We undertook this announced inspection on the 25 November 2015. At the previous inspection, which took place on 4 September 2013 the service met all of the regulations that we assessed.
Continued Care from Oakville Ltd is registered to provide personal care to people who live in their own home. The service supports people who live in the Settle, Bentham, Long Preston and surrounding villages. The agency office is in the centre of Settle. There is parking available nearby, in a ‘pay and display’ car park. Visits vary in duration and support is offered for such things as personal care, twenty four hour care, end of life care, companionship, domestic tasks and escorting to medical appointments. At the time of this inspection the agency was providing support for 60 people. The agency employs 20 care staff and a registered manager.
There was a registered manager at this service. 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 they felt safe and trusted the care staff who came into their home to support them. They described staff as ‘excellent, trustworthy and considerate’ Staff were aware of safeguarding procedures and could demonstrate how they had taken action to safeguard people when necessary. Staff also told us that the registered manager listened and acted on their feedback. The safeguarding policy was up to date. Appropriate risk assessments were in place to reduce the risk of harm. These were kept under close review and the staff approach was very flexible to allow for changes in circumstances.
The service recruited staff in a safe way making sure all necessary background checks had been carried out. Care workers were organised and deployed in a way that met people’s individual care needs, with small individual teams of staff who knew people well. People who used the service and their relatives told us that they received an individual, consistent and reliable service.
The service had health and safety related procedures, including emergency plans, in place. Staff had regular contact with other healthcare professionals at the appropriate time to help monitor and maintain people’s health and wellbeing. We saw staff had been pro-active where people required medical attention and they were provided with care and support according to their assessed need.
Systems were in place for reporting and recording accidents and incidents, including detailed reviews and actions, were in place. The care records we looked at included individual risk assessments, which had been completed to identify any risks associated with delivering the person’s care. Where people’s needs were complex relevant professionals had been involved to provide advice and training. People gave good examples where staff had acted quickly in accessing medical assistance for them when needed. This meant staff acted quickly and appropriately to ensure their health care needs were met. Records also showed that risks were managed positively, so that people were supported to develop confidence, skills and independence.
Care plans were comprehensive and detailed to ensure people’s care needs were met by staff from the service. Some of the people who used the service were supported with taking their prescribed medication and staff were trained and competent to assist people with this. People we spoke with confirmed that they received good support from staff with their medicines and that they always got them or were reminded to take them.
People’s care records showed that their needs had been assessed and planned in a very detailed and person centred way. People who used the service and their relatives told us that they were involved in planning and reviewing their service and that their views were listened to. We saw clear examples where staff had supported people to take positive risks and develop their independence. People we spoke with told us that staff from the service obtained their consent and treated them in a dignified way and always respected their wishes.
We saw exceptional examples of where staff had gone the ‘extra mile’ ensuring people they supported not only received good quality care, but also maintained their various interests. One example being a person’s interest in cars was rekindled. Another example was where one person was supported to access the community they lived in. This meant that people became less socially isolated and enabled them to live their own lives within their own home. This had a positive impact on people’s well-being.
People and their relatives told us that staff were caring, treated them well and respected their privacy. Staff were able to describe how they worked to maintain people’s privacy and dignity. We saw clear examples of people being supported to develop their independence.
Staff had been provided with training and support to help them carry out their role. This included specialist training and support from relevant health care professionals where someone had complex needs. People who used this service and their relatives told us that staff were competent and knew what was expected of them. Staff told us they were well supported by the registered manager and other managers, who had clear expectations and provided regular support. We saw evidence of staff being encouraged to develop their own professional expertise and there was a strong focus on professional development.
The service supported people in their own homes and provided help with meal preparation, eating and drinking where this had been agreed as part of the person’s care package. If people needed support with eating and drinking this was detailed in their care plan and professional advice had been sought if people had complex nutritional needs.
People had been provided with a handbook about the service, which included the formal complaints process. People also told us that they were given opportunities to raise issues or concerns on an on-going basis. We saw complaints that had been made since the last inspection had been thoroughly investigated and responded to by the service. There were many compliments and letters of thanks.
People who used the service were extremely positive in their comments about the running of the service and the staff. They told us that this was an ‘excellent service’ with people being ‘100 % satisfied.’
The service was well-led. The registered manager was very well qualified and experienced. The management team were committed to providing a good quality service. People who used the service and their relatives all told us the service was very well led, with an ethos of providing high quality, person centred care. Staff were passionate about providing high quality services that focused on the individual.
The service had introduced and had implemented the role of ‘staff champions’ in areas such as dementia, medicines, safeguarding people, dignity and respect and disabilities in all of their care teams working for the organisation.
Systems and processes were in place to monitor the service and make improvements where they could. People who used the service, relatives and other professionals were routinely involved in meetings, reviews and on-going work so that their feedback could be taken into account.
There were excellent auditing and monitoring systems in place to identify where improvements were required and the service had an action plan to address these. Policies and procedures had been updated to ensure they were in line with current legislation.
The service had exceptional systems in place for people who used the service or their relatives to communicate with them. For example a ‘web portal’ had been introduced. This could be accessed remotely from people's own home or their relatives home. This allowed people to access and view the care schedules and see who was attending the visit and to book and amend visits and send messages directly to the rota coordinators. The service also arranged ‘service user forums’ although this had been declined in Settle. This gave people who used this service the opportunity to meet with other people who also received a service from Continued Care. The service also arranged each year a Christmas Party for people who used the service. This had also been declined by people in Settle.
The leadership team had an appetite to continually improve the service; one example of this was their focus on work to develop ‘service user champion roles.’ This would give people who used the service opportunity to discuss their ‘user experience’ at the ‘service user forums.’
The organisation continued to be audited both internally and externally to check and set benchmarks to ensure the services practice, quality and standards of care were continually maintained to a high standard. The service had sustained outstanding practice and improvements over time as they held the Investors in People – Gold. The service is also an ISO 9001-2008 accredited organisation. This is recognition in good practice that the service had continuously held which was audited by external auditors, who verify and benchmark practice.