All Care (GB) Limited - Basingstoke Branch

• All Care provides personal care and support to people living in their own homes and specialist ‘extra care’ housing. At the time of the inspection there were 280 people receiving personal care from the service.

• For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk.

People’s experience of using this service:

• People and their relatives consistently provided positive feedback about the quality of care they received.

• One person told us, “My care is first class. I need to choose my carers and need to know that nobody else will come. My carers are out of this world. They know me and my needs. They are the only carers I have ever trusted.”

• People were protected from avoidable harm, neglect, abuse and discrimination. Staff ensured the human rights of people who lacked a voice, were upheld and respected.

• Risks to people's safety had been identified and management plans gave staff the required guidance to mitigate these risks. Staff delivered safe care in line with people’s risk assessments.

• Without exception, staff supporting people within the ‘extra care services’ felt extremely valued and respected, and demonstrated high levels of morale.

• However, some staff supporting people in their own homes reported being frustrated by lack of communication from the management team and office based coordinators. These frustrations had been identified by the registered manager who was analysing these concerns at the time of inspection, to develop a strategy to improve communication.

• Staff had developed and maintained the required skills to meet people’s needs effectively, which led to good outcomes for people’s care and support and promoted their quality of life.

• We saw people were treated with kindness and compassion by staff who supported them to express their views and be actively involved in making decisions about their care.

• People’s care plans were comprehensive and up to date, providing staff with the required information about their needs and how to meet them.

• The registered manager and provider had worked effectively with local organisations to improve care practice and outcomes.

Rating at last inspection:

• Good. (The last inspection report was published on 13 July 2016).

Why we inspected:

• This was a planned comprehensive inspection based on the previous rating.

Follow up:

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

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

In April 2015 the scale of All Care’s care provision increased considerably due to a change in local authority commissioning arrangements. This meant that the number of people supported by the service rose from about 100 people to 289. At this time staff from other services also transferred to All Care from other providers under a recognised employment process.

During this transitional phase people told us they had experienced some mistimed calls and did not know the staff supporting them. People told us that the organisation and coordination of visits had improved dramatically, which meant that they now experienced good continuity and consistency of care.

People were protected from potential harm, because staff were trained to recognise and deal with possible abuse. During the previous year the registered manager and staff had reported and taken appropriate action in relation to four safeguarding incidents. People felt safe with regular staff who knew them and their needs well.

Risks affecting people’s health and wellbeing had been identified. The service managed these risks safely to protect people from harm while promoting their independence. People experienced safe care provided in accordance with their risk management plans.

People and their relatives had no concerns regarding staffing levels. The registered manager completed a weekly staffing analysis for the provider to ensure there were always enough staff to provide the required support, which rotas confirmed and we observed in practice.

The provider’s recruitment coordinator ensured staff had undergone relevant pre-employment checks. These checks were then verified before staff were able to provide people’s care. The provider had ensured people were safe because they only deployed staff whose suitability for their role had been assessed.

People received their medicines safely, administered by staff who had completed safe management of medicines training and had their competency assessed annually by supervisors. Staff were able to tell us about people’s different medicines and why they were prescribed, together with any potential side effects.

Staff completed an induction course based on nationally recognised standards and spent time working alongside experienced colleagues. New staff had their competency assessed by the training coordinator and supervisors before they were allowed to support people independently. This ensured they had the appropriate knowledge and skills to support people effectively. Staff told us their training was refreshed regularly, in accordance with the provider’s policy. This ensured staff were enabled to retain and update the skills and knowledge they required to support people effectively.

The provider had a thorough system of supervision, which the registered manager and senior staff operated effectively to ensure staff were supported to deliver high quality care.

People told us staff always sought their consent before providing their care and explained what they were doing during the provision of their care. Staff had completed training in relation to the Mental Capacity Act 2005 (MCA) and people had their human rights protected by staff who understood legislation and guidance regarding issues about consent and mental capacity.

People were supported by staff who understood their dietary preferences. We observed people supported appropriately to ensure they received sufficient to eat and drink. Where people had been identified to be at risk of malnutrition they had been referred to relevant health professionals.

Staff were aware of people’s changing needs and took prompt action to ensure relevant healthcare services were contacted when required.

Staff had developed warm and caring relationships with people and knew about people's needs and the challenges they faced. Staff understood people’s support plans and the events that had informed them. People liked the staff who were supporting them and were relaxed and comfortable in their company.

People were supported by thoughtful staff who treated them with dignity and respect at all times. Staff invested time to get to know people and were able to engage in meaningful conversations with them, which did not just focus on the person’s care needs.

Wherever possible people were involved in making decisions about their care. When people required support with their care planning, the registered manager consulted their relatives, social workers and the commissioners of their care. The supervisors involved in completing support plans told us how they focused on what ‘Outcomes’ people wanted, for example; ‘To remain independent and live in my own home for as long as possible’.

People were supported to make advanced decisions and were involved in planning their end of life care. Staff knew about people’s advanced decisions and who they were legally obliged to consult in relation to them. The provider had ensured people were supported to make advance decisions which were taken into account by staff.

People were treated as unique individuals and experienced care and support that reflected their wishes. If the provider through their needs assessment identified that people’s care required more time to be delivered safely or that people’s needs had changed, they promptly addressed this with the commissioners. The service was flexible and responsive to ensure that additional care was provided for people when required, for example; when people needed support to attend medical appointments.

People and relatives knew how to make a complaint and raise any concerns about the service. People who had made complaints told us that staff responded well to any concerns or complaints raised. Those who had not made a complaint told us they were aware of the complaints procedure and felt the registered manager would listen to their concerns and act upon them, if the need arose.

Staff told us they were proud to work for All Care and the service they provided. People were cared for by staff who understood and practised the values of the service in the provision of their day to day care.

The registered manager had created a transparent culture within the service, where staff were encouraged and supported to take responsibility and learn from mistakes. The registered manager understood their duty to be open and honest when things go wrong. We reviewed an incident where the registered manager had investigated concerns raised by a person’s relative, acted upon them and apologised.

The provider had appointed a quality assurance coordinator to audit various aspects on the operation of the service to ensure compliance with regulations, for example; medicines management audits. Audits identified where actions were necessary to improve practice, which the registered manager ensured were completed.