This inspection took place on 19 and 21 September and was announced. At our last inspection we rated the service Good. At this inspection, we found the evidence had improved to support the rating of Outstanding, with an improved rating of Outstanding in caring and well-led. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.
The service is a domiciliary care agency. It provides personal care to older and younger people who may have learning impairment, a dementia related condition or a physical disability and live in their own houses and flats in York and the surrounding areas.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of this inspection the service was not supporting any persons with a learning impairment.
Not everyone using Home Instead Senior Care receives regulated activity; 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. At the time of this inspection 111 people were receiving a service and of those 58 received a regulated activity.
People and their relatives were extremely satisfied with the care and support they received. People told us that staff paid attention to the little things that mattered to them, working above and beyond their normal duties to support them. One relative advised they had travelled home thinking about the bedding being on the washing line in the rain. When they arrived home, the care worker had taken the initiative to bring the washing in and fold it up. This meant the relative could spend more time with their loved one, rather than rewashing all the bedding. Where people had interests they felt unable to pursue, staff would explore them and find either similar interests to adapt to their current circumstances or get creative with people to spark their enthusiasm. Staff clearly cared deeply for the people they supported.
Staff described how people were supported to remain as independent as possible, whilst having an awareness of their human rights. Care plans contained detailed information about people’s levels of independence to support staff knowledge and practices. People and their relatives told us staff were conscientious and promoted the utmost dignity at all times. Staff told us they treated people like part of their own family and were extremely considerate of people’s privacy.
Communications across the service were excellent and people’s needs, choices and preferences were considered. Information was available to people in different formats and staff had a good awareness of how to support people with sensory impairments. The provider had also completed research in the local areas to ensure information was available on local services to which promoted people’s independence and well-being.
The provider had developed excellent strategies in line with CQC’s approach of safe, effective, caring, responsive and well-led. Innovative ideas were suggested, actioned and shared with other organisations and local authorities to promote exceptional community links. This reflected the changing needs and preferences of people whilst improving care outcomes.
People and their relatives felt the management and leadership worked exceptionally well to deliver high quality support tailored to their individual requirements.
The management and staff team had a positive and inclusive culture. They listened to people and empowered them to have a voice in all aspects of their care and the running of the service. This resulted in high quality and extremely person-centred care and support where people self-directed the care they wished to receive.
Management celebrated staff achievements and promoted high levels of constructive engagement with all equality groups. Staff felt motivated, valued and encouraged to challenge practices. This demonstrated a commitment to considering people and staff at the heart of everything they do.
Staff received safeguarding training and described how they protected people from avoidable harm and abuse. The provider’s policies and procedures supported these practices and staff knew how to report safeguarding incidents or concerns to their management team or external agencies.
Risk assessments for environmental and social risks were in place and included measures for staff to take to mitigate them. These were regularly reviewed and updated when necessary. Some risks associated to people’s health conditions would benefit from additional guidance. This area was in the process of being reviewed to include more detailed information.
Medicines were managed safely and regular audits identified any errors so that these could be immediately addressed and analysed so that lessons were learnt. We found that some improvements were required in records for medicines administration. The provider was updating their policies and procedures and updating medicine care plans to address this area.
All the staff we spoke with told us they had sufficient travelling time in between their calls and records supported that calls were delivered on time. People we spoke with told us staff never missed any of their calls and that staff arrived on time.
The provider had systems in place to ensure that staff were consistently delivering a personalised service. Training courses ensured staff were equipped with the knowledge and skills to tailor care to each person’s specific needs. The provider had staff that were licenced to deliver training up to City and Guilds Level in house for dementia training. ‘Key Players’ delivered in-depth training courses to all staff to ensure they were Staff received regular supervisions, appraisal and observations of practice.
People’s nutritional needs were assessed and support was provided with meal preparation and assisting people to eat and drink, where this was part of their care plan. Staff supported people to access hospital and GP appointments when needed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Where people had expressed a wish for their relatives or representatives to be involved, the provider ensured invitations were extended to include them. A complaints procedure was in place with clear guidelines for staff to follow.