Manor Community Domiciliary Care Agency

Manor Community Domiciliary Care Agency is a domiciliary care agency providing personal care to 24 people aged 18 or over. The service was provided to people in their own homes. 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 told us they felt safe and there were sufficient numbers of staff to ensure people received the support they needed.

Risks to people were identified, assessed, managed and monitored in a timely way. All risk assessments were included in care plans that were person-centred. These were subject to regular reviews to ensure any change in needs was addressed. Staff sought to improve people’s care, treatment and support by identifying good practice.

People were supported with the preparation of food, drink and medicines when they were required. People were supported to follow interests and staff knew people's preferences and hobbies.

People were supported by staff who were kind and caring and who understood their needs well. People’s views and opinions were sought and listened to. Independence was encouraged and supported.

There was a person-centred culture within the care provided. Care plans were clear and gave good information about the ways in which people wanted to be supported. 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.

Staff training was developed and delivered around people’s needs. The provider recognised continuing development of skills, competence and knowledge was integral to ensuring high-quality care and support. Their performance and development needs were monitored.

Improvements were required with regards to monitoring and oversight and provision of personal care in one of the supported living placement. We have made a recommendation on following regulations in this area.

Rating at last inspection

The last rating for this service was outstanding (published 10 March 2017).

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

Why we inspected

The inspection was prompted in part due to concerns received about staffing, neglect and untimely responses to peoples changing health need. We have found evidence that the provider needs to make improvements. Please see the Well-Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Manor Community Domiciliary Care Agency on our website at www.cqc.org.uk.

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.

At the time of this inspection the service was providing the regulated activity of personal care to 13 people who lived in their own homes. The service was provided to younger adults and older people.

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.

The feedback we received from people was positive throughout. Those people who used the service expressed great satisfaction and spoke highly of all staff and services provided. One person told us, “The whole experience has been great; I don’t know what I would do without them”.

The safety of people who used the service was taken seriously and the registered manager and staff were aware of their responsibility to protect people’s health and wellbeing. There were systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed.

Staff were very highly motivated and proud of the service. They were fully supported by the registered manager and a programme of training and supervision enabled them to provide a high quality service to people.

The registered manager ensured that staff had a full understanding of people’s care needs and had the skills and knowledge to meet them. People received consistent support from care workers who knew them well. People had positive relationships with their care workers and were confident in the service. There was a strong emphasis on key principles of care such as compassion, respect and dignity and promoting independent. People who used the service felt they were treated with kindness and said their privacy and dignity was always respected.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care package amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. People who used the service felt able to make requests and express their opinions and views.

The provider and registered manager were very committed to continuous improvement. The registered manager demonstrated strong values and, a desire to learn about and implement best practice throughout the service.

The registered manager demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us; what we observed and the records we looked at. There were 20 people using Manor Community domiciliary care agency at the time of our inspection.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found that the staff were aware of what to do if they witnessed abuse and had been trained with regard to safeguarding adults. The manager was aware of what actions to take in response to abuse allegations and suspicions. We saw that the manager had reported issues to the local safeguarding team appropriately. This meant that the agency had safeguarded the welfare of the people who used the service.

The evidence that we saw confirmed that there were systems in place to gain and review consent from people or their advocates; and that their decisions were respected. Where people lacked the capacity to make complex decisions then appropriate others, such as relatives were involved to ensure people's best interests were considered.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. While no applications have needed to be submitted by Manor Community, policies and procedures were in place. Relevant staff had received training in relation to DoLS, mental capacity and safeguarding.

We found that systems were in place to assess risks to people who used the service. This meant that people benefited from safe care and support, due to effective management of risks to their health, welfare and safety.

Is the service effective?

We found that staff were trained and had received good support from the management team in order to carry out their role effectively. Staff assessed people's needs and provided appropriate support. Staff supported people that used the service to see health and social care professionals if they needed to.

We found that support was planned and delivered in a way that was intended to ensure people's safety and welfare. For example; one person's plan described the support they needed in relation to moving and handling. Another person had management plans in place for the risk of self-neglect, medication and isolation.

We looked at questionnaires that had been sent to people that used the service and their advocates by the agency. We found that all the people, apart from one, had indicated their satisfaction with the service. Comments included ' All the staff are very good at what they do' and 'Mum is very happy with her ladies who visit.' With regard to the person who was unhappy with the service, a review meeting had been held in order to discuss the issues raised.

Is the service caring?

People told us they liked the service provided by Manor Community. One said ''They are really good, like a family to me'' and added ''They are the best I have ever been with.'' Another person said ''Overall I'm happy with them, I would recommend them.'' One person who used the service had written on a questionnaire 'Staff are always polite and courteous.'

Is the service responsive?

We found that the agency had been responsive to people's healthcare issues. A staff member told us how they had had contacted a person's general practitioner (GP) when they had found them to be unwell. In another case, a community nurse had been contacted and made aware of a healthcare issue.

We found that the service took action in response to complaints and concerns. Where one person was unhappy about the agency, the manager informed us of the action they had taken to resolve the issue.

A six-monthly telephone questionnaire had recently been introduced in order to gain more feedback from those using the service. Unannounced spot checks were carried out to review service delivery and staff competency. Reports were produced along with action plans if required.

Members of staff told us that regular staff meetings were held and those we spoke with told us they felt they were able to voice an opinion at meetings. One told us ''Action is normally taken if you suggest something.''

Is the service well-led?

We found that there were regular quality assurance processes in place to monitor the service provided to those using the agency. This protected people's welfare and enhanced practice.

The staff received regular supervision and support. Members of staff told us that they felt supported and that they were listened to. One said '' It's a good place to work, if you have a worry you can talk about it.'' Another told us ''There is always someone you can contact if you need to talk something through.'' We saw that staff were supported to receive regular training and undertake further qualifications to enable them to meet the needs of those using Manor Community's services.

The provider and manager were available throughout the inspection and both were very knowledgeable about people they supported, the policies, procedures and systems in place to ensure the continued smooth running of the service. The agency provided tailored packages of care and support to meet individuals' needs. They were providing this service for 26 people at the time of our inspection.

People and their relatives shared with us their experiences about using the service and everyone expressed positive comments. People told us, 'I couldn't wish for a better service, I have everything I want and nothing is too much trouble for the staff' and 'We made the right choice. I can honestly say we have never had any problems and the staff are so kind, we have peace of mind and we have increased the hours of the care package that our relative receives'.