The Care Company provides care and support to people who live in their own homes in the South Hams and Torbay areas. The services provided include assistance with personal care and domestic work as well as ‘live-in’ carers for those people who require a higher level of care and also companionship. One of the company directors held the role of registered manager and managed the service on a day to day basis. 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.
This announced inspection took place on 8, 11 and 15 July 2016 and included visits to the office, staff interviews and visits to people in their own homes. At the time of this inspection 83 people were using the service, of which 45 were receiving support with their personal care needs. Domestic help is not regulated by us, and therefore this inspection looked at the care and support of those people who received assistance with their personal care. The service was previously inspected in January 2014 when it was found to be meeting the regulations at that time.
People, their relatives and staff told us the service was well-led. One relative said, “They are unbelievably good. It is a very well run organisation.” The registered manager demonstrated a commitment to continually improve and develop the service. People said they felt safe with the staff when receiving care. They said they had a regular staff team whom they had come to trust and know well. Staff had received training in safeguarding adults and knew how to recognise signs of potential abuse. They understood how to report any concerns in line with the service’s safeguarding policy and said any issues would be dealt with thoroughly. One member of staff said, “our concerns would never be ignored.”
Risks to people’s health and safety had been assessed and regularly reviewed. These assessments included information about how to minimise the chance of harm occurring to people and staff. Staff were provided with step by step instructions about how to help people safely, and in a consistent manner which promoted people’s confidence. One person told us staff needed to use equipment to help them change their position. They said they were confident when the staff used the hoist and said staff always checked the sling to make sure it is safe before they used it. Should an accident occur in a person’s home, the circumstances of the accident were reviewed to identify any actions to reduce the likelihood of a reoccurrence. The service supported some people to take their medicines. Care plans provided information about each person’s medicines and why they were prescribed. People told us the staff supported them safely and they received their medicines as prescribed.
The service employed sufficient numbers of safely recruited and well trained staff to meet people’s needs. Staff told us they had “lots of training” including diabetes, dementia care, care of someone following a stroke as well as health and safety topics. Should a person have very specific care needs, such as the care of a feeding tube, this was undertaken directly with the person and their staff team. One person told us they found the staff, “well trained, competent and excellent in their work”. Staff told us they “loved” their job and felt valued by the registered manager.
People told us they had never had a missed call, and if the staff were going to be late they always received a phone call to notify them. Staff told us they had no concerns over the planning of visits and they were provided with sufficient paid travel time. They said they had enough time to ensure they delivered care safely and visits were not compromised by having to leave early to get to their next person on time.
People and their relatives were very positive about the way staff supported them. Each person we spoke with told us their care staff were kind and compassionate. One person said, “The staff are excellent and charming, I couldn’t be happier with them”. The registered manager reviewed staff performance through observation, spot checks and supervisions to ensure they were meeting people’s needs and following the guidance in people’s care plans.
A number of people were receiving support from a ‘live-in’ carer. This meant a carer moved into the person’s home to provide care and support. People and their relatives told us this had worked very well for them and it meant people had been able to remain at home rather than move into care home. One relative described the “outstanding care” their relation was receiving.
Care plans were developed with each person and people told us they had received a copy. These plans described the support the person needed to manage their day to day needs and to remain as independent as possible. Staff knew people well and were able to tell us how they supported them. The service was flexible and responsive to changes in people’s needs. For example, one person told us they had been admitted to hospital in an emergency and the staff had increased their visits to prevent their wife having to go into a care home.
Some of the people receiving a service were living with dementia which affected their ability to make decisions about their care and support. The registered manager and the staff had a good awareness of the Mental Capacity Act 2005. Staff said they asked people everyday about whether they were happy to receive care and to allow them to make what decisions they could.
The service recognised some people were at risk of social isolation and found it difficult to spend time out of their home. They arranged regular social events for people and their relatives to attend and provided staff and transport if necessary.
People and their relatives had no concerns over the care and support they received and they felt able to make a complaint if something was not right. One person told us, “I have no complaints whatsoever. I am absolutely happy with the care, the girls are marvellous.” The service had received three complaints in January 2016. These were investigated in line with the service’s policy and the outcome recorded and discussed at the following month’s staff meeting. Records showed the complaints were resolved to the complainants’ satisfaction.
Regular management and staff meetings provided opportunities to review the development and continued improvement of the service. Staff told us the registered manager and providers were very approachable, were keen to hear their views and were always available. A reward and bonus scheme recognised staff’s professionalism and commitment to their work and was much valued by staff.
Audits were carried out monthly to monitor the quality of the service. Unannounced checks to observe staff’s competency and interaction with people were carried out on a regular basis. The service sought regular feedback from people who used the service and the results of the most recent surveys sent to people in May 2016 were very favourable. The registered manager kept up to date with current issues in the care profession by accessing care related websites, attending external training events, meeting regularly with other care providers, as well as the local authorities’ commissioning groups.