Alina Homecare was registered with the Care Quality Commission (CQC) in February 2014 as a domiciliary care agency. It provides personal care to a range of older adults and younger adults living in their own houses and flats in the community. These included people living with dementia, a mental health illness, a physical disability, a learning disability, people with substance misuse, sensory impairment or an eating disorder. The service was also registered to provide care for children from 0-18 years; although at the time of inspection no children were receiving a service.At the last inspection in March 2015, the service was rated as good in all five areas. The overall rating was good.
At this inspection, we found the service had improved and was now outstanding in two areas and good in three areas. The overall rating had improved to outstanding.
This comprehensive inspection took place on 2 November 2017 and was unannounced.
There were 130 people receiving a service from the agency. Although the majority of people using the agency received a regulated activity, some received support visits only. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. The time of visits ranged from 15 minutes to one and quarter hours, with the frequency of visits from once a week to four times a day. There were 17 people who required two care workers at each visit to support them. There were 65 full and part-time staff employed.
There was registered manager in post. A registered manager is a person who has registered with the CQC 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.
The care people received was outstanding. Care workers treated people with respect, dignity and compassion. They were motivated, passionate and proud of their jobs. People said care workers went ‘the extra mile’ and the agency put people at the heart of their service. They went above and beyond what was expected of them when they needed to. There were many examples of when this happened and how the agency had dealt with emergency and unusual situations in a professional, exceptionally kind and responsive way.
People were at the heart of the service. Care workers knew what mattered to people the most. They recognised how important it was for families and friends to be involved in people’s care, support and wellbeing. Two people commented, “All the staff are good … I can’t speak more highly of them … they are very caring” and I have nothing but praise for them … they are so kind and polite to me … they are lovely girls, nothing is too much trouble for them.” Care workers recognised the importance of pets in people’s lives and regularly cared and looked after them as part of the family.
People were encouraged to be as independent as possible by care workers they trusted and felt safe with. They were supported to lead as good a quality of life as possible. People were never rushed and care workers took the time to support them in the right way. People commented, “I never feel rushed … they always make sure I’ve got everything I need before they go. They are more like friends, it’s as if we’ve known each other for years … they’d do anything for me” and “They’re lovely girls … I’m lucky to have them.”
Care workers treated people equally, irrespective of their beliefs, opinions or preferences. Meaningful relationships had been developed between people, their relatives and staff. People felt comfortable and trusted the care workers who came into their home. Caring for people’s wellbeing was an important part of the agencies philosophy. People had a regular team of care workers and felt they had become part of the extended family. A relative said, “… I’ve seen them (staff) with her and they hold her hand as they talk to her. It’s like having extended family.”
Regular social activities, events and networks were planned by the agency throughout the year. People who lived in isolation were encouraged to attend and the agency fostered strong links with the local community. The agency regularly supported charity events and raised money for these events.
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. Care workers had received training on the Mental Capacity Act 2005. They ensured people were asked for their consent before they carried out any care or support.
People were cared for by care workers who were aware of their safeguarding responsibilities. Staff had received training in how to safeguard people from potential abuse and knew how to identify the risks associated with abuse. Care workers were safely recruited, trained and supervised in their work. They enjoyed their jobs, felt included and listened to in the running of the agency. Staff were recognised for achievements in their work and learning. Regular incentives were given to show staff they were valued and appreciated. Annual awards ceremonies were held where staff were presented with awards and certificates in recognition of their work.
Each person had risk assessments and a care plan in place. People and their families were involved in the planning of their care and these were regularly reviewed. When changes in care support were required, these were carried out in a timely way. Comments included, “They don’t just say they will see what they can arrange, they get it sorted when I need extra support” and “We are kept updated and reviews are regular either all together or on the phone.”
Care workers had been trained to give people their medicines safely and ensured medication administration records were kept up to date. Care workers supported people to eat a nutritious diet with food and drinks of their choice. In between care visits, care workers always made sure people had snacks and drinks available.
The leadership and management of the service was outstanding. People had confidence in the management of the service and the registered manager acted as a role model for the staff team. People and their relatives told us the service was very well led and that they were provided with a high level of service. People knew how to voice any concerns and had confidence they would be listened to and resolved. The registered manager and care workers delivered a service where the emphasis was placed on enhancing people’s lives by providing outstanding care and support. They took into account people’s individual choices and preferences at all times. Comments included, “I think the office is excellent and the manager is very kind and organised”, “The manager always has time to listen to you” and “The manager is organised and proactive and I find she is a good listener and gives accurate advice.”
The provider was committed to continual improvement and governance was embedded in every part of the service. There were extremely comprehensive quality monitoring systems and processes in place which were robust and regularly carried out by a variety of senior staff. These drove continual improvement of the service.