This inspection was announced and took place on 6 September 2016. We gave the provider short notice of the inspection as we needed to make sure we were able to access records and gain permission from people who used the agency to telephone them or visit them in their own homes. The last inspection of the service was carried out 9 May 2014. No concerns were identified with the care being provided to people at that inspection.
Managed Care Ltd provides is a small domiciliary care agency that provides personal care and support to people in their own homes. At the time of this inspection the service was providing support to six people. The agency offered people a range of hours of their choice. Support ranged from half hour drop in visits to assist people with meals to visits that supported people with personal care to accessing the community.
During our inspection the registered manager was present. The director was the registered manager of the agency. 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 and their relatives were very complimentary about the quality of the service provided and of the registered manager and staff team. They felt the care was exceptionally good. One person said, “Excellent service first class, we have received support for many years and it has always been the same”. The registered manager informed us they were proud of the standards of care it provided. The service worked in partnership with its clients, their representatives and allied professionals to deliver good quality services to people in their own homes. Staff monitored people's health and referred them to other healthcare professionals when needed
People and their relatives told us they appreciated the agency being small. It meant they always knew the people who were coming to support them in their homes. The registered manager also worked as part of the team. This meant people using the service felt that their care was monitored closely by people they knew and who know them well.
Staff had an excellent knowledge of the needs and preferences of people they cared for. All Staff spoken with were able to describe how they supported the people they visited. Staff were enthusiastic when they described how they tried to make their visits the highlight of a person’s day.
Staff had received training in safeguarding vulnerable adults from abuse. Staff told us they were aware of the risks of financial abuse. However the service required improvement to ensure records were in place to protect people and staff. Although independent audits had been recently carried out for one person, financial records had not been maintained at the time of the inspection for this person. Following the inspection the registered manager immediately implemented changes to financial recordings people using the service. They also stated all records would be audited on a monthly basis.
People who required support to take their medicines received support from staff who had received training in this area. However systems were not in place to ensure the administration of medicines were recorded. Although records needed to be improved for one person, the person said they had received all their medicines at the appropriate times. The registered manager told us future records would be kept of collection, storage and administration of medicines handled by all staff on behalf of people they were supporting. Whilst the registered manager took immediate and positive action it was reactive and not proactive.
Staff told us, and records seen confirmed that all staff received training in how to recognise and report abuse. Staff spoken with had a clear understanding of what may constitute abuse and how to report it. All were confident that any concerns reported would be fully investigated and action would be taken to make sure people were safe. The safeguarding policy was comprehensive and very clear providing staff with all required information and guidance on actions to be taken if they were concerned about anyone
Care was planned and delivered in a way that was personalised to each person. Staff monitored people’s healthcare needs and supported them when they were unwell or had health emergencies. Where changes in needs were identified, care was adjusted to make sure people continued to receive care which met their needs and supported their independence.
Care plans contained risks assessments which outlined measures which enabled care to be provided safely in people’s homes. When risks had been identified management plans were in place. All care plans held individual risk assessments. There were generic risk assessments that included the safeguarding of people, premises and equipment.
Risk assessments relating to assisting people with mobility recorded the number of staff required and the equipment needed to minimise risk. All staff received training in safe moving and handling procedures.
People were supported by staff who had the skills and knowledge to care for them effectively. Care staff held a range of qualifications, all were encouraged to continue to develop their skills in the provision of domiciliary care. The registered manager told us, “The team has not changed in many years but still need to receive training”. They told us they were planning to introduce additional skill development for all staff, with a learning programme designed to enable staff to continue to provide safe compassionate care to people.
People were encouraged to maintain a healthy, balanced diet based on their individual needs. Staff ensured people with particular health issues were supported to purchase nutritional food which ensured they remained healthy.
There were ways for people to express their views about the service they received. Each person had their care needs reviewed on a regular basis which enabled them to make comments on the care they received. When we visited people who received a service we saw they were happy and relaxed both with the care staff and the registered manager.
The registered manager demonstrated an understanding of the importance of effective quality monitoring. The systems in place enabled checks of the service provided to people and to ensure they were able to express their views so improvements could be made. However these systems had not picked up the issues we found during the inspection. whilst the registered manager took immediate and positive action it was reactive and not proactive.
There was a high level of satisfaction with the service. Staff was proud to work for the service and felt valued for their work. A positive culture was demonstrated by the attitudes of staff when we talked with them about how they supported people.