Background to this inspection
Updated
2 May 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This announced inspection took place on 13 and 26 February 2019. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to ensure the registered manager or member of the management team would be available to give us access to records. One inspector and a specialist nurse advisor visited on the first day and two inspectors visited on the second day. An expert-by-experience made phone calls to people and their relatives to gather their views about the service. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
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Prior to the inspection we reviewed the information we held about the service including notifications we had received. Notifications are information about important events the provider is required to tell us about by law. We also reviewed the Provider Information Return (PIR) we received from the provider. PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used this information in the planning of the inspection.
During the inspection, we spoke with three people, and 11 relatives about the care they received. We spoke with the registered manager, deputy manager, nominated person/head of personal care service and members of the administrative team. We conducted focused group meeting with 11 care workers. We reviewed 10 people’s care records including risk assessments and medicines administration record charts. We looked at five staff files which included recruitment checks, training records and supervision notes. We looked at other records relating to the management and running of the service; such as the provider’s quality assurance systems, complaints and compliments.
Following the inspection, we received feedback from one professional involved in the service.
Updated
2 May 2019
St Christopher’s Personal Care Service is a domiciliary care service that provides people care to people in their own home. At the time of the inspection the service was providing personal care for approximately 100 people in their homes.
At the last inspection of the service in August 2016, we rated the service good.
The service had a registered manager 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 provided end of life care to people in their own homes that enabled them to actualise their wishes and experience a comfortable, dignified and pain free death. People and their relatives spoke highly of the personalised service they received. Care plans were person-centred and focused on achieving the best possible outcomes for people and enabled people to achieve their wishes and promoted their preferences. The service adopted an individualised approach and focused on giving people positive experience and fulfilment. The service actively involved people and their relatives in planning their care and considered their views. They worked with a range of health and social care professionals to ensure people received timely and appropriate care and support. Staff were very experienced in delivering end of life care because they benefitted from comprehensive training and they were well supported to do this. Staff respected people’s dignity and knew to preserve the dignity of the dead in line with people’s cultural and religious beliefs. Relatives were given support in form of counselling and bereavement support groups to cope with their loss and bereavement. The service had a system in place to ensure they continued to receive the support they needed when they moved between services.
There was solid leadership and management. The service focussed on delivering a high quality, personalised service to people and enabling people to die as they wished. The person-centred approach and care people received was evident in all aspects of the service. Staff were passionate about their roles; they felt listened to, supported and empowered to develop their knowledge and skills. The service valued the views of people, their relatives and staff regarding the service provided. Regular feedback was obtained, and an annual survey was conducted to gather the views of those involved in the service. Actions were developed to addressed areas requiring improvement. The quality of the service was monitored closely through audits, checks and quality improvement meetings. The provider put steps in place to constantly improve quality. People received care and support from a team of health and social care professionals both within and outside the service. Staff liaised effectively with these professionals to ensure people’s symptoms and conditions were well managed. The provider worked in partnership with local and national agencies to develop best practice guidance and training on end-of-life care.
Staff were supported to undertake various training courses to improve their skills and knowledge in the job. Staff were also supported through reflective practice, group supervisions, and workshops. Staff had access to one-to-one counselling to help them cope with difficult deaths they might have experienced. There were enough numbers of experienced staff to support people. Staff recruited were vetted to ensure they were suitable to deliver care and support to people. Staff were trained to keep people safe from abuse.
Senior, qualified and experienced staff members carried out an assessment of people’s needs and risks. The service followed best practice guidelines in assessing people’s needs and risks. The likelihood of people experiencing avoidable harm was therefore reduced. People received their medicines from staff who were trained to do so in line with safe administration procedures. People were supported to maintain their nutrition and hydration. Incidents and accidents were reported by staff and these were reviewed by senior management and lessons shared with staff. Staff followed procedures to reduce the risk of infection.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People consented to their care before it was delivered. People and their relatives were involved in making decisions about their care. Staff and the registered manager understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005.
People received care from staff who were compassionate and caring. Staff supported people to make day to day decisions about their care. People were encouraged to maintain their independence. People’s privacy was respected, and their dignity was promoted. Staff maintained positive relationships with people.
People’s care was delivered in a flexible manner and met their preferences and requirements. People knew how to complain if the wished. The registered manager investigated and addressed each complaint received about the service.