We carried out this unannounced inspection of Home Instead Senior Care Limited (Home Instead) between the 26 & 27 September 2016. We last inspected in January 2014 and found the service was meeting the legal requirements in force at that time.There was a registered manager employed. 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.
Home Instead is a domiciliary care agency based in the High Lane area of Stockport currently providing services within four of the surrounding local authority areas. The service provides support to approximately 120 older people who may have a learning disability, mental health problem, physical disability, sensory impairment or dementia.
The feedback we received from people using the service and their relatives was excellent. One relative told us, “Home Instead have been a godsend when I did not know where to turn. I also am aware that if I need more help then they can provide it for all aspects of my (relative's) care which means she can indeed stay ‘home instead’ of having to move to a care home. People told us that they were consistently looked after by staff that were exceptionally caring, understanding and compassionate. People felt like they mattered, they told us that staff were patient, and demonstrated a huge amount empathy in how they looked after them.
Staff made "huge efforts" to ensure people had all their needs and wishes catered for when they had been diagnosed at the end of their life. One person had been helped to draw up a "bucket list" and staff went to great lengths to ensure that all these wishes where met for that person. A relative of a person at the end of their life was given informal respite and breaks to help them cope.
We saw the service had a very strong, visible person-centred culture. All staff were passionate about caring and supporting people in ways that mattered to the individual. The owner said, “It’s all about delivering the best care we can possibly give. We empower the staff so that they can make a difference to people's lives." With this in mind the company had a policy of only accepting only one hour visits as a minimum. This was very important in ensuring that people felt respected and that their dignity was upheld by visits that could be paced to suit the needs of each person and that people never felt rushed. One person said, “There’s always plenty of time for chats. I can honestly say I’m not as lonely now.” We found that people were treated with a great deal of dignity and respect.
People were supported in their own homes by well-trained staff that were able to meet people’s needs safely. The agency had robust systems to ensure that there were sufficient numbers of staff employed to meet people’s assessed needs. A family member of a person in receipt of the service told us, “They are the only care agency I would trust my own family with. I have no concerns. It’s been a relief to find them”.
Home Instead took people’s safety very seriously. They carried out comprehensive risk assessments to reduce and manage the risks to peoples’ health and welfare. There were systems in place to make sure that people were supported to take medicines safely and as prescribed. A supervisor had a specific role of medicines coordinator to ensure staff were trained, confident and competent to handle medicines safely.
People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us they felt safe and were well cared for. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns.
Newly recruited staff had thorough pre-employment checks and received induction that prepared them for the demands of their job. Staff confirmed their induction provided them with the essential knowledge and practical guidance they needed before they took up their care duties.
Training was given a very high priority in this agency. A full-time dedicated training manager was employed who had developed a programme of extensive training that was designed around the needs of the people they were supporting.
People’s care plans reflected their needs and choices about how they preferred their care and support to be provided. People were encouraged to be involved in the development and review of their care plan and were enabled to be independent. The service demonstrated very well that people were empowered by packages of care that were tailored to support people to maintain a life of their own choosing.
People's experiences of care were overwhelmingly positive. Staff were very caring, friendly, and responsive to people’s changing needs. The registered manager and owner spoke of their passion to give people the best support possible. One person said of the care given, “The staff are so kind and thoughtful. They really do go the extra mile, the owner even came and changed a light bulb for me. I can’t tell you how this sort of thing makes me feel so well supported and cared for. It’s knowing that at all times someone is at the end of the phone. Don’t get me wrong I hardly ring at all but it’s just that knowing that somebody cares is the main thing.”
People told us they received a “really reliable” service and were kept informed in a timely way whenever staff were unavoidably delayed, or when another staff had to be substituted at short notice. There were robust systems in place for checking that staff knew who they were going to and to let people know who to expect. This was double checked prior to the weekend to ensure people always received a visit. Senior managers had a 'post weekend' report meeting every Monday morning to review the weekends care and to attended to any matters that may have arisen, such GP's being called out and any follow ups that were required.
Complaints were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary. People knew how to raise concerns and complaints and felt comfortable doing so. One person told us, “I have never had any reason to complain and would certainly recommend them. They do listen and try to sort things out.”
People’s rights were protected and staff obtained people’s consent before providing care. The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA). People made their own decisions about their care and support. They were given information by the agency that was in formats they could understand so that people were making informed choices and were enabled to be involved in decisions.
The culture of the service was positive, clearly person centred, forward thinking and inclusive. Everybody that we spoke with echoed this and said that the service delivery was excellent, inspiring and enabling. The service had very strong leadership team who promoted clear values and an open culture. The registered manager and registered provider demonstrated a very good understanding of the importance of effective quality assurance systems in promoting a high quality of service. Both the owner and registered manager had high expectations of staff and gave them as much support and training needed to provide a reliable, efficient and compassionate service to people. Staff were extremely proud to work for the organisation.