Archived: Duchy Care

Updated 2 May 2018

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 unannounced inspection took place on 9 and 10 April 2018. The inspection team consisted of one inspector and an expert by experience. An expert by experience is a person who has experience of using or caring for someone who uses this type of care service.

We requested and were provided with a Provider Information Return (PIR) from the provider prior to the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. Before the inspection we reviewed information held about the service and notifications of incidents we had received. A notification is information about important events which the service is required to send us by law.

Before the inspection visit we contacted 14 external health care professionals who were familiar with how the service was run. During the inspection we spoke with the deputy manager, 21 people who used the service, three relatives and six staff members. We also accompanied staff to visit with four people who received a service and spoke with them about their experience.

We looked at three records relating to the care of individuals, four staff recruitment files, staff duty rosters, staff training records and records relating to the running of the service.

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Updated 2 May 2018

We carried out this inspection on 9 and 10 April 2018 and it was announced 48 hours in advance in accordance with the Care Quality Commission's current procedures for inspecting domiciliary care services. The service was last inspected in December 2015 when it was found to be meeting the regulations and was rated as ‘Good’ overall.

Duchy Care provides personal care to people who live in their own homes in the Newquay and surrounding areas of Cornwall. At the time of our inspection the team of 22 care staff were providing support to approximately 43 predominantly older people.

There was a registered manager in post. 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.

Everyone told us staff were kind, caring and compassionate while also being respectful of people’s privacy and dignity. Comments included, “People that work for Duchy are worth their weight in gold”; “I can’t speak too highly of them”; “Nothing is too much trouble for them”; “They are respectful of my dignity; I don’t see how they could be more respectful” and “I think they are marvellous.”

People were supported by a stable staff team who knew people well and had received training specific to their needs. People told us they were introduced to new staff before they supported them in their home and although they had experienced changes in the staff team over time people were positive about the quality of service they received. People said they had built up positive relationships with staff. Comments included, “I get a variety of carers; I’m fine with that”; “I get different carers, they are all very respectful” and “My carers were changing but they are going to give me a regular carer.”

The staff team comprised of male and female carers of differing ages, from 23 years to retirement age. People told us they could request a male or female carer according to their preference and wherever possible, this would be accommodated. People’s preferences in relation to the gender and age of their care workers were respected during the visit planning process.

The service's visit schedules were well organised and at the time of our inspection visit there were a sufficient number of staff available to provide people's care visits in accordance with their preferences. This meant people received home visits at their preferred time. People told us staff were never rushed and were kind and respectful in their approach. People also confirmed they had not experienced any missed calls, received their visits as scheduled and were informed if there were any significant delays that would impact on them. We reviewed service rotas which demonstrated that visits were generally provided as scheduled. Staff were provided with appropriate travel time and consistently provided the care visits of the correct visit length.

Care records were up to date, had been regularly reviewed and accurately reflected the person's care and support needs. They provided clear direction for staff about the appropriate support required. Risk assessments clearly identified any issues and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

People said staff were well trained and understood how to meet their specific care needs. Training records showed staff had been provided with the necessary training to do their job, which had been refreshed regularly. Staff told us they were provided with appropriate training to meet people’s needs. We spoke with an external training consultant who had experience of how the service trained staff. Their comments included, “I have been involved as a training advisor with Duchy Care for over two and a half years. The registered manager takes great pride in ensuring staff are well trained. Staff are provided with a very good foundation of training and lots of support to help them progress. The registered manager recognises when a staff member has particular strengths and will actively promote this. For example, recently a staff member showed great understanding, interest and empathy for people with dementia.[registered manager’s name] has promoted this person as the dementia champion for the company.”

The service's systems for the induction of new members of staff were effective and complied with the requirements of the Care Certificate. Training was provided in accordance with the 15 fundamental standards. Staff said they were encouraged to attend training to develop their skills, and their career. Comments included, “I have recently completed my care certificate and found the whole induction proved comprehensive and informative”, “We have a mixture of hands on training like first aid and safe manual handling and e-learning courses which are refreshed regularly” and “We have recently had a new training room opened. It’s a good space for team meetings, training and a quiet space where we can sit and complete on-line training courses.”

Staff told us they felt well supported by the registered manager and senior staff. Staff had received appropriate training and supervision. All staff received an appraisal of their work. Staff comments included, “I am well supported. [Registered manager’s] door is always open and she actively wants to know what is going on with clients so we provide feedback on a daily basis” and “I’ve worked here for a number of years now. It is a really supportive workplace. I travel quite a way to get here and I do that because I love my job. It’s very worthwhile.” The registered manager recognised the staff team for their work and had begun a ‘Duchy Care annual awards’ celebration to celebrate the hard work of staff throughout the year.

Staff had been recruited safely, which helped ensure they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Staff were knowledgeable about the people they cared for and responded appropriately as people's needs changed. Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and goals. Comments from staff included, "The best thing about my job is feeling like I’m making a difference to people’s lives; helping people to live as independently as possible and stay at home as they wish.”

People said they were involved in decisions about their care and staff encouraged and empowered them to achieve their goals. For example, one person had set a personal goal to keep fit and regularly use the gym and go swimming. As well as supporting the person with personal care tasks, carers who enjoyed being active supported the person to fulfil their goals and socialise in the local community. Another person told us, “I want to continue to do as much for myself for as long as I am able and they are very encouraging of me.”

Duchy Care worked effectively with other health and social care services to ensure people's care needs were met; and had supported people to access services from a variety of healthcare professionals including GPs, occupational therapists and district nurses to provide additional support when required. During the inspection we saw a situation where a person needed to go into hospital. Staff were thorough in their assessment of the situation, reassuring to the person about what was taking place and stayed with the person until emergency medical professionals had taken charge of the situation.

Care records demonstrated staff shared information effectively with professionals and involved them appropriately. Healthcare professionals told us, "They are good at seeking advice when needed and keeping us informed of changes in people’s needs” and " I have always found them to be very good, [manager] is always friendly and will try to help in taking service users that I will call her about. The feedback I have had from service users is always positive and if there are any issues staff are good at listening and putting things right. Happy to recommend Duchy Care as a provider” and “I have no concerns about Duchy Care. They are always very helpful; they act on any instructions we provide and they are good at identifying and alerting us to any concerns with people they visit. I would say they provide a good service to people.”

The service acted to ensure people's needs were recognised by health professionals. For example, we heard the deputy manager contact health care professionals and family to arrange a medical appointment for a person because a carer had shared concerns that the person had a sore ear because of an ill-fitting hearing aid.

Management had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

People told us they understood how to report any concerns or complaints about the service. People said if they had a complaint they would ‘call the manager’. Where a complaint had been received these were recorded and resolved in a timely manner. Records showed the minority who had raised concerns with management were happy with how the service had addressed and resolved their concerns.

The service had a contingency plan in place to manage any emergencies. Risks to people, in the event of an emergency, had been assessed and rated, in order to identify who would be at the highest risk. Staff were on call outside of office hours from 6.30am to 11pm and carried details of the roster