alongside community based health providers.

There was a clear management structure in place. Staff were aware of what was expected of them in relation to the standards of care they provided and their own professional behaviour. Staff also said they felt the service was well managed and the management team were approachable.

Governance systems ensured the management had oversight of service delivery. Any issues identified had been addressed. Staff also told us they felt involved in the service and their views were considered.

The service had expanded since the last inspection to support more people. There was a clear strategy in place to develop the service further in ways that consolidated practice to ensure the quality of care could be maintained and improved.

The service had continued to work in partnership with other agencies and organisations including the local authority, local commissioners and Bolton council forum.

All necessary statutory notifications had been received by CQC. The service's CQC report and rating continued to be displayed in the office and on their website.

Without exception, people we spoke with told us they felt safe using the service.

The service had appropriate systems and procedures in place which sought to protect people who used the service from abuse.

The service had a whistleblowing policy in place and this told staff what action to take if they had any concerns.

We found the care and support records of people who used the service were comprehensive, well organised and easy to follow and included range of risk assessments to keep people safe from harm.

We found there were robust recruitment procedures in place and required checks were undertaken before staff began to work for the service.

We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure that people who used the service were safe. We looked at the medicines administration record (MAR) charts for people when we visited them in their own homes and found that these had all been completed correctly and were up to date.

There was an appropriate up to date accident and incident policy and procedure in place and details of any accidents and incidents were recorded appropriately.

There was an up to date business continuity plan in use which covered areas such as loss of utility supplies, loss of staff, loss of IT systems and adverse weather.

People who used the service told us they felt that staff had the right skills and training to do their job. New staff were given an employee handbook at the start of their employment which identified the principles and values underpinning the service. There was an ‘induction and job start checklist’ in place which was used to audit the progress of new staff relative to the induction process.

Staff were given a copy of the organisation’s policies and procedures which were available electronically or in paper format and staff knowledge of these policies and procedures was tested out at supervision meetings and as part of the process of induction.

Staff told us they felt they had received sufficient training to undertake their role competently showed staff had completed training in a range of areas, including dementia, safeguarding, first aid, medicines, the Mental Capacity Act 2005, infection control and health and safety.

Staff received supervision and appraisal from their manager and the service which kept a record of all staff supervisions that had previously taken place.

The service used an electronic staff scheduling and monitoring system which enabled real-time live updates to be sent to care staff members which reduced the potential for missed or late visits.

Before any care and support was given the service obtained consent from the person who used the service or their representative.

We found that each person who used the service had a comprehensive Health Assessment which was easily accessible within their individual care and support plan.

People who used the service and their relatives told us that staff were kind and treated them with dignity and respect.

Support planning documentation used by the service enabled staff to capture information to ensure people from different cultural groups received the appropriate help and support they needed to lead fulfilling lives and meet their individual and cultural needs.

People’s care and support plans contained a ‘service user compatibility assessment’ which recorded each person’s preferences for the staff who supported them. This was matched with available staff members who were then introduced to the person prior to any service being delivered.

People who used the service had a care plan that was personal to them with copies held at both the person’s own home and in the office premises. The structure of the care plans was clear and information was easy to access. Regular reviews of care needs were undertaken by the service.

Some staff members were multi-lingual which meant that people who used the service were not excluded from day to day conversations and were empowered to actively participate in the delivery of their care and support.

The needs of people were assessed by experienced members of staff before being accepted into the service and thorough pre-admission assessments were completed to ensure the service could meet people’s individual needs.

The service did not provide end of life care directly but worked alongside and supported other relevant professionals such as district nurses and Macmillan Nurses through the provision of a night sitting service.

There was a registered manager 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.

People told us that should there be a need to complain they felt confident in talking to the manager directly and had regular discussions with management. They told us they felt the culture of the service was open and honest and it was easy to talk to the manager. The service sought the views of people using the service and their relative’s through the provision of satisfaction surveys. The service regularly undertook audits to ensure quality of care provision.