About the service:

Kestrel Homecare, 1 Southdown's View is a domiciliary care service. The service is a family run business where the provider is also the registered manager.

It provides personal care to adults living in their own houses and flats in the community. At the time of the inspection the service was supporting 37 people, only 27 were receiving personal care. The service provides care and support for people in Heathfield and the surrounding area. CQC only inspects the service being received by people provided with personal care, where they do we also take into account any wider social care provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

•The registered manager and office manager completed regular audits and checks on the quality of the service and look at ways to improve. However, shortfalls found at the inspection had not been identified and addressed.

•The registered manager had not ensured that all records were kept up to date. Staff supervisions were taking place, but the registered manager was not always recording these. Risks to people identified but these were not always recorded accurately in peoples care plans. These shortfalls had not directly impacted on the car and support people were receiving.

• At the last two inspections in 2015 and 2016 we recommended that the registered manager join a professional network for registered managers to ensure best practice and continuous drive to improve the service and keep up to date with best practise. This recommendation had not been addressed.

•People told us they felt safe and supported by staff in the way they preferred. Staff demonstrated good knowledge and received training on how to protect people from abuse. Staff could identify the forms of abuse and what they would do if the suspected or witnessed the different types.

•People spoke with staff about any potential risks to their health and welfare. These were assessed, monitored. Staff knew how to keep people safe from risks, however the potential risks were not fully recorded to make sure staff had clear written guidance on what to do to keep risks to a minimum and what action to take if the risk occurred. There were environmental risk assessments in place for staff.

•The registered manager made sure there was enough suitably trained staff to provide support to people. People said they were confident in the staff’s skills and abilities to look after them and keep them safe. Staff felt supported and valued. The registered manager checked that staff were undertaking their roles safely and effectively.

•Staff were recruited safely. Gaps in employment had been explored by the registered manager but a record of this was not available. People told us that they received their calls from regular staff who were on time and they had no missed calls. People received support from the registered manager and office manager when they needed it. They said there was always someone at the end of the phone.

•People's needs were assessed before they started using the service to make sure staff could deliver the care that they needed. People had agreed to the care and support they received.

•People had been able to plan their visits with staff and how they wanted their care provided. Care plans were developed and reviewed regularly.

•People were able to make decisions about their care and support and to maintain control of their lives. Staff supported people to do as much for themselves as possible.

•People said staff were kind, compassionate and caring and took their time to carry out their duties and did not rush. People said they were listened to and that they were treated respect.

•People told us they received their medicines when they needed them. Staff administered people’s medicines safely.

•People were supported people to access health care professionals when they needed them. The staff worked with oth

We inspected Kestrel Homecare Ltd on 21 July 2016. This was an announced inspection. The service provides support and care for people living in their own homes within an approximate 15 mile radius from their office. At the time of inspection 47 people were using the service.

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 provider had ensured that medicines were being administered in a safe way. Staff were trained to administer medicines and demonstrated good understanding on the services policy and procedure. Medicine audits were taking place and investigations where there were gaps identified in people’s medicine records.

The provider had not ensured that all environmental risk assessments gave guidance on how to reduce risk when working in people’s homes. We have made a recommendation about this in our report. The provider had ensured that individual risk assessments on people’s needs were being completed and gave guidance to staff.

Staff demonstrated good knowledge and received training on how to protect people from abuse. Staff could identify the forms of abuse and how they should react if they were to witness abuse.

The provider had ensured that there was enough suitably trained staff to provide support to people using the service. The registered manager had systems in place to ensure that cover was available during times of low staff. Staff received mandatory training and had the option to take additional training to further develop their knowledge.

The provider had ensured that the principles of the Mental Capacity Act 2005 were followed. Staff demonstrated good knowledge of the Mental Capacity Act 2005 and all staff had received training.

The provider has ensured that people’s nutritional and hydration needs were met. People were assessed so that the correct level of support could be provided. Staff were given guidance on how to support people. Staff understood the importance of communicating change to the registered manager so referrals were made to relevant health professionals when required.

People and their relatives told us that staff were kind, compassionate and had sufficient time to carry out support. Staff demonstrated good knowledge of the people they supported and understood their needs. Staff ensured that people’s privacy and dignity was respected when giving support.

The provider had ensured that people’s personal information was stored securely and access only given to those that needed it. People had freedom of choice at the service.

The provider carried out routine reviews of care plans and reviews that were prompted by events. Care plans were developed to include people’s wishes, likes, dislikes and history. People told us that staff told them about any changes.

The provider had ensured that there were effective processes in place to fully investigate any complaints. Outcomes of the investigations were communicated to relevant people. The registered manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with them at any time and know they would be addressed appropriately. The registered manager was open, transparent and responded positively to any concerns or suggestions made about the service. The provider carried out surveys to identify shortfalls with the service.

The provider had not ensured that all records were kept up to date. Policies and procedures were not always documented as being updated. Staff supervisions were taking place but the registered manager was not always recording the outcomes. We have made a recommendation about record keeping.

At this inspection we spoke with the registered manager and the administration worker. We also spoke over the phone with ten care staff and sixteen people who used the service, or their relatives.

The inspection was carried out by one inspector. We answered our five questions; 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. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that there was a lack of risk assessments in place which detailed how potential risks could be minimised to ensure that people were kept safe. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The service did not have policies and procedures in place to safeguard people who used the service. We identified two occasions where the provider had not taken appropriate action where safeguarding concerns were identified. Not all staff had received training in safeguarding vulnerable adults. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

We identified gaps in training which meant that not all staff had received the training needed to support them in their roles. Some staff told us that they did not feel supported and did not have an opportunity to discuss work in private with the manager. One staff member said "I say things to a manager which are not acted on" and another said "There is no communication". This meant that staff were not fully supported to deliver care and treatment safely and to an appropriate standard. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People told us that they were happy with the care that had been delivered and that their needs had been met. Comments included "First class", "No problems at all", "Kestrel are very good" and "Absolutely wonderful". The staff we spoke with demonstrated a commitment to making sure people were looked after. We found that people were treated as individuals and that their privacy and dignity was maintained. One person said "They want to know I am ok" and another told us "They are polite and helpful".

Is the service responsive?

People’s needs were assessed and reviewed. The provider had taken appropriate action where changes in needs had been identified. People told us that they felt listened to and that when changes were requested they were followed through by the service. One person said "They respond immediately to any requests I make".

Is the service well-led?

People who used the service were given opportunities to express their views. One person said "I speak with the manager who came to visit last week". People's complaints were acted on and appropriate action taken. However, the provider did not have an effective system to identify non-compliance or the risk of non-compliance with the Regulations and take necessary action to return to compliance. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People we spoke with were complimentary about the care and support they received. One person told us:" The care is simply superb, the manager and staff are so efficient and kind". Another person told us: "I am 110% satisfied".

We found that the provider operated an effective recruitment procedure in line with their policy. We saw evidence that the provider had obtained appropriate safety clearance checks for all new members of staff. We saw that all staff records were comprehensive and complete, including employment history, ongoing training, vehicle insurance details and photographic identification.

We found that there were enough qualified, skilled and experienced staff to meet people's needs. A person who used the service told us "The girls never rush, they take their time, they have never let us down". A relative stated: "The staff are prompt, efficient, friendly, and they do their work thoroughly, they are never in a hurry and respect my husband's pace".

We spoke to staff and consulted records which confirmed that the provider supported their staff with training suitable to their role. Staff received regular supervision and appraisals, and their needs for professional development were taken into account.

We looked at the provider's complaints policy and procedures and found that these were appropriate. All the people we spoke with told us that they were aware of the complaint procedure and that they enjoyed good communication with the manager.

As part of the inspection we arranged with the provider to accompany staff on a number of visits to observe them delivering care and to afford us the opportunity to talk to their clients. People told us that the service was “absolutely first class” and they were always treated with respect and dignity.

People described how they were given choices about how care was delivered and were always fully involved in the designing, planning and reviewing of their care. We were told that the provider was a “wonderful and caring person who understood fully how to treat people with the utmost respect”. They told us that they felt very safe with her and the other carers who came to visit them. One person said “nothing is ever too much trouble for this team of angels”.

This inspection took place on the 23 and 28 January 2015. This was an announced inspection. This means the provider was given notice due to it being a domiciliary care provider and we needed to ensure someone was available.

Kestrel Homecare Ltd is a domiciliary care company based in Burwash Weald. They provide support and care for people living in their own homes. The age range of people was 55 to 99 years of age. Some people were at risk of falls and had long term healthcare needs. The service also provided support to people who were at the end of their lives. Kestrel Homecare Ltd provide their services within an approximate 15 mile radius from their office in Burwash Weald. The catchment area is predominately rural. At the time of our inspection 41 people were using the service. There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We last inspected Kestrel Homecare Ltd on 18 June 2014. We found the provider was not meeting all the regulations we inspected against. There were not adequate risk assessments being undertaken. There were not suitable safeguarding procedures in place with regards to polices, reporting and staff training. Staff did not feel supported or have an opportunity to talk to the registered manager in private. There were no effective systems in place to measure the quality of the service provided. The provider submitted an action plan which stated all the required improvements would be made by February 2015.

At this inspection we found that the manager had updated policies and procedures and made improvements to the quality assurance system. However, there remained areas where there was not effective provision to monitor the quality of the service. For example, care plans and medicine records were not routinely audited.

The provider did not routinely submit statutory notifications to the Care Quality Commission, as required. Under the Health and Social Care Act 2008, providers are required by law to submit notifications of incident affecting people.

People told us they felt Kestrel Homecare Ltd offered a safe service however we found areas of concern with medicines. The service on one occasion had not followed its own policy. We found gaps in a person’s Medication Administration Records (MAR) this had not been picked up by the registered manager as no medication audits were undertaken. There was no staff signature sheet within people’s care plans.

Peoples care plans had been reviewed regularly and updated when appropriate to reflect changes in people’s needs. Improvements to risk assessment had been made. However there remained areas where risk assessment and care plan guidance had not met the needs of individuals.

Staff told us they felt supported in their roles. A supervision and appraisal programme was in place. Staff were trained in safeguarding and were confident about what they should do if they had any concerns or suspected someone was at risk of abuse. People were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

The registered manager was aware of the requirements of the Mental Capacity Act 2005 (MCA) and care plans reflected assessments had been undertaken where appropriate.

People felt their health and care needs were met. There were some areas of good practice and District Nurses were complimentary about Kestrel Homecare Ltd.’s staff.

The feedback we received about the registered manager was positive. There was a clear philosophy of care at the service which was understood by staff. This included the importance of dignity, privacy and choice.

People had been consulted about their care and were clear how to raise concerns if they had any.

We found a number of breaches of Regulations. You can see what action we told the provider to take at the back of the full version of this report.