I Care Service

I Care Service is a service based in Dereham, which provides personal care to people in their own home. At the time of our inspection the service was providing care to 68 people living within an approximate 10-mile radius of Dereham. The Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care'. Not everyone who used the service received 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

Feedback from people using the service and staff was positive and all the people we spoke with recommended the service.

People's individual needs and requirements were discussed with them before their care started. Staff received appropriate induction and training and people said staff were skilled in providing their care. Staff monitored people's health and helped them access health and social care services whenever needed. People were supported to have a balanced diet and assisted effectively with their care needs. 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. However, the policies and recording systems used in the service did not always support this practice. We have made a recommendation about recording mental capacity issues.

People felt safe around the staff who provided their care. Staff understood their role in protecting people from harm and abuse. Care plans and risks assessments were person-centred and detailed. Recruitment practice was thorough and ensured staff were of appropriate character to provide support. People felt their care was not rushed and there were sufficient staff to ensure people mostly received care from familiar staff. People were supported well to receive their medication as prescribed. Appropriate infection control measures were in place.

People described the staff as kind, helpful and respectful. Several people told us staff often went ‘the extra mile’ to help. People were encouraged to participate in their care planning and were given opportunities to feedback on the service provided. The staff actively encouraged people's independence and dignity.

The care planning was person-centred and responsive to people's needs and preferences. The provider was quick to respond to changes in need and reviewed the efficacy of the care provided regularly. People were actively encouraged and supported to access their social networks and community. People had rarely needed to make complaints but knew how to do so and felt communication with the service was effective and friendly. The provider worked with people and their community health professionals to plan and provide personalised and skilled end of life care.

People felt management and staff at the provider's office were well-organised, approachable and took their views on board. Staff enjoyed their work and felt well-supported and valued by management. The provider used quality assurance systems and best practice forums to monitor and drive improvement in the quality and safety of people's care.

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 ‘Requires improvement’ (published 1 March 2020).

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.

I Care Service is a service based in Dereham, which provides personal care to people in their own home. At the time of our inspection the service was providing care to 79 people living within an approximate 10-mile radius of Dereham. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’.

A manager was in post, who re-registered with the CQC at the same time as the service was re-registered in August 2017. A registered manager is a person who has registered with the 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.

Improvements were required to care plan records. We found the assessments of peoples’ needs, choices and risks varied in quality. Care plans represent people's needs, preferences and life stories to enable staff to fully understand people's needs and wishes. There was usually a good overview of the situation and support required. However, we found limited details in care plan records and individual risks had often not been assessed and mitigated for in people's care plans.

People told us they felt safe receiving the care and support provided by the service. Staff understood and knew the signs of potential abuse and knew what to do if they needed to raise a safeguarding concern.

Robust recruitment and selection procedures were in place and appropriate checks had been made before care staff began working at the service. People were receiving calls at their preferred time but feedback regarding the consistency of care staff was mixed. Whilst the service acknowledged that they had had recruitment and retention difficulties previously, the evidence indicated that there were now enough staff to provide care and protect people's health, safety and welfare in a consistent and reliable way. People using the service noted that this had led to more consistency of staff provided recently, promoting positive relationship building and more person-centred care. The registered manager was working creatively to recruit and retain staff.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines administration was audited weekly by a designated staff member and medicines were managed safely. Staff were aware of appropriate infection control measures.

When incidents had occurred, the registered manager was able to explain analysis and demonstrate improvements and changes in procedures had occurred where appropriate. However, there was not a structured recording or systematic analysis process to ensure ‘lessons were learnt’ and incorporated into practice

People using the service felt that staff mostly had the skills required to provide the service safely and effectively. Staff had received appropriate induction training, tailored to the level of experience and knowledge of each new starter with shadowing and competency checks completed before staff worked independently. Staff had ongoing supervision and competency checks regularly.

Training records were not clear that all staff were receiving training in all core subjects and showed that not all staff were receiving regular refresher training in core subjects. Staff however demonstrated good knowledge and understanding of the skills needed to provide care, including safeguarding adults at risk.

People reported they were supported to choose their own food and drink and maintain a balanced diet where this was required. Some feedback from people indicated that not all staff had sufficient knowledge to cook simple food.

Health care needs were met well, with referrals and liaison with healthcare services made when necessary and escorts offered to medical appointments as required. The service kept a separate record of communications with external professionals to monitor and manage this support.

The management team and staff had an understanding of the Mental Capacity Act 2005 and consent to care and treatment. The service was aware of enabling choice and promoting decision-making by people using the service whenever possible. They consulted appropriate representatives where mental capacity to make a specific decision was lacking.

Staff treated people with kindness, compassion and respect. The service had a good understanding of people's needs and promoted choice and independence. Staff usually recognised people's right to privacy and promoted their dignity, although sometimes, particularly when demonstrating care to new staff, staff were not always ensuring dignity and privacy were respected.

We found the service took a personalised response to care provision and sought regular feedback from people using the service.

There was a complaints policy and information regarding the complaints procedure was easily available. All listed complaints had been responded to by the manager in person and via letter to the complainant,

The service provides appropriate end of life care and support, working with allied professionals as required.

Staff felt supported and valued by the service’s management. Staff were encouraged to provide feedback and report concerns to improve the service and the management gave staff clear leadership. The service had developed an open and positive culture, which focused on improving the experience for people and staff. The role of senior care staff had been introduced, with the aim of improving consistency in the delivery of care, support for newly employed staff and an additional link between the office and people being supported in their own homes.

We found the management of incidents and complaints required improvement. Management had responded appropriately to people using the service. However, there was not a systematic procedure and recording system to support this process or incorporate lessons learnt. We found that the service did not always notify the appropriate authorities of safeguarding incidents and their outcomes as required and was not sufficiently aware of this duty. The management did however redress this concern during the inspection, through implementation of a clearer incident process and recording system.

We found that quality assurance practices required improvement. Audits were not always systematically managed or recorded to ensure accurate records, analyse practice or drive improvements.

The registered manager attended local forums and sort external feedback to promote learning and improvements. We found the registered manager approachable, open and enthusiastic about providing a high standard of person-centred care to people.