People in Action Domiciliary Care - Warwickshire and Coventry

People's experience of using this service:

People felt safe with staff who visited them in their home.

People's safety had been considered and risks were managed to maintain their safety.

Staff had received training in relation to safeguarding and knew how to protect people from harm.

Medicine was managed safely.

The risk of infection spreading was reduced by good hygiene practice.

People told us they were supported to have choice and control of their lives, live independently and chose everyday how to spend their time. However, documents describing where people had the capacity to make their own decisions were not always clear and did not always show people’s consent to their care arrangements.

At the time of our inspection visit the provider was offering staff and managers additional training in how to interpret the Mental Capacity Act 2005 (MCA), they were introducing new care records formats to better record decision making processes.

The provider delivered person-centred care. People’s needs were assessed in detail to ensure the service could be tailored to meet their individual social, care and health needs.

People were treated kindly and compassionately by staff.

Staff respected people's privacy and dignity.

People were supported to take part in activities of their choice.

Information was provided in a range of formats to support people’s understanding.

The provider had a complaints policy and process in place; people feel comfortable raising complaints.

When people reached the end of their life, the provider had policies in place to meet their wishes and preferences.

The provider had quality monitoring arrangements through which they continually reviewed, evaluated and improved people's care.

People, stakeholders and staff had an opportunity to shape the service.

The provider invested in staff development to ensure people received care from experienced and caring leaders.

Rating at last inspection: Good. The last report for PIA was published in November 2016. At this inspection we found the provider had maintained their Good rating.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor the service to ensure it meets its regulatory requirements.

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

The registered provider, People in Action Domiciliary Care – North Warwickshire, is part of a not for profit charity called 'People in Action', which provides domiciliary care, support and care to adults with a learning disability or mental health difficulties in their own homes. The majority of people receiving a service lived alone, whilst others lived with family members or shared accommodation with other people supported by the provider. The contracted hours for the services provided to people ranged between 24 hours a day to 10 hours per week. At the time of our inspection, the provider was supporting 41 people.

The service had a registered manager. 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. We spoke with the registered manager, who had overall responsibility for the service, however we were informed the day to day running of the service was undertaken by four service managers and their assistant service managers.

People told us they felt safe and comfortable with the support workers employed to meet their needs. Support workers knew their responsibilities to protect people from the risk of abuse and received training to assist them. People's legal rights were protected and support workers ensured people's right to make decisions were respected. We found people were supported with their medication by support workers who were trained and assessed as competent to give medicines safely in a timely way and as prescribed.

The provider had introduced a new risk assessment form which identified specific risks for each person and gave guidance to support workers about how they could assist people in a way which would not restrict their independence and choice. Work was still being undertaken to complete the new risk assessments for all people receiving a service.

The provider’s support worker rota system was flexible enough to ensure support workers could safely meet people's needs on most occasions. People told us and we observed that they enjoyed the time they spent with their support workers. We also found that people were also supported to be part of their community and attend activities on most of the occasions that they wanted.

We found that the provider had a system in place to ensure fairness and non-discrimination in the interview process and conducted pre-employment checks prior to staff starting work to ensure workers could be safely employed. Support workers confirmed they had not been able to work until the checks had been completed.

People were able to make choices about their lives and were supported to do so. Their support plans focussed on the individual care and support needs of the person, and copies were stored securely at the main office and at people’s homes. Support workers were responsive to people's needs and where people's needs changed, ensured support plans were adjusted to reflect the change. We found the support plans provided details about people’s preferred method of communication, favourite activities and dislikes.

People had access to health professionals when needed and the provider advocated on behalf people to ensure appropriate health care was provided. People knew what to do if they had any concerns, and the provider responded positively to any issues or complaints raised.

The Support workers we spoke with felt senior management were supportive and confirmed they had regular supervision meetings, appraisals and team meetings. They had access to training and professional development and a system was in place to ensure training was up to date. Support workers and service managers had also received training on mental capacity and demonstrated an understanding and application of the Mental Capacity Act (2005).

We found the provider had systems in place to assess, monitor and improve the quality of the service and was exploring different ways of obtaining feedback on the service. Support workers were given responsibility and were involved in the day to day running of the service. They felt able to make suggestions about how the service could improve. We also found that the views of people and their relatives about the service were listened to and in response appropriate actions were taken.

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Relatives we spoke with told us that they were happy with the service provided. We were told, "X has been with them quite a while, I cannot fault what they have done and put in place" and "The staff know his needs and care for him well."

We saw that people had support plans in place. Staff told us that the plans were very detailed and were reviewed regularly. "Everyone has up to date care plans. If something changes we have to let our line manager know" was one comment made.

We saw that there were robust recruitment processes in place which meant that people were assessed to determine if they were suitable to work with vulnerable adults. We found that staff were provided with support to enable them to carry out their roles effectively.

We saw that information on how to make a complaint was available to people. Relatives we spoke with told us they did not have any complaints but knew how to raise them if they ever did. We were told, "I have no concerns and X is able to say if he was unhappy with anyone or anything."

The people we spoke with told us they were happy and satisfied with the care and support they received from the agency. We were told, "I have learned lots of new things. I join in with my support plan reviews and staff help me with my goals."

People and their relatives made positive comments about the staff and management team. We were told, "I can't praise them enough" and "The staff are brilliant."

People told us they had been given information about how to raise concerns or complaints about the services provided by the agency. We were told, "I have mobile numbers I can call if I'm not happy or have a question."

We saw that there were systems in place to review the service provided to people, which included asking for their views and opinions. We saw evidence that people had been listened to as part of this process.