An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?As part of this inspection we spoke with five people who use the service, four relatives, the registered manager, five staff and visited four people in their homes where we observed how people were being cared for. We also reviewed records relating to the management of the service which included, five care plans, daily care records, quality assurance systems and staff training records.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
Is the service safe?
People were safe because staff used both formal and informal methods to share information on risks associated with their care, treatment and support. Hazards were minimised and procedures were in place to keep people safe in their homes. Staff raised concerns with the provider when people's needs changed to make sure they received care and support which kept them safe and healthy.
People were safe because there were plans to respond to any emergencies and these were understood by all staff. People using the service said, "If staff are held up in an emergency, the office call me", "In an emergency I rang the office, they sent a carer to help". A relative stated, "In an emergency they were brilliant."
People who use the service were safe because the provider ensured staff were available to cover when they were needed. People said they knew which staff would be coming to provide their care and at what time. They said staff were flexible. Relatives told us, "Care was increased when needed", "They will arrange cover whenever needed, they never leave us in the lurch".
People were safe because they were protected from abuse and avoidable harm, including breaches of dignity and respect which could result in psychological harm. Staff understood how to keep people safe and when to report concerns about changes in their health or wellbeing. Relatives told us, 'I really trust them', 'They are very trustworthy'.
Is the service effective?
People received an effective service because their individual needs, choices and preferences were reflected in their care plans. People's likes, dislikes and routines important to them had been recorded in their care plans. Staff spoken with had a good understanding of people's needs. Staff had the skills, knowledge and experience needed to support people with their care and other daily activities.
The service was effective because people's health was regularly monitored to identify any changes that might require additional support or intervention. Referrals were quickly made to health care professionals when people's needs changed.
People received an effective service because staff had effective support, induction, one to one meetings and training. Relatives told us, "They take the initiative, they have lots of training, are knowledgeable and caring", "I know extra training is provided. I have observed the care and they appear to do things correctly".
Is the service caring?
A caring service was provided because staff knew the people they were caring for and supporting, including their preferences and personal histories. Relatives told us staff had a good understanding of people's needs. One person told us, "They ask my wishes before they do anything. They are friendly but courteous."
Staff showed concern for people's wellbeing in a caring and meaningful way and responded to their needs at the time they needed it. Staff provided care sensitively, respectfully and professionally. They offered reassurance when needed and encouraged independence when appropriate.
The service was caring because staff actively asked for, listened to and acted on people's views and decisions. Staff were observed offering choices about the way in which people's care was provided.
Is the service responsive?
The service was responsive because people had their individual needs regularly assessed and met. When their needs changed care records had been updated to reflect these making sure staff had access to the latest information about people's needs.
The service was responsive because it allowed staff the time to provide the care and support people needed and ensured staff timetables were flexible should their needs change. A person said staff would 'always go that extra mile'. Relatives told us the provider was flexible with the care they provided and could be relied on to help out with extra visits when needed.
People, their relatives and friends were encouraged to provide feedback. There were a variety of ways in which they could express their views including an annual survey, reviews of their care and making a complaint. There was evidence the provider took action in response to feedback they received to improve the service provided.
Is the service well led?
The service was well led because they promoted an open and inclusive culture. Feedback from people who use the service, their relatives and staff was encouraged. Action had been taken in response to their feedback. The management demonstrated good management and leadership through being available and accessible.
The service was well led because there were a clear set of visions and values that included involvement, compassion, dignity, independence, respect, equality and safety. A person told us, "All the girls have different talents. They have an instinct and foresight for the care and help you need". A relative said, "They are lovely, they really are Angels."