Allcare Shropshire Limited

Allcare Shropshire Ltd provides personal care and support to people in their own home. The agency provides care and support for older people, adults with disabilities and people who live with dementia. At the time of our inspection visit, Allcare Shropshire Ltd provided services to 85 people.

People’s experience of using this service:

People told us the registered manager and staff were extremely kind and caring and very good at their jobs. They said they felt safe with their carers and liked and trusted them. People praised the standard of care provided and described the service as exceptional. They said their staff often gave them care and support that was way more than they needed to. We were repeatedly told of occasions where staff had gone above and beyond what was expected of them, often in their own time. This included staff making special meals, taking people on trips out and other extras.

The registered manager was one of the two directors of Allcare Shropshire Ltd and also the nominated Individual. They were passionate about supporting older people and people living with dementia. They worked closely and extremely effectively with other organisations and groups promoting dementia awareness. The management team encouraged and rewarded high performance and innovation and the staff team stepped up to this and were enthusiastic and dedicated. Staff were committed to delivering outstanding and inclusive personalised care and strongly focused on supporting people’s diverse needs and preferences.

People were supported to attend events organised by the service or activities they chose. These included celebrations, coffee mornings, afternoon teas and various fund raising events. Transport was provided so they could attend. These events provided people with the opportunity to socialise and make friends.

People were supported by staff who had been recruited safely, extensively trained and supported. People told us the staff were extremely reliable, rarely late for visits, informed them if they were going to be late and never missed their visits. Staff turnover was low, and people told us they were supported by staff who knew and consistently met their needs. Staff had the skills, knowledge and experience required to support people with their care and social needs. The service used practical and creative ways to teach staff care skills and put this into practice to provide outstanding care.

The service liaised confidently and efficiently with health and social care professionals. They were prompt and proactive in seeking advice or referrals when people were ill. They also supported people to attend healthcare appointments to ensure their health and well-being was maintained.

People’s care and support was planned proactively and in partnership with them. They told us they felt consulted and listened to about how their care was delivered and staff ‘really’ listened to them. They said staff were respectful, friendly and extremely conscientious. Staff had a strong emphasis on encouraging independence and empowering people while balancing this against assessing risks and safety.

Staff worked in partnership with other organisations to make sure they followed good practice and people in their care were safe. The management team used a variety of methods to check the quality of the service and develop good practice. They were extremely proactive in encouraging people to discuss how their support could be improved or raise concerns. They acted promptly where areas of improvement were identified.

There was a strong emphasis on the importance to support people to eat and drink well. Staff were aware of people’s individual preferences and had the skills, knowledge and ability to meet their dietary requirements. People told us staff managed their medicines safely and they received them at the times they needed them. Staff understood the importance of supporting people to have a comfortable, pain free and peaceful end of life. Where someone was heading towards the end of life staff were particularly flexible, changing times of or care at very short notice.

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.

The registered manager continued to provide excellent leadership and showed empathy and a real desire to increase people's wellbeing. All staff had a clear vision of what was required of them and focused strongly on doing so.

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

Rating at last inspection:

At the last inspection the service was rated good (published 22 August 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We may inspect sooner if any issues or concerns are identified.

Allcare Shropshire provides personal care for people in their own homes. At this inspection they were providing care and support for 97 people.

A registered manager was in post and present during our inspection. 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 safe from abuse as staff had been trained and knew how to recognise and respond to signs of abuse. Staff had access to care plans and risk assessments and were aware of how to protect people from risks of harm associated with their care. Any incidents and accidents were investigated to identify any learning and to minimise the risk of reoccurrence. Staff members knew the recommendations from investigations in order to improve their practice.

The provider completed appropriate checks on staff before they started work to ensure they were safe to work with people. People received help with their medicines from staff who were trained to safely administer these and who made sure they had their medicine when they needed it. Staff followed safe practice when assisting people with their medicines.

People received care from staff that had the skills and knowledge to meet their needs. People had positive relationships with the staff members who supported them. Staff knew the people’s individual histories, likes and dislikes and things that were important to them.

Staff attended training that was relevant to the people they supported. Staff received support and guidance from a management team who they found approachable. Staff members felt valued by the provider and that their suggestions and experiences mattered to them.

People were involved in decisions about their care and had information they needed in a way they understood. When people could not make decisions for themselves staff understood the steps they needed to follow to ensure people’s rights were upheld.

People felt able to raise any concerns they needed and were confident they would be investigated. People received feedback after any concerns were raised.

People had their privacy and dignity respected and information personal to them was treated with confidence. People had access to healthcare when needed and staff responded to any changes in need promptly and consistently. People were supported to maintain a diet which promoted well-being.

People and staff felt able to express their views and felt their opinions mattered. The provider undertook regular quality checks in order to drive improvements. The provider engaged people and their families and encouraged feedback. People were kept informed about any development within the provider’s organisation and received regular newsletters or memos.

The registered manager engaged the local community in raising awareness of dementia and provided training to anyone who wished to increase their knowledge. The provider assisted people to remain as independent as possible in their own homes and their community.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe because their rights and dignity were respected and they were involved in making decisions about any risks they may decide to take in their daily lives. One person said, 'Oh yes, I feel that I am safe and secure when the staff are in my home.'

We spoke with staff and they told us they knew what to do if concerns about abuse were raised and they were aware of the provider's policies and procedures to safeguard people from potential abuse.

The staff and the provider understood the requirements of the Mental Capacity Act 2005, its main Codes of Practice and put them into practice to protect people. This meant that people who used the service were protected from harassment, avoidable harm, abuse and breaches of their human rights.

The service dealt effectively with untoward events and emergency situations in the community. 'Grab sheets' containing important information were in care plans to be used when a person had to transfer to hospital.

People were safe because the service made sure that the equipment they were responsible for was safely used, installed, maintained, tested and serviced. For example, the use of bed rails.

Is the service effective?

People told us that they could express their views about their health and quality of life. They said these were taken into account in the assessment of their needs and the planning of the service. People told us they had been involved in the assessment of their needs prior to accepting care from the agency. The care records we looked at reflected people's current individual needs, choices and preferences. A person commented, 'The staff are very good and the agency always send staff that I am familiar with and that know me.'

People had the support and equipment they needed to enable them to be as independent as possible. A person told us, 'Staff had been on training and then recommended a new piece of equipment to me. This has improved the quality of my independence.'

Is the service caring?

People told us that they were treated with kindness and compassion and that their dignity was respected when receiving personal care. People explained how their individual needs were met, including needs around age and disability. Staff we spoke with knew the people they were caring for well, including their preferences and personal histories. This meant that caring, positive relationships were developed with people living in their own home. One person told us, 'Staff are very adept at assisting with moving me about they know how to hold me correctly and are very caring in their approach.'

Records were stored in the office so that people were assured that information about them was treated in confidence. Staff we spoke with described how they promoted respectful behaviour and positive attitudes. We were shown records that showed staff had been trained in policies and procedures and how to respect people's privacy, dignity and human rights in their home. This meant people's privacy and dignity was respected and promoted.

People and those that mattered to them were encouraged to make their views known about their care and support, and these were respected. This meant people were listened to and felt that they mattered.

Is the service responsive?

People said that they and their family were encouraged to make their views known about their care and support. Care records detailed how people's individual needs were regularly assessed and met. The way staff talked about people showed that they actively sought and listened to people's views and decisions. This meant people were supported to express their views and be actively involved in making decisions about their care and support.

People were enabled to maintain relationships with their friends and relatives. Staff we spoke with recognised the risks of social isolation and loneliness with people. Staff reviewed preferences for activities during assessments of need. Staff tried to balance the risk against what people were able to do and how they wanted to live their life. This meant that people received personalised care that was responsive to their needs.

The provider brochure described how concerns and complaints would be dealt with. Records showed that concerns and formal complaints were encouraged, explored and responded to in good time.

People told us they felt confident to express any concerns or complaints about the service they received.

Is the service well-led?

Discussion with the provider and staff showed there was an emphasis on fairness, support, transparency and an open culture in the service. Staff were supported to question practice through robust supervision arrangements. The provider operated a clear set of values that included involvement, compassion, dignity, respect and independence. This was understood by all staff we spoke with. This meant that the service promoted a positive culture that was person centred, open, inclusive and empowering. A person told us, 'The staff are all different but wonderful in their own way.'

Quality assurance was in place and used to drive improvement. There were effective arrangements to continually review health and safety in people's homes, and to find out people's views of the service.

The provider had links with organisations that acted as sources of best practice. For example, for best practice guidance and training. This meant that the provider demonstrated good management and leadership.

Staff we spoke with knew and understood what was expected of them. They were motivated, caring and well trained. Effective supervision processes were in place for staff to account for their decisions, actions, behaviours and performance. This ensured that responsibility and accountability was understood at all levels.

There were effective arrangements to review safeguarding concerns. However, the provider acknowledged that CQC needed to be notified when referrals into the local safeguarding process were made.

People considered they had the same staff to meet their current needs, which they liked. They said, "We know who is coming and are never left waiting for them to arrive". People considered staff were well trained to do their job and one person said, 'They have good personalities which counts for a lot'. People considered the service would be responsive to their changing needs and that staff cared.

People told us they were regularly asked if their service was satisfactory. They confirmed formal surveys were in place to gain their views about their care or how the service was run.

The provider had systems in place that enabled them to identify problems swiftly and act upon them to keep people safe at all times. This meant that the service was managed well.