Your Life (Cheltenham)

Your Life (Cheltenham) is a domiciliary care service that provides personal care and support to people living in Jenner Court. The service supported eight people at the time of the inspection.

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

People and their relatives were positive about the caring nature and approach of staff. People told us they were supported by staff who were kind and compassionate. They told us they felt safe when staff visited and were confident that any concerns would be dealt with promptly. Appropriate numbers of staff were employed to deliver the care and support people 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.

Staff told us they had received appropriate training which supported them to carry out their role. Staff told us they could seek advice from the registered manager and senior carers. The registered manager and staff were passionate about the care they delivered and were driven to improve the service. They communicated and engaged with others such as family members to improve the lives for people who used the service.

The manager acted on concerns to ensure people received care which was safe and responsive to their needs. Staff were trained in safeguarding people and protecting them from harm. Any concerns or accidents were reported and acted on.

The manager monitored the delivery of care through staff observations and feedback from people. Effective quality assurance systems had been established to monitor the quality of the service being delivered.

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

Rating at last inspection

The last rating for this service was Good (published 24 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected the service in March 2016. At the March 2016 inspection we rated the service as “Requires Improvement”. We found the provider was meeting all of the requirements of the regulations at that time; however we found that good practices had not always been established and maintained in relation to the amount of staff deployed and maintaining people’s care records. During this inspection we found improvements had been made to how staff were deployed and in the maintenance of people’s care records.

Since our March 2016 inspection a new registered manager had been recruited and registered with the Care Quality Commission. 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 comfortable living at Jenner Court, and when receiving support from Your Life (Cheltenham) care staff. People felt their needs were met by skilled and dedicated care staff. People spoke confidently about the registered manager and were happy with the care and support they received. People received personalised care in order to meet their needs This included help with personal hygiene needs and with taking their prescribed medicines. People told us they felt listened to and they could not fault the care they received.

Care staff told us the service had improved. Staff had access to appropriate training and had the skills they needed to meet people’s needs. They spoke confidently about the support they had received from the registered manager and they told us their professional development was promoted.

The registered manager and provider had systems to monitor the quality of service people received. The systems enabled the registered manager and provider to identify concerns and drive improvements. People’s views were sought and acted on by the registered manager to improve the quality of the service they received.

Jenner Court is a complex of 68 privately owned one and two bedroom apartments. There is a communal lounge, a restaurant and gardens which were used by the people who lived there. Staff from the provider’s domiciliary agency provided a range of supportive services. This inspection focused on the part of that service which provided support to people with their personal care needs. At the time of this inspection 10 people were receiving this type of support.

The general manager of the complex was registered with the Care Quality Commission in respect of this activity. A registered manager is a person who has registered with the Care Quality Commission to manage such a 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. This manager had however notified us that she was due to leave on 20 April 2016.

People told us they always felt safe and secure. People’s rights were upheld and there were processes in place to protect them from harm and abuse. They told us they enjoyed being supported by the same group of staff who they knew and liked and who knew what their needs were. This continuity was possible because staff who worked for the provider’s domiciliary care service were purely based at Jenner Court. Staff had received training and support to be able to meet these needs. People told us staff received care when they expected to and for the full designated time. They told us that if the staff were running late they were informed about this. They also confirmed this was rare. Staff told us the time they were given to provide people’s support in was sufficient for them to do this in an unrushed manner.

As more people had wanted this type of support additional staff had been recruited in December 2015. Recruitment processes had been robust and therefore people were protected from potentially unsuitable staff. There had been some periods of time where there had been one member of staff on duty able to provide care. Apart from some reported incidents when care had to be interrupted in order for the staff member on duty to take an incoming call this had not had a negative impact on people. The registered manager however told us it was not ideal and would aim to avoid this level of staffing. People mostly arranged their own health care appointments, such as visits to and by their GP, dentist and optician. Many had family members who also supported them in doing this but if this were not the case staff would be available to help. Where staff provided people with help to manage their medicines.

People had care plans which outlined what their needs were and how these should be met. Care plans had been formulated and reviewed with the individuals receiving the support; sometimes people's family represented them. People had full access to these records as copies were kept in their homes. Care plans needed some improvement to make them more specific and relevant to the person’s needs. As people were able to direct staff and staff communicated well between each other, this lack of written guidance had not had a negative impact on anyone. The potential risk to people resulting from a lack of accurate information about their needs had been recognised and work had started to improve the accuracy of people’s care plans. The registered manager told us they had wanted to up-skill some staff to be responsible for doing this as they considered them better placed to do this. They told us this was not going to be achieved before they left but they hoped it would remain something that the next manager could support.

There was a process in place for people to be able to raise a complaint, have this listened to, investigated and resolved although none had been recorded since the last inspection in May 2014. Various meetings and an open door policy enabled people to raise ideas, suggestions and areas of dissatisfaction with the registered manager. There were mixed views on how effective the management were in responding to their feedback.

The provider had already organised for an interim manager to manage the service until another permanent manager was appointed. The provider had quality monitoring processes in place to ensure the service remained compliant with various areas of regulation and legislation. Changes in the area management support to the service had also taken place recently. A fresh review of the service’s management, processes and systems was therefore due to take place soon in order to support future improvement of the service.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and what the records told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were enough staff recruited to ensure people's care needs were met. Where people had health care needs there were arrangements in place to meet these, for example, people were visited by a community nurse where needed. There were arrangements in place to manage emergencies. These included staff knowing what to do in the case of people's individual illnesses or accidents. People's care needs were assessed and care plans were devised to ensure staff knew how to meet a person's needs safely. One person said, "It all works very well."

Robust policies and good staff awareness on subjects such as how to protect people from abuse and who to contact outside of the service, if they had concerns, helped to ensure people's safety. This was further enforced through the use of good staff recruitment practices. People told us they felt confident to be able to talk about any concerns they had. One person said, "I could tell (registered manager's name) anything and they would sort it out".

Is the service effective?

The service ensured there were suitably qualified and experienced staff on duty to meet people's needs. This was achieved through the appropriate recruitment of staff and by maintaining a good skill mix within the team.

Is the service caring?

People were supported to make their own decisions relating to what care they required and how this would be provided. One person said, "You feel you are being treated well and they maintain my dignity."

We observed staff knocking on people's doors or ringing their front door bell before entering people's accommodation. This showed that people's personal space was respected and people's privacy was maintained.

Staff had taken time to find out people's specific preferences and wishes and these had been incorporated into people's care plans and into the practical support/care they received.

Is the service responsive?

Staff followed people's written and agreed care plans which meant people received individual care that met their personal needs.

Although the service had not received any complaints since it started in July 2013 there were arrangements in place for complaints to be made, listened to, taken seriously and investigated. People had been given information on how to make a complaint about how their personal care had been provided to them if they needed to. Arrangements described by the registered manager on how complaints were investigated in other locations owned and managed by the provider told us that the provider wanted to learn from the complaints received.

The same proactive arrangements were in place for learning from incidents and accidents. Two examples were given to us of incidents that had happened in other locations, but where the provider had shared this information, which then resulted in action being taken in the Cheltenham service in order to prevent a reoccurrence.

Risks to people were effectively managed so that they could remain independent. We found two examples of where risks to people had been managed well. One included managing the potential risks of a person slipping or falling and another involved the person's personal safety when out walking.

Is the service well-led?

Both the people who use the service and the staff told us the registered manager had an open door policy. One person said, "I honestly say I have no complaints." This person went on to explain that if they did have a complaint they would make it to the registered manager and they had confidence in the fact that the complaint would be sorted out.

Staff told us the registered manager was approachable and very supportive. The registered manager told us they were aware of what was going on in their service, not only by the use of checks and audits but by engaging on a daily basis with staff and people using the service.

The provider also had arrangements in place to assess and monitor the standard of care and services being provided. This was done through visiting the service monthly, by asking people for their view on the services provided. By checking the audits completed by the registered manager and by having arrangements to ensure that any subsequent required action to improve the service had been completed.

Staff told us they were clear about their roles and responsibilities. Where issues arose these were escalated and actioned appropriately. There was a robust quality assurance system in place which ensured the service remained safe and provided services to a good standard.