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Inspection carried out on 31 July 2019

During a routine inspection

About the service

Numada Homecare is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 29 people at the time of the inspection. The service provided short term reablement support, usually up to six weeks, with the aim of supporting people to regain their independence and assess any ongoing support needs. The service had a single point of referral from the local authority reablement service, the Community Response Team (CRT) we have referred to the CRT in this report.

People’s experience of using this service and what we found

People and their relatives told us the service provided safe care. Staff were aware of people’s risks which were assessed with plans developed to mitigate these. There were enough staff to meet people’s needs and staff and people told us there was enough time during calls to meet people’s needs without rushing. Staff were recruited safely and knew how to safeguard people from abuse.

People were protected from the risk of infection and staff were checked to ensure they used the appropriate equipment to promote safe and hygienic care. Medicines were mostly managed safely but information about ‘as required’ medicines was missing from the records. This information supports the safe management of people’s medicines. We have made a recommendation about this. Information from incidents at the service was used to make improvements and prevent a reoccurrence.

People’s needs were assessed by the CRT prior to the person using the service and the provider added to this information during their initial visits and as people’s needs changed. People were asked about their protected characteristics to inform people’s needs and support non-discriminatory practice. 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. Staff completed training to meet people’s needs and this was monitored for completion. People’s nutrition and hydration needs were assessed and met where applicable. People were supported to access a range of healthcare and other services to meet their needs with a focus on enabling people to regain and maintain their independence.

People and their relatives told us staff were kind and caring. Staff knew how to provide respectful care that promoted people’s dignity and privacy. People told us they were involved in decisions about their care and their consent was sought by staff.

The provider occasionally supported people at the end of life and told us they relied on the CRT for a care plan in these circumstances. The provider’s policy did not detail all the information that may be required to care for someone appropriately at the end of their life, so they could check people’s needs had been fully explored. We have made a recommendation about this. People told us their needs were met by the service and they were supported to achieve positive outcomes. Complaints about the service were investigated, responded to and used to identify trends and improve practice. People were asked about their communication needs and the service was able to provide information in appropriate formats to meet these.

An effective system was in place to monitor the quality and safety of the service. The registered manager used information from incidents and audits to achieve continuous improvements. Staff spoke positively about the culture and management of the service and people told us they were ‘happy’ with the service they received. Feedback from people was sought but the registered manager was working on making the current system more meaningful to service development. Staff were asked to give feedback but the analysis of this could be improved to show learning and actions taken as a result. We have made a recommendation about this. The service worked in partnership with other agencies to prom

Inspection carried out on 22 November 2016

During a routine inspection

The inspection took place on 22 and 24 November 2016 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

The service was last inspected by CQC on 12 August 2014, at which time it was compliant with the regulations at that time.

Numada Homecare is a domiciliary care provider and is registered to provide personal care to people who live in their own homes. The service focusses on helping people regain their independence, for example after a stay in hospital, by providing short-term support, usually for a maximum of six weeks.

There were 30 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.

People using the service felt safe and we saw the provider operated an out-of-hours phone line in case of unforeseen circumstances. Staff had received training in safeguarding and displayed a good understanding of what signs could indicate someone who used the service was at risk of harm.

Risks were initially assessed and managed well through an ongoing review process.

We saw there were sufficient numbers of staff on duty to meet the needs of people who used the service. Pre-employment checks had been undertaken to ensure staff were suitable to work with potentially vulnerable people.

Staff had received medication training and demonstrated good knowledge of people’s needs in this regard.

Training and induction included safeguarding, moving and handling, infection control, health and safety, first aid and dementia awareness. Refresher training was planned via the use of a training matrix.

Staff liaised well with external healthcare professionals to support people to regain their independence in a timely fashion.

People who used the service, relatives and healthcare professionals told us staff were caring, compassionate and treated people with dignity and respect. People also confirmed staff were supportive and encouraging in helping them regain their independence.

People who used the service and staff confirmed they received generally good levels of continuity despite only using the service for short periods of time.

Staff were well supported through regular supervisions, appraisals and ad hoc support.

People were encouraged and supported to contribute to their own care planning and review, with family members also involved. We saw that personal sensitive information was stored securely.

People who used the service and healthcare professionals told us staff were accommodating to people’s changing needs and preferences.

People who used the service knew how to complain should the need arise and we saw this information was provided to all people who began using the service.

The registered manager and office staff were described in positive terms by people who used the service and we found the leadership of the service had successfully managed the service through a period of organisation change without any impact on people who used the service.

We found auditing and quality assurance systems were in place, with accountability at all levels, although the manner in which audits were recorded required improvement. The culture of the service was focussed on the individual and their regaining independence, in line with the goals of the statement of purpose and the ‘Service User Charter’, as set out in the service user guide.

Inspection carried out on 12 August 2014

During a routine inspection

We carried out a scheduled inspection of this Domiciliary Care Agency (DCA) on Tuesday 12 August 2014. The service provided support and care to approximately 95 people in the Fareham and Gosport area. The service was divided into two separate areas of work. The React Service worked closely with the local authority to provide support for people over a six week period to return to independent living in their own home. A further section of the service supported people who required on-going support with their personal care in their own home. On the day of our visit we spoke with the registered manager of the service and the provider. Through telephone interviews we spoke with staff members and service users or their representatives.

One inspector visited the service. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service caring, responsive, safe, effective and well led?

This is a summary of what we found-

Is the service caring?

People told us they were supported by kind and attentive staff. Staff treated people as individuals and provided care which was in line with their agreed plan of care. People we spoke with, and their representatives, spoke highly of the service they received. Comments included; ��Absolutely superb service, couldn�t be nicer,� and, �I would recommend them to anyone, they are all so caring and helpful I would be lost without them.�

Is the service responsive?

People�s needs were assessed and reviewed regularly to ensure their needs were met. People and their representatives were encouraged to participate in care planning and review. The registered manager or senior staff regularly spoke with people, their representatives and staff to ensure people�s needs were being met. This meant that people were able to express their views of the care they received and have them acted upon.

Is the service safe?

People told us they felt safe when staff visited them in their home. People were cared for by people who had the appropriate skills and experience to ensure their care and welfare. The risks associated with people�s care and treatment had been assessed, and agreed actions to reduce these risks had been made.

People were supported to take their medicines by staff who had received appropriate training to ensure people were safe. The provider had effective policies and procedures in place to ensure any allegation of abuse was addressed. Staff were aware of policies and procedures in place to ensure the safety and welfare of people.

Is the service effective?

We saw that people received care which was individualised and planned in line with their needs. People told us they received good care in line with their needs. Records showed as people�s needs changed they were supported to discuss and change the care they received. People who received support through the React service told us the care and support they had received from the service encouraged their independence and supported their recovery from ill health.

Is the service well-led?

Staff told us they received good support from the registered manager and provider. They were clear about their roles and responsibilities and understood the need to inform office staff of any concerns they or people using the service may have. Records showed staff had regular meetings and one to one supervision sessions with management to ensure they were supported in the work place. This meant staff were supported in their roles to ensure the safety and welfare of people.