Home Instead

Updated 19 August 2021

The inspection

This was a targeted inspection to check to check on whistle blowing complaints we had received about the support for Caregivers and culture at Home Instead Senior Care. We found no evidence during this inspection to substantiate these concerns.

Inspection team

One inspector visited the Home Instead Senior Care offices and telephoned members of care staff (called Caregivers). An Expert by Experience telephoned people who were supported by the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service had two managers registered with the Care Quality Commission (referred to in this report as registered manager 1 and registered manager 2). This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was to be sure that the provider or registered manager would be in the office to support the inspection. Inspection activity started on 21 July 2021 and ended on 26 July 2021. We visited the office location on 21 July 2021.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and used all this information to plan our inspection.

During the inspection

We spoke with ten members of staff including the provider, both registered managers, client lead, care co-ordinators, field care supervisor and a Caregiver. We reviewed a range of records, including quality assurance, staff communications and client assessments.

After the inspection

We spoke with six people who used the service and nine relatives by telephone about their experience of the care provided. We also spoke with eight Caregivers about working for Home Instead Senior Care.

We continued to seek clarification from the provider to validate evidence found. We looked at training data, staff supervision records and the annual survey.

Updated 19 August 2021

This inspection took place between 01 and 07 November 2018 and was announced.

This service is a domiciliary care agency. It provided personal care to people living in their own houses and flats in the community. The service supported older adults who were living in the Trafford and Wythenshawe areas of Greater Manchester. At the time of our inspection, the service was providing support to 177 people, of whom, 71 received support with the regulated activity ‘personal care’. All people using the service either fully or part funded their own care.

Not everyone using Home Instead Senior Care received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where people receive such support, we also take into account any wider social care provided by the service.

We last inspected Home Instead Senior Care in January 2016 when we rated the service good overall and in all key questions other than well-led, which was rated outstanding. At this inspection we found the evidence continued to support the rating of good, and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

The registered manager had recently resigned, and finished working their notice during this inspection. We saw the provider had recruited a new manager who had accepted an offer of employment and was working their notice in their current 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.

People received a reliable service from staff who attended their calls in a timely manner. There had been no missed calls to people receiving a regulated service in the past year, and people told us staff turned up on time. The provider had systems in place to monitor staff availability when deciding whether they had capacity to accept new care packages.

Staff assessed risks to people’s health, safety and wellbeing. Whilst some risk assessments were limited in detail, we found staff were aware of appropriate steps to take to keep people safe. Risks were also reduced as people received support from consistent staff teams.

Staff provided the support people needed to take their medicines as directed. However, in one case, we found staff had not followed safe procedures, and the provider’s own policy in relation to the administration of over the counter medicines. We saw the provider was introducing a new medicines administration policy at the time of our inspection that staff were receiving training in. The director confirmed this covered requirements in relation to the administration of over the counter medicines.

People’s needs were assessed prior to staff starting to provide a service. People felt that Home Instead Senior Care had a good understanding of their needs and preferences. People were supported to access other services to meet their health and social care support needs. However, we found some assessments were limited in detail and had not always been updated promptly following changes in people’s needs.

Staff received support and an induction that prepared them to undertake their job roles. People told us they were confident that staff had the skills and experience needed to meet their needs. We saw the provider carried out staff spot-checks and competency assessments. Reviews of people’s service also considered whether staff required any additional training to meet people’s assessed needs.

People were asked to sign forms to different aspects of their planned care and handling of records and information. However, we found shortfalls in this process. For example, one person had signed a consent form when they did not have capacity to do so, and other people had not consented to aspects of care that staff were carrying out. It was not always clear how decisions in relation to people’s capacity had been made, although we saw the provider had carried out adequate formal capacity assessments and best-interest decisions in relation to more significant decisions about people’s care.

People received support from small, consistent teams of staff. The provider had a system whereby no person received support from a staff member until they had been formally introduced. This helped ensure staff were aware of people’s needs and preferences and were able to build positive, trusting relationships with them.

Feedback from people using the service about their care staff was consistently positive. We received multiple comments from people who told us that their care staff were more like friends, although they stated they were also aware of professional boundaries. The provider had a policy of only carrying out calls of a minimum length of one-hour, which staff and people using the service felt helped people build relationships, and staff provide person-centred care.

The service produced a ‘what’s on where’ guide that provided information about community events, groups, charities and support groups. The provider told us these were handed out to all people using the service and by other health and social care professionals. The provider was involved in arranging or supporting a number of initiatives that aimed to reduce the risk of older adults becoming socially isolated, and developing dementia friendly communities.

People and their representatives were involved in planning and reviewing their care. People told us staff understood their needs and preferences, and we saw care plans documented people’s preferences and social histories. Where it was part of people’s planned care, we saw staff supported people to take part in meaningful activities, and remain a part of their communities.

People told us they had not had cause to raise any complaints but said they would feel confident doing so if needed. We saw previous complaints had been investigated and responded to appropriately.

There was a significant management structure in place to support service delivery. This was in addition to support the service received from the franchises national office. The service had grown since our last inspection. Because of this, the director had introduced a new management structure, with separate teams that focussed on people using the service (the client experience team), staff (the care givers team) and a planning/development team.

There was a high level of satisfaction amongst people using the service who talked about receiving a reliable and professional service. Staff were also motivated, and we saw the opinions of staff and people using the service were sought and considered as part of the service’s drive for continuous improvement.

We found there was a system of checks and audits to help the provider/management team monitor the safety and quality of the service. However, these checks had not identified the issues we found in relation to medicines management, consent forms/capacity assessments and the review of care for people with deteriorating health.