Archived: Ideal Home Care Solutions Limited - Head Office

At the last inspection on 15 to 21 December 2016, we found the provider was in breach of Regulation 9 (Person centred care), Regulation 12 (Safe care and treatment), Regulation 13. (Safeguarding service users), Regulation 17 (Good governance), and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as ‘Requires improvement’ in all areas with an overall rating of ‘Requires improvement’.

Following the inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve all the key questions to at least ‘Good’.

We found significant improvements had been made to the service when we returned on 31 July 2018, and the service was no longer in breach of the Regulations. We have judged their rating to be 'Good'.

Ideal Home Care Solutions provides a domiciliary care service. It is registered to provide the regulated activity of personal care and treatment of disease, disorder or injury to people in their own homes, including older people, people with dementia, people with a physical and sensory impairment and younger adults. At the time of the inspection, the service was caring for 145 people with 74 staff supporting them.

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.

Systems were in place to ensure people felt safe. Missed and late calls had been significantly reduced through the implementation of technology which monitored staff movement of calls, rota arrangements and identified early action to take. The service had reviewed its staffing levels and arrangements and sufficient staff were in post to keep people safe. Additional management staff had also been employed to supervise the day to day delivery of care.

Care was provided in a safe way as the service now managed the risks to people’s health and wellbeing. Improvements had been made to people’s assessments of need and any risks associated with providing their care. These were carried out and provided detailed guidance to staff in caring for them safely. People told us that they were listened to, respected and communication with the management of the service had significantly improved.

The management of medicines had been improved and staff now recorded accurate information about how they administered people’s medicines. Systems were in place to ensure medicines were monitored and, staff competency to administer them, was checked and recorded.

The recording of information in people’s care plans had been improved to ensure staff understood and implemented the guidance and advice from professionals so that people received effective care. The recording of people’s needs and the review of their care was now accurate and consistent. The daily notes were person centred, respectful and clear.

Systems to monitor the quality of the service had significantly improved and were all in place to ensure the oversight of the service and the provision of high-quality care.

Staff knew how to protect people from the risk of harm. They had received training in how to recognise the signs of abuse and knew how to report any safeguarding concerns to their managers.

People were cared for by staff who had been safely recruited. Staff did not start work until all required employment checks had been carried out. Staff had the skills and knowledge to care and support people effectively.

Staff understood how to minimise the risk of infection, they had been trained, and had access to personal protective equipment such as gloves and aprons.

All the necessary training and supervision was in place for staff and they knew how to support people effectively. People were supported with a healthy diet and sufficient fluids. The service worked well in partnership with other professionals to ensure that people received the health care support they needed. Staff ensured people’s healthcare needs were met in a timely way.

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.

People were supported by friendly, kind and caring staff. Their independence was encouraged while minimising any risks to help keep them safe. People told us staff gave them the time they needed and what they expected and respected their dignity and privacy. Confidential information about people was stored safely in line with the new data protection requirements.

People and their relatives were very complimentary about the service. They told us they were kept involved in decision-making and had good contact with the management through visits and calls.

People received care that was responsive to their needs. Care plans had been improved as they were now written in a personalised, detailed and respectful way. People’s wishes to have a male or female staff member provide their care for example was recorded and now acted upon. More recorded information about people's diversity would ensure the service acknowledged their different needs.

There was a complaints procedure in place and people had confidence that any complaints would be dealt with quickly.

The service was well led and managed. There was a clear vision for the future of the service. Staff displayed sound values when talking about how they cared for people. Staff could tell us about the improvements to the service for people who used it and in their day to day work.

The registered manager learnt from audits and investigations and made the necessary improvements.

Further information is in the detailed findings below.

Ideal Home Care Solutions provides a domiciliary care service to people in their own homes. The domiciliary care service provided care and support to 173 people and 101 staff supporting them at the time of our inspection.

A registered manager was in post and the service was well established. The registered manager was also the joint owner of the service. 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 were not being kept safe as calls were often late or missed resulting in people not having the care they required at the time they required it. There were insufficient staff deployed to meet the individual needs of people who used the service

Risk assessments, care plans and reviews were not sufficiently detailed to provide staff with an accurate description and understanding of people’s care and support needs.

Systems were not in place to ensure that people received their medicines safely, in a timely way and the process was checked to ensure people were kept safe.

The service was not always caring as arrangements of the rotas meant that people would not get their assessed needs met as staff would not have sufficient time to listen to them and involve them in making decisions.

Quality assurance systems were in place but were not being used to monitor and evaluate the service effectively to provide a high quality service.

There was visible leadership in the service with a clear vision and values. The management arrangements had been improved with the implementation of a new staffing structure to manage staff arrangements. Staff told us that they were mostly supported in their role and received encouragement to do their job well.

People were cared for by staff that had been recruited and employed after appropriate checks were completed. Staff had most of the skills and knowledge to provide care and support to people.

Induction, training and support system was in place for staff including supervision, appraisal, and competency checks in carrying out their role.

Complaints and concerns were logged and the management acted on the information about the quality of care people had received.

We found that standards of support and care were not consistent across the service. There had been a high turnover of staff and this had resulted in a lack of continuity for some people receiving a service. The manager had put various strategies in place to support staff. This had resulted in reduced turnover of staff and reduced sickness/absence in 2014.

During our inspection we gathered evidence to help us answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

The majority of people we spoke with said that they felt safe when Ideal Home Care staff visited their home. People we spoke with told us that they felt in control of decisions about their care and support. People and their relatives appreciated that new staff were introduced to them before they started. One person receiving support said, 'I feel safe when they're in the house and when they help me to move.' A relative told us, 'We both feel very safe when staff visit. I like the fact that we're introduced to new staff.'

One relative considered that the service did not always provide a safe service because staff had made errors with a person's medication. The manager was arranging more advanced medication training for the management team. They were also improving the recording of medicines. The manager then planned to cascade the training to staff who were providing the care.

There were systems in place to protect people from poor practices or abuse. The majority of staff we spoke with had an understanding of the different types of abuse that could occur and how to refer any concerns.

Is the service effective?

The majority of people we spoke with considered that the service met their needs. However, three people felt that some aspects of their care could be improved. One person expressed appreciation of the staff but said, 'I don't feel I get a proper wash.' Another person told us that staff seemed 'very experienced'. However, two other people considered that some of the newer staff were not competent. One person said, 'The new one (support worker) doesn't seem very confident. We have to keep telling them what to do and how to do it every time they visit.'

Some people told us that staff came at the right time and stayed the agreed time. They said that they had continuity with a small group of staff providing their support. Other people said that there was a high turnover of staff, which led to a lack of continuity. Some people and relatives told us that staff were regularly late and they were not always notified of this beforehand. They said that this could make it difficult for them to plan their day.

People particularly appreciated that staff helped to promote their independence. This enabled them to remain in their own homes for as long as possible, which was what they wanted. A relative told us, 'They motivate (my relative) to do more for themselves and be more independent. I don't know how I'd manage if I didn't have their support.'

Is the service caring?

The majority of people we spoke with were very complimentary about the staff, describing them as 'very helpful', 'caring', 'very good' and 'respectful'. One person told us, 'I have jokes with them and enjoy their visit.' Another person said, 'Staff do everything I want and ask if there is anything else they can do before they leave.' A relative of a person who had had a stroke told us, 'Staff talk to (my relative) about their interests. They motivate (my relative) and help them to communicate.' Another relative wrote a complimentary letter stating, 'The carers are fantastic and have given (my relative) their life back.'

Two people considered that a minority of staff did not have the right attitude. One person said that a member of staff seemed uncomfortable providing their care and this made them feel as if their 'space was invaded'. Another person felt that staff did not understand the seriousness of their medical condition and made them feel as if they should not be receiving care.

Is the service responsive?

The majority of people we spoke with told us that staff were responsive to their changing needs. They said that the office staff would swap the staff who supported them if they were not happy with them for any reason. A number of people and relatives told us that the office staff were helpful and organised a change in visit times if this became necessary.

One person we spoke with appreciated the fact that the office staff had liaised with their social worker when their care needs increased. This resulted in them having extra care hours for a bath each week. We also saw a complimentary letter that thanked staff for remaining with a person for five hours while they waited for an ambulance. The manager said that they tried to adjust visit times to fit in with people's religious and cultural needs, for example, fitting visits around prayer times.

Is the service well-led?

The quality assurance programme needed to be developed. This mainly assessed whether systems were in place and staff were completing the correct forms. The assessments did not assess the quality of the completed documents or whether the appropriate care management was in place. Although reviews of people's care had been completed we noted that one person had a care plan that was over five years out of date.

Staff told us that they enjoyed working for the agency. They said that they had regular staff meetings and supervision and good support from the management team. One member of staff told us, 'I have a really good co-ordinator, they bend over backwards to keep their staff happy.' The majority of people considered that the agency was well managed. One person said, 'The staff are all very happy in their work and that makes a big difference to me.' The majority of people told us that they had never felt the need to raise any concerns.

During the inspection we spoke with nine members of staff, one of whom told us: 'This is one of the better companies I have worked for, especially with back up and supporting you in the job.' The staff members we spoke with were knowledgeable and professional. They told us; 'We used to have weekly training sessions but they stopped; now we get them once a week. The coordinators are constantly in touch, I'm always getting phone calls or text messages giving me updates and letting me know of any changes [to peoples care needs].'

We found the care records we looked at to be organised, person centred and easy to read. There were policies and procedures in place for the protection of people who used the service. People told us they were happy with the service.