Broad Oak Manor Domiciliary Care

Broad Oak Manor Domiciliary Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It also provides assisted living to people with more independence. It provides a service to people living with dementia, people with a physical disability, older people and people with sensory impairments. Its office is based in a rural area of Hertford. At the time of our inspection visit there were seven people receiving a service of personal care.

The service is on the same site as another of the provider’s services, Broad Oak Manor Care Home. Also on site is a converted barn that people can use to socialise. This contains comfortable seating areas, a television and a café area that members of the public can also use.

Peoples experience of using this service:

People’s care was person centred and based on what was important to them. People's concerns were dealt with and acted on before they became a complaint and to the person’s satisfaction. One staff member told us how they danced to encourage a person to get out of bed. Systems were in place to meet people’s end of life care needs and help ensure a dignified and pain free death. One compliment from a relative stated, 'The family wish to express our sincere thanks to all the staff who cared for [person] and [staff] who looked after then with such kindness. Thank you also for the kind expression of sympathy and condolences which were a great comfort to us all.'

Skilled staff were provided with the necessary support including coaching, shadowing experienced staff and regular supervision, staff maintained their skills. People's needs were completely met. One relative told us of the significant difference staff made to their family member in being able to live at home. People's independence was upheld and promoted with enough to eat and drink. Staff enabled people to access healthcare support by working exceptionally well with others involved in 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.

People were cared for by staff with compassion, kindness and dignity. Staff knew people well and they promoted people’s privacy, culture needs and independence. People had a say and choice in who and how their care was provided. One person told us, "I absolutely can’t praise staff enough for what they do. They go the extra mile every time and do the little things that mean so much.”

The registered manager promoted and supported an honest and open staff team culture. Staff upheld the provider's values by helping people live a meaningful life. Governance and oversight of the quality of the service was highly effective in driving improvements which changed people's lives for the better. People were at the heart of determining how the service was run. The service and its management team worked extremely well and successfully with other organisations. People received care that was highly coordinated and as a result they led a meaningful life. Many people complimented the service for the quality of care provided. One relative told us that all staff had totally transformed their family member’s life and how pleased they were at how well the service was run.

Risks to people were identified and managed well. Appropriate steps had been taken to safeguard people. Sufficient numbers of staff with the required skills had been recruited safely and deployed to keep people safe. The provider’s monitoring systems were useful in alerting any reason staff were running late. One person spoke fondly of their care staff and said, “I feel safe knowing I can rely on [staff]. I have never ever had a missed [care] visit” People were supported to take their medicines as prescribed by trained and competent staff. Lessons were learned when things did not go quite so well. Infection control systems promoted good hygiene standards.

Rating at last inspection: Good (report published 03 December 2016). At the latest inspection the service had improved to outstanding.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People who used the services offered by the provider owned their own properties which were situated on the same site with a nursing home owned by the provider and other facilities including a restaurant, a coffee shop and a converted barn which was used for social events. People had staff at hand over a 24 hour period if they needed help because staff were based on the site and able to get to people`s houses within a few minutes.

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.

Staff received training in how to protect people from harm and they were aware of how to report any concerns internally and externally. People and their relatives told us that the care and support people received from staff was safe and had a positive impact on people`s lives.

People told us staff were respectful and offered care and support in a caring way which promoted their independence. Health care professionals praised the staff for the effective care and support they gave to people and for their dedication to help people keep in good health. People were involved in developing their own care plans based on their needs and wishes.

Staff had comprehensive induction training when they started working for the provider and they attended regular refresher training sessions. The registered manager identified and offered specialist training for staff to develop and progress in their career.

Health professionals told us staff were skilled and competent in recognising people`s changing health needs and were prompt in involving them in people`s care. This meant that people received health care support in a timely manner enabling them to remain in their own homes.

The provider successfully supported people to overcome the risk of social isolation. They had facilities for people to use and organised regular events to encourage social interaction. People were given opportunities to pursue their hobbies and interests.

People and their relatives told us they had good communication with staff and the managers who were running the service. They felt their voice was listened to and any suggestions they mentioned to staff were actioned to their satisfaction. People confirmed that staff sought their consent before assisting them and the service worked in accordance with the principles of the Mental Capacity Act 2005.

People and their relatives told us they felt the service was well managed and well led. Health care professionals were complimentary about the registered manager who they felt was running a service which had people`s best interests at heart. People we spoke with told us how they enjoyed living and being supported by staff at the service. Regular audits were carried out by the registered manager and areas identified as being in need of improvement were actioned and the quality of the service provided was improved.

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 30 April 2014 and 02 May 2014. Broad Oak Manor Domiciliary Care provides personal care to people who live on site at Broad Oak Manor. At the time of our inspection there were six people who required support and personal care.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

During our inspection of the service people told us they had been treated with respect and dignity. One person said, 'They [staff] help me in a way that is very respectful and kind; I never feel awkward. At first I was very worried, anxious and embarrassed. I need not have worried'.they put me at ease and reassured me straight away and now I feel comfortable.'

We looked at records which showed that people's care and support needs had been assessed, documented and reviewed. These were personalised and gave staff clear guidance on how to deliver safe and appropriate care that met people's individual needs.

We saw that the provider had put suitable arrangements in place in relation to the safe ordering, management and administration of people's medicines.

The provider had ensured that staff recruited were suitably qualified and of good character. Staff did not provide care to people unless appropriate checks had been carried out. One staff member we spoke with told us, 'The whole process was thorough and very robust, [manager] was very helpful, and any questions [manager] went out of their way to help me with.'

Is the service effective?

People told us they had been involved in the assessment of their individual needs and in the planning, delivery and reviews of the care and support they received. One person said, 'It's just lovely here, whatever we need we just need to ask for.'

People had access to their care and support plans. We saw that these had been reviewed and updated with them on a regular basis.

Is the service caring?

We spoke with three people who used the service and two relatives. They were very positive and complimentary about the levels of care provided and the care staff who supported them. The relative of one person who used the service told us, 'The carer is lovely, always arrives on time, is polite and always does what needs to be done. My [family member] has the same carer all the time who is never late and always stays the agreed amount of time.'

We observed during our inspection staff assisting people with various tasks. We noted that staff were patient and took time to explain what they wanted to do. People who used the service frequently asked staff about elements of their care and staff took the time to explain it in sufficient detail.

We spoke with two members of staff who demonstrated a comprehensive understanding of people's individual care needs. One staff member we spoke with told us, "[ Name] is a very private person. As such it is important that by assisting them to keep their independence we ensure we respect their privacy and don't make choices for them."

Is the service responsive?

People were provided with sufficient information which enabled them to understand and make informed choices about the levels of care they required.

We saw that where changes to a person's health or mobility needs occurred, staff reviewed the person's care and support plans with them and their relatives where possible. . We saw that where required staff had sought the advice and support from professional health professionals such as GP's and physiotherapists.

Is the service well led?

The manager had sought the views of people who used the service and their relatives. These views had been reviewed by the manager to ensure that people were satisfied with the quality of service they received.

Incidents and accidents were routinely reviewed and measures implemented to reduce the risk of recurrence.

We saw that the manager carried out frequent checks to ensure the quality of the service was maintained. For example, they reviewed people's care records, audited medicines, and monitored staffing issues such as supervisions, appraisals and training to ensure they had been carried out. . Where care was provided to people in their home staff carried out environmental risk assessments.

People experienced care and support that met their needs and protected their rights. People, and their relatives, told us that the staff understood and met their, or their relatives, care needs. One person said the agency staff had 'done exactly what I wanted.' They went on, 'They looked at safety issues and were flexible about how long and how often they came. I couldn't have asked for more.' A relative of another person told us, 'I can't praise them enough. It's changed my [relative's] life'. They are so good.'

People were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found there was an effective recruitment procedure in place. People made positive comments about the staff who provided care to them and their relatives. One person told us the staff, 'all know what they are doing. They're very good here.' Everyone we spoke with told us they felt the care workers were competent in their roles. During our visits to people's homes we observed positive interactions between the people receiving care and the staff supporting them.

The provider had an effective system in place to regularly assess and monitor the quality of service that people receive. However, people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.