Age Concern Home Care North Manchester

Age Concern Home Care North Manchester is a domiciliary care agency providing personal care to people living in their own homes. The service provides support to older people and people living with dementia. People who have learning disabilities or autistic spectrum disorder, physical disabilities and people living with mental health illness. At the time of our inspection there were 107 people using the service.

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.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

People’s experience of the service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

People were supported safely, and staff were aware of any risks people may present. The administration of medicines was safely managed. Staff were recruited safely, and staff had sufficient time to ensure they could meet people’s needs. Staff generally arrived at people’s property on time although there was mixed feedback on timings for weekend staff. Staff were aware of infection control policies and had access to person protective equipment such as aprons and gloves.

Staff received an induction, regular training, supervision and spots checks to assure the provider they were competent to undertake their role. People received an assessment which captured their needs and preferences. People were supported to eat and drink and have access to health and social care professionals when required. The provider worked within the framework of the Mental Capacity Act.

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 and family members told us staff were caring and provided dignified and kind care. Staff supported people to retain their independence and people felt included in making decisions about their care and felt in control. Family members spoke positively of the staff being respectful and increasing people’s confidence.

Care plans captured people’s needs and described what staff needed to do to support people effectively. People were involved in drawing up and implementing their care plans. Staff had the time to read people care plans and were aware of people’s personal preferences and needs. People were supported to remain in their home with staff providing care and support should they be at the end of their life. Complaints were acknowledged and responded to. People and their family members felt comfortable to raise any concerns they had.

Staff felt the registered manager was supportive and provided them with the leadership they required. People and their families felt the registered manager was responsive and were updated about any changes to their care and support. The provider sought feedback about the care provided and aimed to improve on findings which were below expectations. Governance systems were in place to ensure the quality of care provided and continually monitored and assessed.

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 18 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Recommendations

We recommend that the provider reviews the provision of staffing at the weekends to ensure the staff are providing consistent and timely care to people. We also recommend the provider reviews the care plans to ensure they reflect people's current needs.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Age Concern Home Care North Manchester is a domiciliary care agency. It provides personal care to people living in their own homes in the community. The service provides care to a range of people with different needs including older people, people living with dementia, learning disabilities, physical disabilities, mental health and sensory impairment. When we inspected the service, there were 76 people receiving domiciliary care. Calls to people’s properties ranged from 30 to 60 minutes per visit and there was one person receiving a regular night sit. Not everyone receives regulated activity; the Care Quality Commission (CQC) only inspects the service being 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.

Our last inspection of this service was on the 10 and 11 October 2016 and we found concerns relating to regulation 17 and 19 of the Health and Social Care act 2008 (Regulated Activities) Regulations 2014. We found that quality checks on operational areas such as recruitment, medication and care plans were not sufficiently robust to provide adequate oversight and some people’s care records did not always contain appropriate information regarding mental capacity. Also, the provider did not ensure that the recruitment and selection process was sufficiently robust and appropriate pre-employment checks were in place. The overall rating for the service was requires improvement. At this inspection, we found significant improvements had been made to the service and found the service to be good in all of our key questions; safe, effective, caring, responsive and well led.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions in safe and well led to at least good. At this inspection, we found that the provider was completing audits and quality checks of recruitment and ensuring that any new staff members had the required pre-employment checks in place before commencement of employment. Furthermore, we also found that there were additional audits in place to monitor medication and care planning. Also, we saw there had been improvements in the service assessing people’s mental capacity and making referrals to the local authority.

The service had 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 were protected from abuse. Staff followed the provider's and the local authorities safeguarding procedures to identify and report concerns to people's well-being and safety. Accidents and incidents were recorded and reviewed.

Comprehensive assessments were carried out to identify any risks or potential risks to the person using the service. This included any environmental risks in people's homes, risks in the community and any risks in relation to the care and support needs of the person.

Staff were recruited safely and trained to meet people's individual needs. Wherever possible people were only supported by staff known to them.

There were enough staff assigned to provide support and ensure that people's needs were met in the week. However, there was a small number of comments made about late calls at weekends. The service had recognised this and put in place procedures to assist in preventing late calls. The service was in the process of recruiting new staff members to train and assist with weekend cover.

Medication was well managed and staff were fully trained in the safe administration of medication,

Legible daily records were kept on each person and documented what care and support had been given.

Care plans were regularly reviewed and individual to the person.

People we spoke with told us that staff members were kind and caring.

Staff received support, regular supervision and attended training to enable them to undertake their roles effectively.

Staff were aware of the requirements of the Mental Capacity Act [2005] and the Deprivation of Liberty Safeguards [DoLS] which meant they were working within the law to support people who may lack capacity who may need to be referred under the court of protection scheme through the local authority.

People were aware of how to raise concerns and felt the registered manager was approachable.

There were quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

The registered manager and deputy manager were visible in the office. They regularly visited people in their own homes and each person we spoke with knew who they were.

The previous inspection took place in August 2014. At that inspection, we found that the service had met all regulatory requirements.

The service had a registered manager who had been in post since July 2013. 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.

We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the end of the full report.

Recruitment processes were not sufficiently thorough which meant that we could not be certain that some staff hired were suitable to work with vulnerable people.

We found that medication administration records (MAR) were not always fully completed. Where required, people were supported to take their medication safely and staff were knowledgeable on administering these.

There were some quality checks in place such as staff spot checks. Additional checks such as MAR and care plan audits were required to help the provider and registered manager maintain safe and effective care at all times. Policies and procedures were in place; however we noted some contained references to outdated legislation. These documents should be updated to help ensure staff had appropriate guidance to carry out their roles. Through regular meetings, staff felt supported in their roles and had the chance to discuss service specific issues with colleagues and the registered manager.

Risk assessments were in place; we noted that some assessments contained more details than others and not all were fully completed. This meant that staff did not always have clear guidance to help ensure an individual was supported safely.

People felt safe supported by Age Concern North. Staff knew people’s needs and there were enough staff to support them effectively. We saw there were suitable systems to help ensure people were protected from harm. Staff were well-informed about the types of abuse and the action they would take if they suspected that abuse was taking place. This meant people using the service were protected from harm due to organisation systems and staff knowledge.

People and their relatives told us care staff were effective and well trained, and always sought their consent before undertaking any task. We noted that care records contained people’s signatures. The registered manager and staff demonstrated a good understanding and knowledge of the Mental Capacity Act (MCA) and we saw there was a policy in place to guide practice. However we did not see all the appropriate mental capacity information in the care records of two people who lacked capacity. We have made a recommendation that the service follows best practice guidelines to ensure all people who use the service and lack capacity have all appropriate documentation in their care records.

The service delivered the Care Certificate induction standards to new recruits. We saw that refresher training was scheduled as needed and further training was offered in areas such as national vocational training in health and social care. Staff received regular supervisions and appraisals to help ensure they received the necessary support to carry out their roles. This meant staff were equipped with the right knowledge and skills and received continuous support to function effectively in their caring role.

People were supported and encouraged to make healthy eating and drinking choices, and where appropriate, given information on health conditions such as diabetes. This should help people to maintain a balanced diet and support their wellbeing. People’s access to health care professionals and medical attention was facilitated, if required. This meant people were supported to receive the right health care when they needed.

People told us they received caring and compassionate support. Care staff were engaging and they had good relationships with them and the office staff. People told us they were involved in the care planning process. This meant that people and their relatives, where appropriate, were included in making decisions about the care they received. People were treated with dignity and respect and their independence was encouraged according to their abilities. This helped to promote people’s wellbeing. At the time of this inspection, no one at the service used an advocate. However there were systems in place to support people should they need to use one.

People told us their care and support was responsive to their needs and gave us examples of how this was done. We were told and we saw in people’s care records that an initial assessment of their needs had been done before any support was provided. This should help to ensure people could be supported effectively. Care plans, which were reviewed regularly, contained person centred information in areas such as medication and personal information such as family background, medical history and social activities. This meant that people’s care and support was reassessed to make sure these were still suitable. Some people’s care plans contained information about their preferences whereas others did not. Such information was important as some people may not always be able to communicate their preferences.

There was a complaints procedure in place and people told us they were aware of how to raise a complaint. They all said any concerns they raised were resolved quickly and efficiently.

People and relatives told us the service was well managed and spoke highly of the registered manager and their staff team. They told us the manager and staff were always helpful and efficient.

This is what we found:

Is the service safe?

Suitable policies and procedures were in place relating to the safeguarding of people using the service. All care workers had received safeguarding training.

Risk assessments were in place for people and these were regularly updated. Systems were in place to make sure staff learned from incidents, complaints and other events.

Is the service effective?

A full assessment of people’s needs was carried out prior to people starting to use the service. People were fully involved in this assessment. Checks were carried out, usually within a month of them starting to use the service, to ensure the care being provided was in line with these needs. Further assessments were then carried out approximately every six months to see if people's needs had changed.

The people we spoke with told us they were very happy with the care and support they received from Age Concern Home Care North Manchester.

Is the service caring?

People were involved in the development of their care plans. We saw they were up to date and reflected people’s needs. We saw people being supported by staff who demonstrated empathy and listened to what each person wanted.

People had an allocated team of care workers so continuity of care was usually provided. People told us their care workers were kind and respectful. They also commented that they were able to state what care and support they required.

Is the service responsive?

The service employed enough care workers to be able to provide care to new people at short notice. Care workers received training so they were competent in many areas of care, including end of life. In the care planning stages people's choices were taken in to account and listened to.

Care was immediately reviewed if a care worker noticed a person’s needs had changed. People were also able to contact the office at any time to request changes. An annual satisfaction survey was carried out by the service and we saw an action plan was in place to monitor any improvements that were possible. Complaints and incidents were also recorded and analysed to ensure any improvements necessary were made.

Is the service well-led?

Age Concern Home Care North Manchester had a statement of purpose that included all relevant aspects of the service.

Staff had a job description and were clear about their roles and responsibilities. They met regularly with their managers. We saw evidence that senior managers within Age Concern were in regular contact with the service.

There was an effective quality assurance system in place and any issues were addressed promptly.

We did not speak to people who used the service during this inspection.

Age Concern Home Care North Manchester operated out of Openshaw Resource Centre since July 2013. The Building was owned by Manchester City Council and leased to Age Concern Manchester. Under the terms of the lease Age Concern Manchester was wholly responsible for the maintenance and the up keep of the building. The building was used to accommodate staff from Age Concern Home Care North Manchester and provided a drop in centre and day care service along with a team of day care staff.

We found that the registered provider had taken action to ensure that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found that the registered provider had taken action to ensure that people, staff and visitors were protected against the risk of fire.

We found that people had their care needs assessed before a service was provided and individual care plans were developed from assessment information.

One person told us: “Age Concern has been very, very helpful. I have the highest praise for everyone who has been involved with me.”

A relative told us: “I’m very satisfied with the care they provide.”

We found that where one or more professionals provided care to people who used the service the agency worked with other providers collaboratively.

People told us they had no complaints and they were satisfied with the service they received.

We found that people who used the building were placed at risk due to fire safety checks not being undertaken on a regular basis and fire fighting equipment not being maintained.