Caring 4 All

Caring 4 all is a domiciliary care agency providing care to older people, people with physical disabilities and people at the end of their lives. The service was supporting 12 people at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People were treated with kindness and care and had positive relationships with staff. One person’s relative told us, “I don’t think they can do any more than what they do. They are very good.” Another person’s relative said, “I’m perfectly happy with all of them. They are all friendly and can have a chat. To me, they are all wonderful.”

People were supported maintain their dignity and comfort at the end of their lives. People had been supported by staff to achieve final wishes. People’s end of life choices were considered, respected and advocated for by the staff team. Staff worked in partnership with other professionals to ensure that people’s end of life wishes were respected.

People were supported safely. Staff knew people well and worked with other professionals to ensure people had the right equipment or other support, at the right time. Staff understood safeguarding and how to raise any concerns about people’s safety and well-being. Staff knew about infection control and how to prevent the spread of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to maintain their independence and staff advocated for this when working with other professionals. People were supported to maintain their privacy and dignity. People received personalised care. Their needs were assessed before they began using the service. People were involved in regular care plans and risk assessment reviews.

People received their care visits when they expected to and for long enough. Times could be changed as needed to accommodate people’s needs. Staff were recruited using safe processes. Staff new to the service were supported with an induction and training. Staff had training to help them support people. Staff felt well supported by the registered manager and had regular supervision and staff meetings.

When things went wrong, staff responded openly and honestly. They took steps to address the issue and prevent it reoccurring. People and their relatives knew how to complain.

The culture of the service was positive, and person centred. People, their relatives and staff told us the registered manager was supportive and approachable. People’s views and quality assurance checks were used to make changes and improvement to the service.

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 19 December 2016)

Why we inspected

This was a planned inspection based on the previous rating.

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.

The last inspection of the service was carried out in July 2014. No concerns were identified with the care being provided to people at that inspection and the provider was meeting the requirements of the Health and Social Care Act 2008. There is 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 who received personal care and support from Caring 4 All told us they were happy with the service provided. One relative told us, “Overall I would say first class we are very happy.” One person told us, “Excellent so far, no ifs or buts, even if I ring at short notice they will do things for me.” Another relative told us, “They have made things far easier for us and they brighten her day.”

Care workers received essential training on medicine management and people confirmed they received their medicines when required at each care call. Care workers demonstrated a firm awareness of how to administer medicines safely. However, medicines risk assessments were not in place. We have made a recommendation about the implementation of robust medicine management risk assessments.

Training schedules confirmed care workers had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Care workers told us how they gained consent from people before delivering care. Consent forms were in place for people to sign to indicate their consent to the package of care, care plan and sharing of information. However, where relatives were signing consent forms, the provider was unable to demonstrate that they had appropriate authority to do so. Where bed rails were in situ, the provider had not considered if the person consented to the bed rails of whether the bed rails were implemented in the person’s best interest. We have made a recommendation about mental capacity assessments and following the code of practice.

A robust quality assurance framework was not in place. The provider was not completing internal audits. Systems to monitor if care workers were staying the allocated times at care calls was not effective. Where care workers were not staying the allocated time, documentation failed to record the reason why. For example, although a care call was funded for 45 minutes, documentation reflected the care workers only stayed 15 minutes. People and their relatives raised no concerns over the timings of care calls and care workers not staying the allocated time. However, we have made a recommendation about a robust quality assurance framework which governs the running of the care agency.

People and their relatives told us care workers were respectful and treated people with dignity, kindness and respect. They told us care staff went above and beyond to ensure they were happy and well. People's privacy was maintained. Care workers had a firm understanding of respecting people within their own home and providing them with choice and control. One person told us, “They are very friendly and I am not made to feel like nuisance they are very caring and patient with me.” Another person told us, “They are very encouraging to me and respect my independence because I try and do what I can and when I am down in the dumps they try and cheer me up.”

People could be confident that good practice would be maintained for their end of life care. One relative told us, “They are caring in every respect. They have a personal warmth because they are dealing with end of life and they are very reliable.” Another relative told us, “I’m staying with her at the moment and they are a big help to me, nothing is too much trouble for them like they will help flush the catheter tube and help with Mum’s teeth, they go the extra mile. They are talented in palliative care and she likes them.” The provider was committed to attending the funerals of the people they supported. A local newspaper article praised the service and the caring nature of the care workers employed.

The culture within the service was transparent, personalised and open. The registered manager led by example and care workers spoke highly of their leadership style. The registered manager kept up to date with legislation and policy and attended various forums in the local community. There were enough care workers to meet people's needs effectively, and people told us they had a consistent and small group of care workers who supported them, which they appreciated.

People were protected from abuse because the provider had systems in place to ensure checks of new staffs characters and suitability to work with adults at risk were carried out. Staff had also received training in adult safeguarding. People said they felt safe when being cared for. One relative told us, “She does feel safe the care workers are wonderful with her.”

People and relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Care workers told us the registered manager and senior staff were approachable and responsive to their ideas and suggestions.

The evidence we gathered enabled us to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people's needs? Is the service well-led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people's needs had been appropriately assessed before they were provided with care support. We saw evidence of this in care files. This meant that staff had the information they needed about people's care needs and were able to provide safe care.

There were sufficient numbers of experienced and competent staff available to meet people's personal care needs. We saw documentation that showed staff had been appropriately trained and received the managerial support they needed to do their job. Staff had all received training in the protection of vulnerable adults and they knew how to report concerns about poor care or respond to allegations of abuse. This meant that people were protected from the risk of neglect or unsafe care.

Suitable arrangements were in place to respond to emergencies, with the manager always being available 'on call' to support staff to manage the situation safely and in a timely way.

Is the service effective?

Staff had received the information, training and managerial support they needed to do their job effectively. There were arrangements in place that ensured staff had the most up-to-date information about people's care needs. This meant staff had a good knowledge of each person's preferences they were able to provide effective care.

Is the service caring?

All the people we spoke with said the staff were friendly, helpful, and conscientious. People were provided with support at a level which encouraged independence and ensured their individual needs were met. On person said, "The carers are all very pleasant and helpful. They have a good manner about them which I appreciate." Another person said that the care staff had always been "respectful" when doing their job.

Is the service responsive to people's needs?

We saw that there was enough staff available to meet the needs of the people. This was also confirmed by the people that we spoke to. People said the service was reliable and flexible. The service reviewed people's care plans to ensure they were up to date.

We found that staff had a good understanding of how to support people in a way that respected each person as an individual, each with their own needs and preferences for how they wished to receive their care and support.

Is the service well-led?

The provider continually monitored areas of risk in the service and made checks on quality. This included visiting people who used the service to ask what their views were of the service provided.

The manager ensured that people's care was planned. Staff understood people's needs because they followed people's risk assessments and care plans. Systems were in place to monitor quality and safety. The manager ensured that staff were recruited with the right skills and experience for the client group they cared for. Staff received an induction when they started with the organisation. Staffs received on 'going training and were supervised by the manager. The provider had not had any complaints, accidents or incidents made to them.

People we spoke with told us their needs were fully assessed and they were 'Very satisfied' with the care and support they received. One person told us, 'They often stay longer than required' and another said, 'My wife really looks forward to their visits'.

We spoke with staff and examined the provider's safeguarding policy. People were protected from the possibility of abuse because staff had received appropriate training and there were procedures regarding safeguarding vulnerable adults in place.

We examined staff files and found that there were robust recruitment, assessment and induction processes in place for new staff.

We found that there were effective systems in place to regularly assess and monitor the quality of service that people received.

The staff we spoke with felt well supported by the manager and we saw that all had received mandatory training.

There were systems in place to ensure continuing high standards including client questionnaires and regular staff meetings.