We visited the offices of IHI Limited to look at records. We spoke with the registered manager. We later spoke with five staff that provided care about the service they provided. On the day of the inspection the service supported around 25 people. We spoke with five people who received care and / or their relatives to ask them about their experience. We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five questions that we always ask:
' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
Below is a summary of what we found. The summary is based on our findings during the inspection. The detailed evidence supporting our summary can be read in our full report.
Is the service safe?
We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they received regular training and support to enable them to deliver care and support safely.
Everyone that we spoke with said that they were happy with their care and said they felt safe with the staff that supported them. One relative we spoke with said, 'They ring me if they have any worries about my mum and are always reliable. I know she is safe.'
The provider had an up to date infection control policy which staff were aware of and followed. People who received care had no concerns about infection control. All the people spoken with told us that staff wore personal protective clothing whilst providing personal care. One person said, 'They always wash their hands before they start and they wear gloves and aprons. They have hand gel as well." We found that people were protected from the risk of infection because appropriate guidance had been followed and staff had received regular training updates.
The registered manager told us that some new staff had commenced employment since our last inspection. We saw that staff files contained the required pre-employment checks. This meant that the provider ensured that people employed were suitable to work with vulnerable adults.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) when applied to care homes. We spoke to the provider about the court ruling regarding DoLS, and whilst no one currently using this service was subjected to a Deprivation of liberty safeguard. The registered manager told us and records showed that all staff had received DoLS training and training in the mental Capacity Act 2005. This ensured that staff had an understanding of their responsibilities in protecting the rights of people who received care from the service.
Is the care effective?
People spoken with told us and records sampled showed that they had been involved in an assessment of their needs and were able to tell staff what support they needed. This meant that people could influence the care they received.
We saw that people's cultural, dietary and linguistic needs were met by staff with the appropriate skills. For example, we saw that people were supported by care staff that were matched to their needs and understood their language or cultural requirements.
We asked staff about the help they provided to people. All staff spoken with were able to give us good detail about the support they provided. One member of staff said, 'I always give them choices of what to wear or meals and drinks.' People told us that they were supported by the same staff on most care calls which meant people received continuity of care from staff they felt comfortable with and who understood their needs.
Is the service caring?
People told us they were happy with the care they received and that staff treated them with respect. We saw that respectful language was used whenever staff described the identified support needs of people in their care records. We saw from daily records sampled that where staff had concerns about people's health, additional visits were made and advice sought from healthcare professionals. We saw that people's involvement with other healthcare professionals was recorded and their advice was followed. One person told us, 'The staff are so kind. They really help me. Nothing is too much trouble.'
Is the service responsive?
People told us that staff did what they wanted them to do. They told us that if their care workers were going to be late they were kept informed either by the care or office staff. One person told us, 'If my carer is going to be late they always let me know.' A relative told us, 'They come when they should and they listen to what my relative has to say; they treat her well and with kindness. I know we can rely on them.'
Records sampled showed that there were systems in place to gather the views of people who use the service and staff. This showed that the service developed and took into consideration the views of people who received a service and staff and improvements or changes were made where needed.
People told us that they were aware of who they should contact if they were unhappy about the service provided. People spoken with told us they were happy with the service and had not needed to make any complaints. There was a system in place to handle concerns and complaints. We saw records which showed that two complaints had been received by the provider since our last inspection in November 2013. We saw that these had been investigated sensitively in a timely way.
Is the service well led?
We saw that the service had a staffing structure that enabled the service to be managed appropriately. This included a manager that we have registered to be responsible for the running of the service. People were consulted about the quality of service they received. Comments and suggestions were analysed to identify where improvements were needed.
At our last inspection the systems to audit the quality of recording of care delivery failed to identify gaps in records about the care that had been delivered. Records sampled at this inspection showed that quality assurance systems had improved. Records sampled showed that audits now identified problems or opportunities to change things for the better and these were addressed promptly. As a result the quality of the service was continuously improving. Staff told us they were clear about their roles and responsibilities and received regular newsletters and had frequent staff meetings. Staff had a good understanding of the service and of the quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.
Spot checks on staff skills and work practices took place regularly. We saw that findings were detailed and feedback was provided to staff.
Records sampled showed and staff spoken with told us that they received regular supervision and training. This ensured that people received care from staff that were suitably skilled to deliver care and feedback was continuously given on their performance.