Archived: Home Helpers Care Limited - 25 The Nursery

There was a registered manager in post at the 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.

The management regularly audited the quality of service delivered. There was an open and positive culture at the service and clear lines of accountability. Staff commented they enjoyed their jobs and the support they received.

People told us they felt safe and the support they received was of good quality. Care staff knew how to assist people to maintain their safety. Care staff understood their responsibility to protect people from harm and abuse and they knew how to report any safeguarding concerns appropriately.

The provider had systems in place for the safe administration of medicines. People were supported to receive their medicine when needed. People were supported to maintain good health and were assisted to access health services when required.

People had individual risk assessments in place, as well as risk assessments of their home environments. Plans were in place to ensure risks were managed. There were sufficient care staff to meet people’s needs and people received their support as planned.

People were cared for by staff that were knowledgeable about their roles and responsibilities and had the relevant skills and experience. Staff received training required for their roles and they told us they were well supported by the management team. Records relating to the recruitment of new staff showed relevant checks had been completed before they worked unsupervised with people.

Staff followed the requirements of the Mental Capacity Act 2005 (MCA). This protected the rights of people who may not be able to make important decisions themselves. People benefitted from staff that understood and implemented the principles of the Act. People told us they were involved in making decisions about support they received.

People told us that care staff were kind and helpful. Staff respected people’s dignity and privacy. People’s confidentiality was respected and their independence was promoted.

People’s needs were assessed prior to commencement of the service to ensure these could be met. People’s care records contained details of people’s personal preferences, likes, dislikes and health needs. People’s care plans were up to date and reflected people’s current needs.

The registered manager sought people’s opinions using satisfaction surveys and spot checks. People told us they knew how to raise concerns and they were confident any issues would be promptly addressed.

A single inspector carried out this inspection to follow up on the previous concerns. We looked at both the home and office care records for 11 people. We found improvements had been made and people were now protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records about them were maintained.

Home Helpers Care Limited is a domiciliary care agency providing personal care to enable people to live in their own homes and maintain their independence.

A single inspector carried out this inspection. We looked at the care records for six people; spoke with eleven people who used the service and seven people's relatives. We also spoke with the registered manager, the care manager and four care workers. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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.

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

This is a summary of what we found:

Is the service safe?

We found that some people were at risk of unsafe and inappropriate care because accurate and comprehensive information about their care was not being recorded. When we previously inspected the agency on 7 March 2013 we found that care records, staff files and operational guidance were not up to date. The provider sent us an action plan to tell us how they would make improvements. We carried out an inspection on the 8 and 14 August 2013 to check the improvements had been made. We found that although significant improvements had been made people were still at risk of unsafe and inappropriate care because accurate and comprehensive information about their care was not being recorded. The provider sent us another action plan and told us the necessary improvements would be made by March 2014. At this inspection we found that not all of the improvements had been made. We found that care plans and risk assessments did not always provide sufficient instruction to staff on how to support people to reduce the likelihood of identified risks occurring. Suitable records were not always kept regarding medication administration and an accurate record for each service user was not always maintained.

People told us they felt safe when being cared for by care workers from the agency. One person said "I feel safe when the carers are here". One relative told us 'they provide a safe service'. The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe.

Systems were in place to make sure that managers and care workers learnt from events such as accidents, incidents and complaints.

Is the service effective?

The service was effective. Staff had received training to meet the needs of the people they were caring for. People told us they were happy with the care they received and felt their needs had been met. It was clear from speaking with staff that they understood people's care and support needs and they knew them well. One person told us, "they [care workers] seem to do what needs doing in a very pleasant way. I am really quite happy'. Another person said, "the care is good, no complaints here'. One relative said, "I am very impressed by the care and the way they [care workers] behave'. This showed us that people were happy with their care and support.

Is the service caring?

The service was caring. Care workers involved people in their care and treated people with dignity and respect. People spoke positively about the care workers and felt they talked with them in a friendly and respectful way. One person told us care workers 'are friendly and polite'. Another person said, 'they [care workers] are nice and friendly and treat me with respect'.

Is the service responsive?

The service was responsive. The agency assessed the needs of people who used the service. We spoke with a relative of a person who told us, 'we have had an assessment for mum to have care that was done beautifully. I have no concerns that this will not meet her needs. It was very thorough and the lady was very knowledgeable'.

We saw evidence that care workers recognised when a person's condition changed or their health had deteriorated and sought the help and advice of other professionals. We saw that the agency provided extra calls for this person until their telephone was repaired to check that all was well with the person. This showed us that care workers were responsive to people's needs.

Is the service well-led?

The service was well led. There was a registered manager in post who was available for people and staff to raise any concerns. We saw that the provider took account of complaints, comments and feedback to improve the service. During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the service had an effective system to assess and monitor the quality of service that people received.

We inspected this agency to judge whether improvements had been made in six areas we identified as being non-compliant at our last inspection on 7 March 2013. We found that the service had made many improvements in a short time. We spoke with a professional who confirmed that 'the quality and management of the service had significantly improved.'

We spoke with four people who used the service and eight relatives during our inspection. We visited some of these people in their homes to gather their views. We also spoke to four staff members.

We found people received the care they needed in the way they preferred. People and relatives we spoke with were complementary about the agency and made positive comments about the care they received. A relative told us ''Staff are wonderful and very good with my husband. They are very thorough and I cannot fault them one bit.' One person told us 'they will always ask me what I would like to drink. I appreciate that they never stop asking or just assume because I had peppermint tea a while ago I would want the same now.'

We found the agency had developed suitable arrangements to protect people from the risk of abuse. Staff we spoke with knew how to identify abuse and how to implement the safeguarding procedure. We found that any identified or suspected abuse was addressed appropriately.

We found people were cared for, or supported by suitably qualified, skilled and experienced staff. The provider had reviewed its recruitment policy to ensure that it undertook the required recruitment checks. People we spoke with described staff as ''wonderful, really thoughtful' and 'brilliant.'

We found staff had received appropriate training. Systems had been put in place to support staff and monitor their competency to undertake care tasks. This meant that people could be assured that they were cared for by appropriately skilled staff.

We found that systems had been developed to enable the manager to monitor the quality of the service provided and to identify and respond to risks. We saw that complaints had been investigated and concerns addressed appropriately.

We saw that records relating to staff training and recruitment as well as core policies had been reviewed and improved. People's care plans and risk assessments had also been updated. We found that these care records did not always provide sufficient instruction to staff in how to support people to reduce the likelihood of identified risks occurring. Staff we spoke with were familiar with people's needs and knew how to deliver the appropriate care. Care plans however did not record the full extent of the care being provided.

People told us they felt safe with staff. We found that the provider did not have guidance in place to ensure staff knew how to respond appropriately to allegations of abuse and that alerts were investigated in an appropriate consistent manner.

The provider did not operate effective recruitment and selection processes. We found staff did not receive appropriate supervision and professional development. Informal support was available and a staff member told us ''I can always chat with the managers if I have any issues or concerns I need to discuss'.

We found the provider did not regularly assess and monitor the quality of service that people received. We saw that satisfaction surveys had been undertaken but people's views were not taken into account when improvements were made.

The staff and management records were incomplete and not always fit for purpose.