Home Instead

Updated 21 December 2018

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.

This announced comprehensive inspection took place on 23 and 25 October 2018. We gave the provider 48 hours' notice because the location provides a domiciliary care service and we needed to make sure the provider and registered manager would be available for the inspection. It also allowed us to arrange to telephone and visit people using the service.

The inspection team comprised of an adult social care inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Prior to the inspection, the provider completed 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 used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

Prior to the inspection we sent 24 questionnaires to people, and received eight replies. We sent 24 questionnaires to relatives/friends, and received three replies. We sent 87 questionnaires to staff and received 42 replies. We sent 23 questionnaires to community professionals and received five replies.

During the inspection we visited two people in their own homes. We spoke by telephone to six people and nine relatives to seek their views about the service. We looked at five people's care plans and at their medicine records. We spoke with both directors, the registered manager and with ten staff which included a care manager, deputy care managers, supervisors, a co-ordinator, recruitment officer and training leads. We looked at five staff files which included details of recruitment, training, supervision and appraisals. We reviewed staff meeting minutes, training records, accident and incident reports, and at complaints and compliments. We also looked at the provider's quality monitoring systems which included audits of medicines, care records and 'spot checks' where senior staff monitored care staff providing care in people's homes. We sought feedback from commissioners, and health and social care professionals. We received a response from six of them.

Updated 21 December 2018

This announced comprehensive inspection took place on 23 and 25 October 2018. At the last inspection in 29 February, 02 March and 04 March 2016 the service was rated Outstanding. At this inspection we found the service remained Outstanding.

Home Instead Senior Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults based in Budleigh Salterton, Exeter and East Devon area. Not everyone using Home Instead Senior Care receives the regulated activity; 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. At the time of the inspection the branch provided personal care to 42 people living in their own home in the. The service employed 77 care workers, known as Caregivers.

Why the service is rated Outstanding.

People praised staff and said they were exceptionally caring and compassionate. Comments included, “Each carer provided warmth and loving care along with great attention to mums needs and interests,” “Nothing is too much trouble for them, they are so kind to her, explaining what they are doing.” Staff were matched with people based on their life, experiences, interests and hobbies. This helped them develop positive, meaningful relationships with people. They knew each person as an individual, and what mattered to them and treated people with the utmost dignity and respect. Staff went that extra mile to promote each person’s wellbeing and improve their quality of life. For example, taking one person to visit their old home and helping another person reconnect with old friends. The service had a strong, visible, person centred culture which people and staff described as “like an extended family.” Staff said, “The hour minimum visit gives us a chance to really connect with clients,” “I am proud to work with this friendly professional caring team that always puts the clients first.”

People were safe because there was an exceptionally strong emphasis on safety. Staff were skilled and proactive in recognising and reducing risk. They used innovative ways to support people to stay safe in their own homes, lead fulfilling lives and minimise restrictions on their freedom. Staff proactively helped people improve their health and reduce their risk of falling. The service held Falls Prevention Workshops for local community groups to spread message about how to prevent falls. They used an innovative mobile lifting chair to help people up, when they had fallen off the floor, which prevented unnecessary admissions to hospital. The agency has also extended this service to local people through their links with their local GP surgeries, NHS staff and Age UK at their local community hub.

People felt safer because staff worked with the police and the fire service to protect people from crime and improve fire safety. The provider promoted a ‘no blame’ culture, whereby staff were encouraged to speak up if they made mistakes or got things wrong. This was so wider lessons could be learned and safety improved.

People and families praised the exceptional skills of staff who supported them. Their comments included: “We are so grateful for the high quality, efficient and reliable care you provide.” Staff were well trained using best practice evidence and felt supported in their role. The service used innovative training methods to help staff understand people’s experience of becoming frailer, and experiencing visual impairment. They were proactive in ensuring people newly discharged from hospital had increased support.

People living with dementia received best practice care and the agency participated in dementia research. They promoted and encouraged people with dementia to live well. The service worked in partnership with local health and social care organisations to improve people's health. Staff taught people, relatives, staff and local people about the various types of dementia, and how it affected people. They signposted people to other local services and trained local volunteers in first aid and moving and handling.

People received an exceptionally personalised service that promoted their independence and enhanced their quality of life. People were at the heart of everything the service did, they felt valued and that they mattered. The agency worked in innovative ways to enrich people's lives and improve their wellbeing. For example, with the Alzheimer’s Society they supported a “Singing for the Brain” group in Exmouth, which used singing to bring people affected by dementia together in a friendly and stimulating social environment. To be more inclusive, the provider was about to start another group, Singing For Wellbeing”, at the Community Hospital Hub in Budleigh Salterton. This will promote wellbeing through singing for a wider range of older people.

People benefitted from a service was exceptionally well led. The provider had robust quality monitoring arrangements through which they continually reviewed evaluated and improved people's care. Professionals said, “The service is well led, the management team are always approachable and helpful, I always hear positive comments regarding them in the local community,” “Clients tell me how happy they are with the care they are receiving from Home Instead.” People’s feedback results and a range of awards showed the service was consistently high performing.

The provider had a ‘Carer of the month’ scheme that recognised, re-enforced and rewarded positive staff values, attitudes and behaviours. The agency was working with the local authority Devon County Council to promote careers in care positively. This was through staff featuring in a series of videos where they spoke about their rewarding experiences of working in care.

People were partners in their care. Their views, experience and contributions were sought and valued and used to make continuous improvements. The agency worked in partnership with local professionals and other organisations to develop joined up, innovative, flexible services and sustainable models of care that improved the health and wellbeing of local people. For example, they contributed to a successful campaign to reopen a closed community hospital as a “community hub,” which offered a range of services to local people. They supported a person, newly diagnosed with dementia, to influence policy by helping them to attend their local dementia alliance group.

Further information is in the detailed findings below