Hills Independent Homecare Service

At the last inspection, which took place on 23 September 2015, the service was rated good. At this inspection, which took place on 24 October 2017 to 3 November 2017, we found the service remained good. At the time of our inspection, 23 people were receiving care.

People continued to be cared for by staff who provided care and support that ensured people's safety and welfare and took into account each person’s individual preferences. People were supported to manage their medicines safely.

People were cared for by staff who had been recruited and employed only after appropriate checks had been completed. There were sufficient staff available to meet people’s needs. Staff were sufficiently skilled, experienced and supported to enable them to meet people's needs effectively.

People were effectively supported with decision making and supported to have as much choice and control of their lives as possible. People were supported to have enough to eat and drink and access healthcare when they required it.

People received care and support from staff who were caring, kind and gentle. Staff treated people with respect and dignity. Staff knew the people they supported well. They understood, and met, people’s individual preferences and support needs.

There was a registered manager in post at the time of the inspection. 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 service was well managed. The provider continued to have a robust complaints procedure in place. There were effective systems in place to monitor the quality of the service people received and continually improve the service provided.

Further information is in the detailed findings below.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found.

Is the service safe?

People were protected from the risk of abuse because staff had received training in how to recognise and report abuse. People we spoke with told us they felt safe with the staff. Staff demonstrated they had a good understanding of what constituted abuse and of their responsibilities to report any concerns.

Assessments of any potential risks, to both people who received a service and to staff, had been carried out and guidance put in place to reduce the risks. The provider had a robust recruitment procedure, which meant that only staff who were suitable to work with vulnerable people were employed. There were enough staff employed to ensure that people received the care they needed.

Is the service effective?

People we spoke with were very satisfied with the service they received. One person told us, 'They've been marvellous. I don't think I could wish for better.' A relative said, 'They're wonderful. I couldn't do without them.'

People's needs, and their preferences for the way staff delivered their care, were detailed in their care plans. People told us that the staff did what they wanted them to.

Is the service caring?

People we spoke with described the staff as 'wonderful', 'fantastic' and 'like friends.' One relative said, 'They're always cheerful, they cheer me up and I'm comfortable with them.'

One person told us that the managers would do anything for them, even visiting out of normal working hours when there had been an emergency.

Is the service responsive?

People we spoke with told us that staff would do whatever they asked them to. They confirmed that staff had never missed a call and were rarely late.

Staff wrote notes at each visit, detailing the time they arrived and left and the tasks they had carried out so that there was a clear record of the care people received. Staff also wrote other information, such as if the person was not feeling well, and what they had done about it. Care plans were reviewed at least every six months to ensure that care met people's changing needs.

Is the service well-led?

St Neots ' Cambridgeshire was a small domiciliary care agency with a total of seven staff providing a service to 12 people. There were two managers, Karen and Sarah Hill, with Karen as the registered manager. Everyone we spoke with (people who received a service, their relatives and the staff) told us how good the managers were. One staff member said, 'I'm really happy at this agency, they can't do enough for you'they're very supportive.' Another staff member told us, 'The agency is brilliant, absolutely brilliant, it's the best place I've ever worked. Karen and Sarah are so helpful and really nice.'

An effective quality assurance system was in place so that the managers were able to monitor the service that was provided. People were asked to complete a written questionnaire, and people who received a service, their relatives and the staff were encouraged to speak with the managers or staff about anything, including any issues that concerned them.

We found that the provider was compliant with the regulations in all the areas we assessed.

We saw evidence of peoples' preferences in the way they wanted their care to be provided and planned. Care and support was appropriately assessed and each care visit was documented with guidelines for staff regarding the care and support the person required.

We saw evidence that staff were trained regarding the administration of medicines. Staff were aware of their responsibilities when recording the administration of medicines that they had given or prompted people to take.

There were induction and mandatory training programmes in place to ensure that staff were competent to deliver care. Care staff were regularly supervised to monitor their work performance and development needs.

The agency did not have an effective system in place to monitor and audit the quality of the services that were provided to people. Improvements are needed to quality assurance arrangements to monitor and ensure that people receive a safe and effective service.

The care records provided clear guidance to staff about how to meet the person's assessed needs and records were kept of the care that had been provided. Regular reviews of people's care needs took place with changes made promptly when needed.

Appropriate recruitment procedures were in place and induction had been provided to ensure that the member of staff had the appropriate skills to meet the needs of people who used the agency.