15 August 2016
During a routine inspection
Alzheimer’s Society Sussex Dementia Care and Support Service is a domiciliary care agency and provides personal care and support for adults living with dementia in their own home in the Brighton and Hove and West Sussex area. This is one of a range of services provided by the Alzheimer’s Society to support people living with dementia and their carers. At the time of our inspection around 80 people who were receiving a service.
On the day of our inspection, there was not 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. However, an application had been made to the CQC to register a new registered manager.
There was a clear management structure with identified leadership roles. There had been a period of change with a new manager and deputy manager. The manager was to be supported by two deputy managers. However, one of these posts was vacant, but had just been recruited to. The manager was assisting in covering this role. The manager supervised the deputy managers who then supervised a group of support workers in a geographic area. The deputy managers visited new people who wished to receive a service, undertook the monitoring visits and reviews of the service. The manager told us, We have a really good team of staff. We are in a really good place.”
There was a detailed care and support plan in place for each person accompanied by supporting risk assessments. However, there was not an up-to-date risk assessment of the environment recorded. This was to ensure the safe working environment for care staff. This is an area of practice that needs improvement.
Relatives told us they felt people were safe in the service. One relative told us, “Yes, they have the same ideas, on the same page, I feel reassured by their protocol.“ Policies and procedures to ensure safe recruitment practices were in place for staff. People were supported by support workers who were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. Medicines were managed safely and people received the support they required from staff. There were systems in place to ensure that medicines were administered and reviewed appropriately. The times that support workers arrived to support people enabled people to have the agreed support provided. For example, to take their medicines at the right time. Any accidents and incidents were monitored within the organisation, had been recorded and appropriate action had been taken and recorded by the manager.
Consent was sought from people with regard to the care that was delivered. Support workers understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation. One member of staff told us when asked what they did when a person refused the care to be provided,” We have a slowly, slowly approach. We don’t force them. When we are introduced as a new worker it’s building up trust and getting to know them. Building on the relationship.” Another member of staff told us, “We’ll leave it a minute. Then we’ll try again later.” Where people were unable to make decisions for themselves, staff had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action .
Relatives told us they, and where possible the person, was involved in the planning and review of their care. Care and support provided was personalised and based on the identified needs of each individual. They told us people always got their care visit, they were happy with the care and support provided. People were supported by kind and caring staff. One relative told us, “I can’t praise them enough. Another relative told us support workers were, “Kind and caring. I feel confident they have everything in hand.” Another relative told us, “They chat to her and talk about the old times.” A member of staff told us, “I am really happy working here. I really like to be a part of the Alzheimer’s Society. I feel it’s a cut above the rest. I can give the clients the time I couldn’t give where I have worked before.” Another member of staff told us, “I really, really enjoy my job. It’s a brilliant company to work for. I hope the customers get as much out of it as I do. If I leave them with a smile on their face my jobs been worthwhile.”
People’s privacy and dignity was considered when personal care was provided. One relative told us, “They don’t patronise her. She (support worker) shows her proper respect for her age, and is very patient.”
People were supported to eat a healthy and nutritious diet. People had access to health care professionals. All appointments with, or visits by, health care professionals were recorded in individual care plans.
There was a detailed complaints procedure. The manager told us that they operated an 'open door policy' so people, their representatives or support workers could discuss any concerns.
The managers provided good leadership and support to the support workers. One member of staff told us, “(Managers name) is always at the end of the phone.” Support workers told us communication was good in the service. Systems were in place to audit and quality assure the care provided. People and their relatives were able to give their feedback or make suggestions on how to improve the service, through the reviews of their care, and they were asked to complete a satisfaction questionnaire to help identify any areas for improvement.