Almost Family is a small domiciliary care service providing the regulated activity of personal care to ten people in their own homes in the Dorking, Leatherhead and surrounding rural areas. Other people use the service to support them with activities such as shopping or social activities, but these are not regulated activities so did not form a part of this inspection. Packages of care varied from providing 24 hour live in support, to people who received a few hours a week. The service had a policy that their minimum care visit would be for an hour’s duration. They did not provide a service to children.This inspection took place on 8 November 2016. The provider was given short notice of the inspection date as the service provides care to a small number of people and we needed to ensure that people would be available for us to speak to at the service office.
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. On the inspection we met with the nominated individual from the registered company which operates the service. They told us the registered manager would be making application to remove themselves from the registration of Almost Family. The service had already appointed a new manager who we met on this inspection. They told us they would be making an application to register, but as they were not yet registered are referred to throughout this report as the manager.
As part of this inspection we received positive feedback from people receiving a service and staff working for the agency. All of the people we spoke with told us that they had a regular small team of carers that knew them well, staff arrived on time, and they never had any missed visits.
People were supported by sufficient staff who had the skills and knowledge to meet their needs. There were clear training programmes for both individual staff and the service as a whole. Although these were not yet completed for all staff, staff were working to complete these in a short time framework. Staff were supported through regular supervision, spot checks and appraisals of their work, and told us they felt the management were approachable and they had the skills they needed.
People were protected from the risks associated with poor staff recruitment. A full recruitment procedure was followed for new staff. This included disclosure and barring (police) checks, references and checks on people’s identity.
People were protected from risks associated with their care because the service carried out regular assessments of the risks and mitigated these where possible. People’s care plans included assessments of people’s skin, falls risks, nutrition, mobility, moving and positioning. They also covered any concerns about their home such as access issues.
People received their medicines safely where this was a part of their care plan. One person told us about how staff were very careful when dealing with their medicines which gave them confidence. Other people were able to maintain their independence with medicines as staff would guide and prompt them to take them when needed.
People’s healthcare was supported because the agency liaised with community healthcare professionals where there were concerns over people’s wellbeing. We heard of how staff had for example contacted community nursing teams in response to concerns over a person’s well being, and in another recent incident had contacted the paramedic service as a person had ben found on the floor. They waited with the person until the person was taken to hospital.
People were supported to eat regular healthy meals where this was a part of their care plan. This included being supported and encouraged to eat a healthy diet where this was possible. Records helped ensure that people received a varied diet where staff provided this.
People were protected from the risk of abuse through the provision of policies, procedures and staff training. Staff understood how to raise concerns about people’s well-being and how to ‘whistle blow’ about the organisation if they suspected people were being abused. Policies were in place to ensure staff were clear about areas such as supporting people with their finances or receiving gifts.
People’s needs were met by staff who related to them in a friendly and positive manner. Staff expressed positive feelings towards the people they were supporting and this was also evidenced in the way records were written, reflecting people’s positive qualities in respectful language. People receiving a service told us how they enjoyed the relationships they had built up with staff and how important they were to them. People’s privacy and dignity were respected and supported, and their confidentiality was respected. Records were maintained securely and computer passwords protected information from people who did not need access to this, for example financial transactions.
People benefitted because staff ensured they understood and respected their wishes and choices about their care. People receiving a service from Almost Family had the capacity to make decisions for themselves and staff supported them with this, by encouraging them to express their wishes. These were then reflected in their assessments and care plans, which people signed to confirm their agreement.
People were protected from the risks of cross infection as staff understood how to reduce these risks. Staff told us they had a plentiful supply of gloves, aprons and hand cleansers to help support good infection control practices in people’s homes.
People benefitted from safer care because the new manager had begun a programme of auditing of the service to identify what was working well and what could be improved. This already had covered areas such as medicines, supervision and recruitment files. The manager and nominated individual took advantage of learning resources to improve the service, including use of the intranet, CQC reports and membership of the United Home Care Association.
People and relatives were able to make changes at the service as they were consulted about their views on how the service could be improved through annual questionnaires. Quality assurance systems were independently operated and audited by an external consultant to help ensure people could feel they could be as honest and open as they wanted to be about the services they received.
People could be confident concerns and complaints would be investigated and responded to. Systems, policies and procedures ensured that complaints would be listened to and actions taken to address any concerns identified.
Good record keeping helped ensure people’s needs were understood and met. Records seen were up to date and well maintained. There were safe facilities for disposal of records no longer needed, and the provider had clear information available about notifications that needed to be sent to the CQC.