Archived: Duchy Care

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

Everyone told us they felt safe and were well cared for by Duchy Care. People’s comments included; “I feel safe”, “The carers are very good,” “They are very good, very caring and always respectful”, “I am well cared for, they know how I need help” and “We are one big happy family.” Relatives told us they were fully involved in the planning and review of their family members support needs.. Two relatives told us they had experienced other care providers before and were not positive about their experience. However both stated they would recommend Duchy Care. One said “This is my second time of receiving care, I would recommend them to people as they have restored my faith.”

People told us they had ‘never’ experienced a missed care visit. The registered provider said “Missed visits are not an option. People in the community are vulnerable and we must and do visit when we say we will. It’s not acceptable for visits to be missed.” The service had robust and effective procedures in place to ensure that all planned care visits were provided.

We found people’s visits were provided on time, staff visit schedules included appropriate travel time and staff consistently provided the care visits of the correct visit length. People told us staff supporting them were on time. They were never rushed and staff stayed for the correct duration of their visit. People said it was “rare” that staff were late, commenting, “If they are late, they call us to tell us they are on their way. It’s understandable why they are late because they get held up at their last visit because of an emergency or because of traffic.” They also said “Sometimes they stay over their time if they don’t finish their job, they don’t rush me.”

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.

The registered manager was confident about the action to take if they had any safeguarding concerns and had liaised with the safeguarding teams as appropriate. 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 all the necessary training which had been refreshed regularly. Staff told us they had ‘lots of training” and found the training to be beneficial to their role.

The service’s systems for the induction of new members of staff were effective and fully 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.

The registered provider and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves, had their legal rights protected. We found that the service acted in accordance with legal requirements.

People were supported by stable and consistent staff teams 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 said they had consistent carers to support them and had built up positive relationships with staff. The staff team comprised of male and female carers of differing ages, from 22 years to retirement age. The registered provider said it was important to “match” carers with the person they supported. For example, if the person wanted a male or female carer or if they wanted a younger or older carer to support them. People preferences in relation to the gender and age of their care workers were respected during the visit planning process.

Care records were up to date, had been regularly reviewed and accurately reflected the person’s care and support needs. Details of how the person wished to be supported with their care needs were highly personalised. They provided clear information to enable staff to provide appropriate and effective support. The service’s risk assessment procedures were designed to enable people to take risks while providing appropriate protection.

Duchy Care worked effectively with other health and social care services to ensure people’s care needs were met. The service had acted to ensure people’s needs were recognised by health professionals. The service’s managers had detailed knowledge of people’s health needs and regularly contacted professionals to check and confirm that guidance provided was correct.

People told us they understood how to report any concerns or complaints about the service. People reported they had never wished to make a complaint and the minority who had raised concerns with managers were happy with how the service had addressed and resolved their concerns. The registered provider believed they did not receive complaints because they had good communication with the people they supported, their relatives and staff.

The importance of communication was shared by all who worked at Duchy Care. The registered provider had introduced a new process so that staff visited the office at the end of each shift. This allowed staff the opportunity to “debrief” so that the management team had up to date information on the current situation for every person they supported. The registered provider said “With this system I feel I know what’s going on out there.”

The management team had a clear set of values which was also apparent in our discussions with staff. The registered manger said “I am really proud of my team.” Staff told us they were proud of how they provided care and said “It’s rewarding work, I come to work with a smile on my face.” The registered manager provided effective leadership and support to the staff team. Staff told us “I can talk to (manager’s names) they are easy to approach and talk too.” All staff felt that the registered provider was approachable and motivating. Staff felt that as the managers undertook care visits in the community themselves this gave them a better understanding of their role and how they needed support. People and relatives told us the service was “well managed”.