Poppy's Homecare Limited

Poppy’s Homecare is a domiciliary care service providing personal care and support for people living in their own homes in the Weston-super-Mare and surrounding villages. At the time of the inspection they were providing personal care for 65 people. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People were supported by a service that was extremely well led and a management team that was passionate about providing high-quality person-centred care for people living in the community. There was an emphasis on including and empowering people to maintain control over their lives and to lead decisions about their care package.

People received care and support from a service which was exceptionally caring and passionate about ensuring people were treated with dignity and respect. Staff at Poppy’s Homecare went over and above what was expected of a community care provider. Staff invariably carried out social visits and support outside of their working time. People and relatives told us that staff did far more than they expected. Staff supported people to maintain friendships and avoid social isolation as well as ensuring they had access to new and innovative information to help them maintain their independence.

The management team worked closely with other organisations to improve the experience of people receiving care and support in their own homes.

People told us they felt safe and looked forward to the visits they had from staff. One person said, “I really don’t know what I would do without Poppy’s. ”Another person said, “I can’t remember life without them [staff]. They have made my life worth living again.”

People received effective care and support from staff who were exceptionally well trained. The registered manager/provider promoted social care as a career and supported staff to progress in care to become social workers or qualitied nurses.

Staff morale was very high, and this was reflected in the high standard of care provided. Staff were listened to and their opinions were valued. People said that all the staff they met were, “Professional,” “Caring,” “Compassionate” and “Well trained.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People could be assured that at the end of their life they would be supported with care and compassion. The registered manager/provider ensured that people reaching the end of their life were not left alone and a member of senior staff was available to sit with them at no extra charge.

There were quality assurance systems which monitored standards and ensured any shortfalls were

addressed. People and staff felt listened to and said they could speak with a member of the management team at any time. Any complaints made were fully investigated and treated as learning to enable the service to improve.

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

Rating at last inspection

The last rating for this service was Outstanding (published 02 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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 visited the office on 9 January 2017. We carried out phone calls to people who used the service, their relatives, and healthcare professionals between 12 January and 23 January 2017. At the time of this announced inspection 64 people were receiving personal care from the service. The service met all of our regulations at the previous inspection in January 2014.

People benefited from a management team who had clear visions and values about how the service was to be delivered. People and their relatives were keen to tell us about the management and consistently high standards of care they received from Poppy’s. Comments included “I can’t speak highly enough of them; Poppy’s are definitely the best”; “They’re the high end of care”; and “I always have outstanding responses.” Professionals who were involved with the service said “They’re brilliant. If I had to choose an agency I can honestly say I would recommend Poppy’s”; “Poppy’s are always top of my list; they’re where they need to be” and “They have a very good reputation.”

People were supported by a strong, stable staff team who knew them well and focused on ensuring they received the highest quality of care. Without exception people and relatives all spoke very highly of the staff who cared for and supported them. Comments included “The carers are excellent; we wouldn’t get by without them”; It lifts my day when the carers come in”; “They’ve almost become part of the family”; “The carers really connect with mum” and “very friendly, helpful, cheerful and they do everything they possibly can.” The registered manager and staff gave us many examples of how they went ‘the extra mile’ for people and the difference this had made for them. For example, staff had supported one person to order a new motability car because they knew how important it was to them to go out. Staff were highly motivated and had gone out of their way to support people in their own time.

People were involved in developing and running the service. For example, people were asked for feedback on staff’s performance through reviews and an annual survey. The survey carried out in 2016 was completed by 41 people and 5 relatives. People and their relatives showed 98% satisfaction overall. In response to the findings the provider had taken action. For example, one person said they would like their visit record in large print. We spoke with the person and they told us they now received a large print rota and it was so much better.

People and their relatives were involved in their care and staff respected people’s wishes. People’s care plans were personalised and included information about how they liked things to be done. People told us staff gained consent before carrying out personal care and respected their choices. People told us they liked to be independent and staff respected this, offering help when needed. Staff said “It’s about enabling the person to live an independent and fulfilled life”.

Staff had an in-depth appreciation of people’s individual needs around privacy and dignity. A health professional commented “They treat people with total respect, it’s so nice.” Dignity was high on the agenda and the management team had made improvements to embed the principles in people’s care and support. One person told us “They are very polite, very respectful and don’t overstep any boundaries.” Staff told us “We consider every aspect of equality, it’s always about them. It’s all geared around choices.”

The service was flexible. People told us office staff always listened to them and they had been able to change times to meet their needs. This meant people were able to attend events and appointments, as well as enabling them to follow their interests. People were able to make decisions in relation to their daily activities. We heard of staff supporting people with activities such as walks, shopping, the cinema, the garden centre, sporting events, and attending therapy. One relative said “It’s so important (name) keeps doing activities” and staff who supported this person knew this was important to them. Care plans contained people’s interests and activities they enjoyed.

People benefited from effective care because staff were trained and supported to meet their needs. People said “They’re all very good” and “They know what they’re doing.” Staff told us they were happy with their training. Comments included “I have experience in a number of care settings, and this was the most intensive and best training I’ve had”; and “The training is top notch.” Reflective learning questions were used after training to check staff had the knowledge they needed. Staff told us they felt well supported and had regular opportunities to discuss their work. Staff said “I absolutely love it. There’s nothing we can’t talk about”; “They look after us, and we look after our clients”; “This is the best care company, I’m proud to put my name to it”; and “They’re a really nice company to work for, I’ll be here until I need care.”

The management team found ways to show staff they were valued and appreciated. Three staff had recently been presented with long service awards. They had all worked for Poppy’s for ten years. The registered manager had looked for creative ways of communicating with care staff to make sure they knew about changes and kept up-to-date with best practice. For example, staff meetings were held on different days so that all staff had the opportunity to attend and contribute to the development of the service. Staff told us “They’re always sending out updates” and “We’re always talking about how to make things better for people.”

The registered manager worked with other organisations to make sure they followed current best practice and provided a high quality service. For example, one of the company directors was a facilitator for the Best Practice in Dementia Care Learning Programme at the University of Stirling. The registered manager accessed professional websites, subscribed to a range of health and social care magazines, and attended local forums. They were also a member of the United Kingdom Home Care Association (UKHCA).

People told us they felt safe and comfortable when staff were in their home and when they received care. One person said “I’d trust the girls with my life.” Another person had fed back to the provider that they were confident they were in good hands if there was an emergency. Staff knew how to recognise signs of potential abuse and understood how to report any concerns in line with the service's safeguarding policy. Safe staff recruitment procedures were in place. This helped reduce the risk of the provider employing a person who may be a risk to people.

People told us staff were usually on time and had time to meet their needs in the way they wanted. People were provided with visit record so they knew which staff would be visiting them. Staff told us they tried to ring people with any changes, and the majority of people confirmed this happened.

Risk assessments had been undertaken for each person. These included information about action to be taken to minimise the chance of harm occurring to people. We saw risk assessments had been carried out in relation to mobility, nutrition, epilepsy, medication, and skin care. Risk assessments relating to each person's home environment had been completed. Staff identified when people were not safe and raised concerns. We received feedback from an occupational therapist who said “I have spoken to the senior carers a number of times when they have identified manual handling risks to the patient and their carers.”

People were supported safely with their medicines and they told us they were happy with the support they received. Staff completed medication administration record sheets to confirm people had been given their medicines. Staff had completed medicines training and were observed administering medicines to check they were competent. Senior staff checked medicines were being administered correctly during checks carried out in people's homes.

People and their relatives felt able to raise concerns or make a complaint. They were confident their concerns would be taken seriously. People told us they didn't have any complaints. Where complaints had been received they had been managed in line with the company policy. Where there were some ongoing issues with a complex package of care, the management team held monthly meetings with the person. This was to review what had happened and look for different ways of doing things when needed.

An audit system was in place to monitor the quality of the service people received. Information could be quickly updated on the provider’s electronic system which meant staff were able to monitor what was happening for people. Records were clear, well organised and up-to-date. Unannounced checks to observe staff’s competency were carried out on a regular basis.

People told us that they were always treated with respect and dignity and that their consent was obtained before any care was given. We reviewed care records which showed that people had been involved in developing their care plans and that they were supported to be as independent as possible.

We spoke with seven staff who worked for Poppy's Homecare who told us that the managers were very supportive and ensured that staff had sufficient time to enable them to 'do a really good job'.

The provider had a medications administration policy and where they were responsible for administering medication, staff completed the paperwork accurately and fully. Relatives told us that they felt that staff were always very responsible and careful when dealing with medication. Staff told us that they had received training in medication and that when any concerns arose they were able to contact managers to discuss and resolve the issues.

The provider had systems in place for monitoring and assessing the quality of service provision including dealing with complaints. People told us that they knew how to raise a concern or complaint, which they felt would be dealt with promptly and fairly.