What life is like for people using this service:

People continued to receive caring and compassionate support from kind and committed staff. The registered manager and director led by example and successfully created a stable and reliable team.

People were complimentary about the support they received and about meaningful relationships they could form with staff.

Staff recognised what was important to people and ensured an individually tailored approach that met people’s needs.

Staff respected people’s privacy and dignity. People were supported to be as independent as possible.

The provider ensured people received safe care and treatment. People complimented the continuity of care provided by skilled and competent staff. People received support to take their medicines safely.

Risks to people’s well-being and safety were assessed, recorded and kept up to date.

People’s rights to make their own decisions were respected. People were supported to maintain good diet and access health services if needed.

The service was well-led. The provider’s quality assurance processes were effective and there was a focus on continuous improvement.

More information is in Detailed Findings below.

Rating at last inspection:

Good (report published 30 January 2016).

About the service:

A&T (Salisbury) Limited is a domiciliary care agency (DCA). The service provides personal care to people living in their own homes. At the time of our inspection the service provided personal care to 17 people.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will monitor all intelligence received about the service to inform when the next inspection should take place.

A & T (Salisbury) provides a domiciliary care service supporting people with individual needs in their own homes. At the time of our inspection 19 people were being supported by this service. This inspection took place on 17 December 2015. This was an announced inspection which meant the provider was given short notice of the inspection. This was because the location provides a domiciliary care service. We wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

There was a registered manager in post at the service and a nominated individual at the time of our inspection. 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. A nominated individual is a person that must be employed as a director, manager or secretary of the organisation with responsibility for supervising the management of the regulated activity. The registered manager and the nominated individual had set up and were running the service jointly. They were both known to people and staff as the managers. The registered manager was available at the time of our inspection and was approachable throughout.

People told us they felt safe and staff were responsive to their needs. Systems were in place to protect people from abuse. Staff had a good understanding of safeguarding and whistleblowing procedures. They knew how to report concerns and had confidence in both managers that these would be fully investigated to ensure people were protected.

Safe recruitment procedures were followed. Staff said they undertook an induction programme which included shadowing one of the two managers, and meeting the people they would support. The provider had undertaken recruitment checks on prospective new staff to ensure they were suitable to care for and support vulnerable adults. Staff were appropriately trained in the core subjects relevant to their role. However, only one staff member had received palliative care training at the time of our inspection. Since our visit, the manager had taken immediate action and booked the remaining staff on a training course for the New Year.

Staff were knowledgeable about the requirements of the Mental Capacity Act 2005 and were confident in noticing signs of declining capacity and reporting concerns. People were supported to access healthcare services to maintain and support good health. Staff were vigilant in noticing changes in people’s health conditions, and the service worked proactively alongside the community professionals.

People and relatives were very complimentary about the caring nature of staff. Staff were knowledgeable about people’s needs and we were told that care was provided with patience and kindness. People’s privacy and dignity was always respected. Staff explained the importance of supporting people to make choices about their daily lives. Comments included, “Yes, I can make choices. I can say anything and they just do it”, “The manager and I discuss it together. The choice is mine in the end” and “Their whole attitude is one of being helpful”.

The registered manager had robust quality assurance systems in place to monitor the service. This meant regular audits picked up areas needing improvement and action was taken immediately.

We spoke with four people who used the service and all spoke very favourably about the care workers who visited them. They told us that either they or their relatives needs were met and that staff were respectful and caring. One person told us that, “I see two regular girls and I rely on them a lot. I don’t know how I would cope without them”. Another person said “ my mum really appreciates their help and the way they treat her is with complete respect”.

The manager and staff we spoke with all demonstrated a very good understanding of what constituted abuse and awareness of their responsibility to protect the safety and wellbeing of people using the service.

We looked at the staff training records. A range of relevant mandatory training courses had been provided for all staff to enable them to undertake their work safely and to an appropriate standard.

The manager told us she and her colleague were able to visit or make contact with all 20 of the people using the service each week. This was to ensure everyone was satisfied with the service they received and if necessary to make any changes.