The inspection took place on 31 August and 5 September 2017 and was announced, to ensure staff we needed to speak with were available. Home Instead Senior Care Central Hampshire is a domiciliary care service which provides support to people in their own homes. Currently 46 people with diverse care needs, receive the regulated activity of personal care, although additional people received non-regulated activities, such as, light housekeeping and companionship. The service had two registered managers. 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.
People and their relatives told us they felt safe in the care of staff, who had undertaken relevant training to enable them to identify signs of potential abuse. Staff had access to relevant policies and procedures to enable them to protect people.
There was a positive attitude to risk taking and the registered managers worked with people’s families and professionals to manage potential risks to people as safely as possible, in order that they could remain at home. People felt risks to them were well managed. Risks to people were documented, safely managed and understood by staff.
Staff said the service was “Well staffed.” People and their relatives told us they received their care calls at the time they wished, from regular staff, who had been introduced to them and who stayed for the required duration. People were kept safe as the provider had completed the required pre-employment checks to ensure staff’s suitability for their role.
Staff had completed medicines training and had their competency assessed. Staff did not always consistently follow the provider’s medicines policy or safe practice when they identified omissions in the recording of medicines administration, nor had they always informed the person’s GP following medicines incidents. The provider took swift action to ensure peoples’ safety when these matters were brought to their attention and made immediate arrangements for staff to be re-trained. It will take time for the provider to be able to demonstrate that the changes have become embedded in staff practice and that staff have consistently followed safe practice.
People felt staff were well trained and skilled. Staff underwent a thorough and comprehensive induction to prepare them for their role. They were supported and monitored by more experienced staff throughout their induction. Staff then received individualised training to enable them to develop their skills and knowledge in relation to the people they personally provided care for.
People and their relatives reported staff sought consent for people’s care. 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 supported this practice.
There was clear guidance for staff with regards to whether people required assistance in preparing their meals and their food and drink preferences. People told us staff supported them with their eating and drinking where required, this ensured they received enough for their needs. Staff understood who was at risk of not eating or drinking properly and told us how these risks were managed effectively.
People told us they received any support they required to ensure their health needs were met. Staff informed us and records confirmed they had liaised with a range of healthcare professionals to promote people’s well- being.
People we spoke with, relatives and professionals all told us how caring, kind and compassionate staff were and how interested they were in people’s welfare. They all felt staff ‘went the extra mile’ when providing their care and support. Staff were sensitive to people’s state of mind and personal events that might affect their state of well-being. Staff had used their skills to enrich people’s lives, through the provision of activities such as music sessions.
Staff had used personalised and creative methods to communicate with people, in order to aid their understanding of both visual and written information. Staff provided people’s’ care in a dignified manner that promoted their independence. People’s views were respected.
People received an initial assessment of their needs and this was developed into their care plan, which covered all aspects of people’s individual care needs. Processes were in place to monitor people’s care, seek their feedback and amend it according to their needs. The service was responsive and flexible to changes in people’s care needs. Staff were trained and skilled in responding to the needs of people living with dementia.
The provider recognised the importance of protecting people from the risks of social isolation and loneliness and had been pro-active in developing social opportunities for people.
People and their relatives told us they felt confident in expressing any concerns or issues they had about the service to the provider. Processes were in place to investigate, resolve and respond to any complaints received.
A relative said it ‘Is a well led organisation.’ The provider had strong links with the local community which they used to promote the rights and understanding of those living with dementia locally. The provision of care was based on a clear set of values that staff understood and applied in their work with people. Staff’s emotional needs had been recognised and met to enable them to care for people. Staff felt management were open to their ideas.
There was a well-developed and clearly defined management structure; both managers and staff were supported in their development. Processes were in place to support and promote communications at all levels of the service. Processes were in place to ensure staff were updated on best practice.
The provider monitored the quality of the service provided as did the franchise’s national office. People and staff’s feedback on the quality of the service was sought and used to improve the care provided.