Archived: Home First Mildenhall

Mildenhall Home First is a domiciliary care service who provide short-term re-enablement packages to people in their own homes. At the time of our inspection there were 38 people using the service. The service shares a registered manager and additional resources with two other services in the area.

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 service took a proactive approach to safety and carried out a thorough assessment of risk before providing care to people. Staff understood how to safeguard people and report concerns to the relevant agencies. People received their calls on time and staff were able to stay for the correct amount of time to provide care and support. People had a skilled, experienced and knowledgeable staff team who supported them to work towards positive outcomes, as identified by their care plans. People were treated with dignity and respect and staff often went ‘over and beyond’ their duty of care to provide exceptional support for people.

People’s backgrounds, social histories, preferences and cultural needs were included in their care plans and they were involved in reviews and meetings about issues relating to their care. Where people required support with administration of their medicines, the service kept appropriate records and information on their file. The service worked closely with other healthcare professionals to support people towards recovery and rehabilitation.

Quality audits were completed regularly to ensure that the service was identifying any areas for improvement and taking appropriate action to resolve them. People were positive about the registered manager of the service and the staff team shared her visions and values. Staff were supported to develop and be empowered within a positive and person-led culture. People knew who to complain to if necessary, and there was an effective system in place for handling and resolving complaints.

At the time of our visit the provider was supporting 16 adults to live within their own homes following a hospital stay, illness or injury. The provider's purpose was to support people while they worked towards regaining their abilities to live independently on a permanent basis. If people required longer term support then the service would be transferred to another provider.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

Is the service safe?

Staff had undergone a thorough recruitment and induction process and had also received appropriate training and guidance including safeguarding of vulnerable adults. We saw that the provider had taken the appropriate action to protect people from abuse. They had followed the correct process for reporting safeguarding alerts to the local authority safeguarding team and the Care Quality Commission.

Records contained detailed assessments of people's needs that had been carried out prior to them commencing with the service.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew the people well. People's health and care needs were assessed with them, and they were involved in writing their plans of care. Where this was not possible staff had sought views from relatives and other health care professionals.

The service had an occupational therapist attached to the team who worked closely with the staff, people who used the service and other health and social care professionals to promote and enable people to regain their independence. People we spoke with were very complimentary about how the staff had enabled them to regain their independence.

Is the service caring?

People we spoke with told us the staff took the time to explain things clearly to them and listened to their responses. They were able to do things at their own pace and were not rushed. One person told us, "The staff are very kind and caring." Another person said, "The staff have helped me to get back on my feet."

Is the service responsive?

We saw that arrangements had been put in place with people to enable them to change the time of their visits, and the frequency, when requested. We saw that where a person's needs had changed, such as an increase in their independence, the care plan and risk assessments had been reviewed and updated. Staff we spoke with informed us that they were informed of any changes to a person's care plan or risk assessment

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We saw that the service ensured the relevant health care professionals had been involved in assessing, planning and meeting people's changing health needs.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff told us they were clear about their roles and responsibilities and that they had received refresher training and had excellent support and supervision from the manager.

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

We found that accurate staffing records were kept and provided us with evidence that the service had robust recruitment procedures to ensure people who used the service were protected from the employment of unsuitable people. Staff records showed that staff were sufficiently supported through induction, training and supervision of their practices to ensure they could carry out their role effectively. Gaps in mandatory training were identified and we could not be assured that staff always had adequate training to meet people's specialist needs.

Records showed us how people using the service were having their needs met in relation to their health, welfare and safety. Gaps in record keeping particularly in relation to the safe administration of medication potentially compromised people's safety.