Background to this inspection
Updated
17 January 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We carried out a comprehensive inspection on the 19, 20 and 22 November 2018. We gave the service 48 hours’ notice of the inspection visit because the location provides a domiciliary care. We needed to be sure that they would be in.
The inspection was carried out by one inspector on the 19 and 22 November 2018. Phone calls to people were completed by an expert by experience on the 20 November 2018. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. They had experience in dementia care and care at home services. We visited the office location on the first and third day to see members of the office and management teams and to review care records and policies and procedures.
Before the inspection we reviewed all the information we held about the service. This included notifications the service had sent us. A notification is the means by which providers tell us important information that affects the running of the service and the care people receive.
We had asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We visited two people and discussed their experience of the service. We had telephone conversations with eight people and nine relatives.
We spoke with the registered manager, care manager, care supervisor, care co-ordinator and four care staff. We reviewed five people’s care files, medicine records, three staff files, minutes of meetings, complaints and audits.
Following the inspection, we spoke with two social workers who provided feedback on their experience of the service.
Updated
17 January 2019
Inter-County Nursing and Care Services – Christchurch is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our inspection there were 36 people receiving a regulated service from the agency.
At our last inspection we rated the service outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
People were actively involved in decisions about how risks they lived with were managed and provided with accessible information to help them make informed decisions. The agency was pro-active at using technology to find innovative ways to support people to remain living in their homes safely. Staff had been provided with training specific to people’s risks and were confident in actively mitigating risks to people’s safety including the use of medical devices. Infection control practices went beyond environmental risk factors and included risks to people who were known to be prone to infection due to health issues. NHS guidance had been shared with people and the staff team with guidance on how to mitigate these known risks. The culture of the service was open and transparent and very focused on protecting people’s diversity and lifestyle choices ensuring people’s human rights and freedoms were respected.
People had their medicines ordered, administered, recorded and disposed of safely. Staff worked with people to support them to remain independent and involved with their medicines and creams. This had included creating pictorial information so that a person could direct staff in cream administration and researching and accessing technology that reminded a person their medicines were due to be taken. Since our last inspection, in line with best practice guidance, the medicine policy now included homely remedy medicines.
Staff had been recruited safely ensuring they were able to work with vulnerable adults. Staffing levels enabled a flexible approach to meeting care needs and providing time for social interactions. Staff received an induction and ongoing training and support that enabled them to carry out their roles effectively. Training had included learning how to use medical equipment to keep people comfortable when they had complex health needs or near the end of their life.
The agency was pro-active and committed to working collaboratively with people, their families, staff and other professionals both at initial assessment and then throughout the time the agency provided care and support. The risks of social isolation had been recognised and people were signposted to community links such as social groups, local activities and specialist services for dementia or bereavement. Technological solutions were sourced to help people remain safe in their homes. This meant people received an outstanding level of care that met their individual needs, lifestyle choices and independence which was responsive to changing health and care needs.
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. Working with other professionals had enabled people to get the care and support they needed including appropriate equipment and access to healthcare. A complaints procedure was in place that people felt able to use and be listened to with actions taken to solve any issues.
People had their eating and drinking needs met and staff were knowledgeable about people’s cultural diversity. To support care staff inexperienced in cooking the staff team had got together and produced a booklet of easy to follow well balanced meals. Where risks of poor appetite were associated with social isolation the agency had sourced solutions in the community such as dining clubs. Care plans had been reviewed and rota’s adjusted so that staff had time to sit with a person and share a mealtime.
People received care that was kind, compassionate and inclusive. Care staff found innovative and practical ways to go the extra mile to make people feel valued and at the centre of their care. People had their communication needs met in order that they could contribute to decisions about their day and express their feelings and views. People had their dignity, privacy and independence respected and this was reflected throughout the agency.
The registered manager provided visible leadership and championed outstanding care both within the organisation and externally. The service was seen as an excellent role model for other services. The registered manager had provided expert knowledge at a parliamentary review on best practice as a learning tool for raising the standards of the care industry. They had also contributed to a ‘Skills for Care’ national publication ‘Good and Outstanding Care Guide’.
At our last inspection the service was rated outstanding. The registered managers commitment, leadership and governance meant that people continued to receive an outstanding service. The registered manager promoted an open and transparent culture and provided visible leadership championing outstanding care both within the service and externally. The agency was seen as an outstanding role model by health and social care professional organisations. staff team were confident, motivated and felt enabled to go the extra mile when providing care to people. Staff were confident and happy in their roles and felt appreciated by the organisation.
Quality assurance processes were effective in ensuring people received high standards of care. Audits were reviewed and updated in line with best practice guidance and regulations to sustain and further improve service delivery. People had been provided with information that explained to them the standard of care to expect. When feedback had been provided it was seen as an opportunity for reflective learning and service development.