Right at home Harrow

Updated 5 March 2019

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, and to provide a rating for the service under the Care Act 2014.

One inspector carried out the announced inspection on 4 January 2019. We told the provider two days before our visit that we would be coming. We gave the provider notice of our inspection as we needed to make sure that someone was at the office in order for us to carry out the inspection. Following the inspection an expert by experience contacted people who used the service and relatives and undertook telephone interviews. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before we visited the service we checked the information that we held about the service and the service provider including notifications we had received from the provider about events and incidents affecting the safety and well-being of people. The provider also completed a Provider Information Return (PIR). The PIR 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. The PIR also provides data about the organisation and service.

During our inspection we went to the provider’s office. We reviewed seven people’s care plans, six staff files, training records and records relating to the management of the service such as audits, policies and procedures.

Some people who used the service were unable to verbally communicate with us due to their mental capacity. We therefore spoke with some people’s relatives. We spoke with three people who used the service and ten relatives of people who used the service. We also spoke with twelve members of staff including care support staff, the registered manager, the director and regional compliance manager.

Updated 5 March 2019

We undertook an announced inspection of Right at Home (Harrow) on 4 January 2019. Right at Home (Harrow) provides a range of domiciliary care services which include live-in care and support, administration of medication, food preparation and housework.

CQC only inspect the service 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 inspection, the service provided care to 54 people, of which 39 people received ‘personal care’.

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.

Our previous inspection of the service in June 2016 rated the service as Good with no breaches of Regulation. During this inspection on 4 January 2019, we found that the service remained Good.

Some people who used the service were unable to verbally communicate with us due to their mental capacity. We therefore also spoke with relatives of people who used the service. People who received care from the service told us that they had been treated with respect and dignity and felt safe in the presence of care support staff. Relatives told us they were satisfied with the care and services provided. They spoke positively about care support staff and management at the service.

Procedures were in place to protect people and keep them safe. Staff knew how to identify abuse and understood their responsibilities in relation to safeguarding people and reporting concerns. Risks to people's and staff safety were identified and guidance was in place to manage and minimise risks of people being harmed and protected them.

Arrangements were in place in respect of medicines management. Staff had received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that these were not always completed fully. There were occasions where the key was used to complete the MAR, but there was no further information recorded on the MAR to indicate whether the medicine had been administered or the circumstances surrounding the administration. Further, where medicines formed part of a blister pack, the medicines were not always detailed on the MARs and therefore it was not clear what medicines had been administered. We discussed this with management and they advised that they would ensure that medicines contained in a blister pack would be clearly recorded on the MAR in future. They confirmed that they would take immediate action in respect of this. Following the inspection, the director sent us an action plan which detailed the improvements they would make and timescales. This included refresher training and workshop sessions.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. People received care from the same care support staff on a regular basis and experienced consistency in the level of care they received. The registered manager explained that each person that received care had an allocated group of care support staff so that they were always familiar with them. The service operated a “No stranger policy” which ensured that people always knew who was providing their care.

Comprehensive recruitment processes were in place and the service carried out appropriate checks so only staff who were suitable to work with people using the service were employed by the service.

People were cared for by staff that were supported to have the necessary knowledge and skills they needed to carry out their roles and responsibilities. Records showed that care support staff had undertaken a comprehensive three-day induction when they started working for the service. They completed training in areas that helped them to provide the support people needed and covered areas such as client care, carer role, duty of care, communication, food hygiene and medication. Training was provided by an external training provider. Topics included moving and handling, medicines, safeguarding adults, infection control, first aid and health and safety. Staff also received regular refresher training to ensure they were informed of developments and updates.

People's dietary needs were understood and supported by the service. People received the assistance and support that they needed to ensure their nutritional needs were met.

People had been visited by the service who carried out an assessment of their needs prior to them receiving care. People received personalised care and the service was responsive to their needs. People were consulted about how they would like to receive their care and their preferences were supported. People's care plans were up to date and included information staff needed about how best to support them. People's daily routines were reflected in their care plans and the service encouraged and prompted people's independence. Care support plans included information about people's life history.

Staff had a good understanding and were aware of the importance of treating people with respect and dignity. They also understood what privacy and dignity meant in relation to supporting people with personal care. Feedback from people indicated that positive relationships had developed between people using the service and care support staff and people were treated with dignity and respect.

The director explained that the service focused on trying to get people out into the community. One example was that the service had arranged a workshop with an external organisation for one person to get together with a younger person to do fun activities. The idea behind this was to encourage the younger and older generation to get together. The service had also arranged a “musical memories” event at a local hall which was held for people with dementia to bring them together to listen to music. The service had participated in the Macmillan cancer coffee morning and arranged for people to come to the office.

The service had a complaints procedure. The service had clear procedures for receiving, handling and responding to comments and complaints. People and relatives told us they did not have any complaints about the service but knew what to do if they needed to raise a complaint or concern.

People and relatives spoke positively about the management of the service. There was a clear management structure in place with the director, registered manager, team of care support staff and office staff which included a recruitment manager, senior scheduler, care coordinator and field care manager.

Systems were in place to monitor and improve the quality of the service. We found the service had a comprehensive system in place to obtain feedback from people about the quality of the service they received through review meetings, telephone monitoring and home visits. The service implemented their own quality assurance system. This provided a structured system for obtaining feedback from people and relatives and ensured that this was consistently carried out for all people.