Home Instead

Home Instead Senior Care 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 111 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.

People’s experience of using this service and what we found

People using the service and relatives were positive about the support provided by the Home Instead Caregivers and the communication with the office-based staff.

Caregivers were also positive about working for Home Instead Senior Care and the support and training they received. There were now more e-learning courses due to the COVID-19 restrictions in place limiting the opportunities for face to face training.

Support plans were written for all clients and were reviewed every 3 months. Caregivers informed the client leads of any changes in people’s support needs or medicines and said these were quickly re-assessed and support plans changed.

A quality assurance system was in place, with regular audits being completed to manage the service. There was regular communication with the Caregivers through weekly newsletters and a new staff forum meeting.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 8 January 2019).

Why we inspected

We undertook this targeted inspection 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. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

There was 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.

People told us they received safe care, which was reliable and consistent. The service had sufficient staff to meet people’s needs, and people were given the time they needed to ensure their care needs were met. We saw that people were protected from avoidable harm. During the inspection we checked to see how the service protected vulnerable people against abuse and if staff knew what to do if they suspected abuse. There was an up to date safeguarding vulnerable adult’s policy in place. Risks to people were assessed and risk management plans were in place. We found that the staff we spoke with had a good understanding of the principles of safeguarding.

People confirmed that staff arrived on time and stayed for the length of time allocated. People also confirmed that visits were rarely missed and that a manager was always available. There had been no formal complaints received over the last twelve months.

Staff had the skills, training and support they needed to deliver effective care. All of the staff we spoke with told us they were well supported by each other and the management team.

The service was working to the principles of the Mental Capacity Act 2005, which meant that care staff supported people to make their own choices about their care. Before any care and support was provided, the service obtained consent from the person who used the service. We were able to verify this by speaking with people who used the service, checking people’s files and speaking to staff.

The managing director had robust recruitment processes in place which included the completion of pre-employment checks prior to a new member of staff working at the service. This helped to ensure that staff members employed to support people were deemed suitable and fit to do so. People who used the service could be confident that they were protected from staff that were known to be unsuitable to work with vulnerable adults.

The recruitment manager and the franchise owner with responsibility for recruitment had developed a recruitment process alongside the main recruitment policy which incorporated the agency’s core values of rapport, empathy and attitude.

We saw evidence of a comprehensive induction pack, with appropriate training provided for roles and responsibilities, along with competency testing. Staff also signed to confirm they had read policies and procedures and that they were aware of the provider's requirements in respect of data protection and confidentiality.

At the time of the inspection the service had recently introduced ‘people planner’ which is a computer software programme specifically produced for the care and support sector to assist them in organising the deployment of staff.

All care staff were given a ‘caregiver’ manual that included policies and procedures, which were discussed with the staff member as part of the induction process. Staff received supervision and appraisal from the registered manager. These processes gave staff an opportunity to discuss their performance and identify any further training they required.

People were supported with a range of services which enabled them to continue to live in their own homes safely. People who used the service and their relatives told us they had been involved in the assessment and planning of the care and support provided and that the service responded to changes in people’s needs. The care records contained good information about the support people required and were written in a way that recognised people’s needs. This meant that the person was put at the centre of what was being described. The records we saw were complete and up to date.

All the care staff who dealt with people’s medicines had received medicine management training, been assessed as competent and were clear about their role in managing medicines safely.

We found people were receiving care from care staff who were deployed consistently in a way that met people’s needs and followed the best matching policy. Some people who used the service lived alone and staff required the use of a key to access their house. We saw the keys were appropriately stored in a ‘key safe’ outside a house we visited.

We found from looking at people’s care records that the service liaised with health and social care professionals involved in people’s care if their health or support needs changed and the service worked alongside other professionals and agencies in order to meet people’s care requirements where required.

People told us that they were listened to by the service. The registered manager told us that if the service received a new referral it would not be accepted unless there were enough staff available to meet the person’s care needs.

People told us the service was well managed and they felt they could approach the registered manager and managing director with any concern and they would be listened to. Care staff told us they enjoyed working for the service, they received good training and felt supported.

Robust systems were in place to monitor the quality of the service provided to help ensure people received safe, effective, care and support. The registered manager and senior care staff had effective audit and quality assurance processes and procedures in place. Any actions required to improve the overall standard and quality of care were raised at the regular staff meetings and in formal supervisions.

There was an up to date accident/incident policy and procedure in place. Records of accidents and incidents were recorded appropriately within people’s care files.

There was an up to date ‘business continuity plan’ in place which covered areas such as loss of access to the office, loss of utility supplies, loss of staff, office damage, loss of telephone/IT systems and adverse weather the action to be taken in each event.

The service had a Statement of Purpose, which is a document that includes information about a service and the standards required. This document included details of how to make a complaint and referenced the Local Authority, the Care Quality Commission and the Local Government Ombudsman. We were told it was given to all clients of the service. We verified this as we saw it in the client journal in people’s homes.

There were detailed systems in place to record what care had been provided during each visit. Care plans contained a client record log document which was completed by staff at each visit.

Staff told us they felt they were able to put their views across to the management, and felt they were listened to. The staff we spoke with told us they enjoyed working at the service and said they felt valued.

The service undertook audits to monitor the quality of service delivery. We saw a number of audits in place regarding safe and good quality care. We found the service had up to date policies and procedures in place, which covered all aspects of service delivery.

The managing director had a clear vision for the future of the service over the next few years. The service benefitted from strong leadership and oversight at managing director and registered manager level.

A relative of a person who used the service told us; 'They talk to my X, the girls take their time to explain what needs to be done such as helping my X to dress. Things are explained to my X fully. The carers understand her and have fun with her and do things in a happy way and a wonderful relationship has developed.'

We looked at a sample of eight care files of people who used the service. Care was planned and delivered in a way that was intended to ensure people's safety and welfare.

A relative said 'The staff have a fantastic relationship with my X, the carer who looks after my X has been an absolute star'.

We found that staff had appropriate training for their roles and responsibilities.

One member of staff told us 'What I like is that the staff are fully supported by the team in the office. They really support me on the ground.'

We found that the provider had systems in place to monitor the quality of the service they provided.

We found that regular 'spot checks' had been undertaken to monitor the quality of the service provided by staff.

We found the provider had effective systems in place to record, respond and investigate any complaints made about the service.

A person said 'If I had real concerns, I feel I could easily voice those concerns and I have confidence they would address those concerns.'

People told us that they always knew the care worker who went to their home, and staff confirmed they were introduced to new people and given time to get to know them and find out about their needs.

All staff had been through a thorough recruitment process and had received mandatory training, including safeguarding training, prior to them starting work.

We saw that the manager regularly checked people were receiving a high quality service, and people had the opportunity to give their opinion of the service and make any comments at least every three months.