About the service:

Agrade Community Care Services is a domiciliary care service providing personal care to people in their own homes in and around the Chesterfield area. The service is registered to provide personal care. Not all people who used the service received personal care. At the time of the inspection the service was providing personal care to 28 people.

People’s experience of using this service:

Feedback about the service from people and their relatives was positive. People received support which was tailored to their needs, delivered by staff who treated them with respect and understood their goals and aspirations. People and their relatives told us they felt the care staff were gentle and caring. People received care and support in a way which suited them. Staff we spoke with were passionate about this work.

The provider ensured care was delivered in a safe way. People were protected against the risk of abuse. Risks were assessed and well managed. Staff had received appropriate training in relation to health and safety and the prevention and control of infection. Staff followed protocols for the safe management of medicines. Staff underwent pre-employment checks to make sure they were of good character and suitable to work with adults and children.

Where part of their care package, people were supported in eating a healthy diet and maintaining good health. 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 supported this practice. Staff told us they received training and support to make sure they had the skills and knowledge to carry out their role effectively. Staff received training and support that was effective and equipped them for their roles.

People’s feedback was sought, so that they could contribute to ongoing improvements within the service. The registered manager fostered a culture of openness and continuous improvement. There was effective communication between staff and managers. Feedback from other professionals, such as social workers and health care professionals was positive.

More information is in the full version of the report

Rating at last inspection:

At the last inspection the service was rated Good (29 June 2016).

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

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Agrade Community Care Services Limited provides personal care to people in their own homes in and around the Chesterfield area. At the time of our inspection there were 42 people using the service.

We carried out this inspection on 29 June 2016. It was an announced inspection, which meant the provider knew we would be visiting. This was because we wanted to make sure that the registered manager, or someone who could act on their behalf, would be available to talk with us.

At our last inspection on 25 April 2014, we found that the service was meeting all standards assessed. It was compliant with the regulations and no concerns were identified.

A registered manager was 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.

Staff were appropriately recruited, trained and supported. They had undergone a comprehensive induction programme and, where necessary, had received additional training specific to the needs of the people they were supporting. Communication was effective and regular meetings were held to discuss issues and share best practice. Staff understood their roles and responsibilities and spoke enthusiastically about the work they did and the people they cared for.

The provider had detailed policies and procedures relating to medicine management. Staff understanding and competency regarding the management of medicines was subject to regular monitoring checks and medicine training was updated appropriately.

Staff knew the people they were supporting and provided a personalised service and used effective systems for gaining consent. Individual care plans, based on a full assessment of need, were in place detailing how people wished to be supported. This helped ensure that personal care was provided in a structured and consistent manner. Risk assessments were also in place to effectively identify and manage potential risks.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Systems were in place to effectively monitor the safety and quality of the service and to gather the views and experiences of people and their relatives. The service was flexible and responded positively to people’s changing needs and any issues or concerns raised. People and their relatives told us they were confident that any concerns they might have would be listened to, taken seriously and acted upon.

On this inspection we spoke with two people who used services and the families of five other people who used services. We spoke with staff and managers and looked at records.

Is the service safe?

Families we spoke with told us that any new staff had been introduced to their relative before they started working with them. They told us this made their relative feel secure as they would not have to open the door to someone they did not know. One person had commented on a customer survey, “You meet carers before the service starts so you are not opening your door to a stranger.” These procedures helped to ensure people were guarded against the risk of abuse.

On the day of the inspection we checked six staff recruitment files. We found evidence the provider had checked people’s identity, employment history, obtained character references and satisfied themselves of the person’s suitability for the job. The provider had also obtained relevant information from the Disclosure and Barring Service (DBS). The Disclosure and Barring Service helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups, including children. It replaces the Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA).

Four recent recruitment files showed staff did not start work until after the provider had received a satisfactory DBS check. However, we discussed two older recruitment files where staff had started their induction period before satisfactory CRB checks had been received. The manager told us they had recently changed the way they obtained DBS checks and staff now only started work after satisfactory clearance from the DBS. It is important that staff are not allowed to work before a satisfactory DBS check confirms they are suitable to work with vulnerable people.

Is the service effective?

We saw that people using the service had been involved in planning their own care. We found that people had been asked what they liked and disliked. When we spoke with people using the service and families of people using the service they told us staff always asked for their choices and preferences when supporting and caring for them. One person using the service said, “Staff always make sure I’m ok with things,” another person told us, “I feel listened to.” A family member told us, “My relative doesn’t feel under any pressure and staff always check things are ok before doing them.” When we read the daily notes staff made we found that staff had recorded people’s choices for meals and activities. This meant that people using the service were asked for their consent and the provider acted in accordance with their wishes.

Is the service caring?

All of the staff we spoke with told us they had enough information to support people using the service. We found evidence of other relevant professionals involved in the assessment and care planning process. The manager showed us evidence of additional advice and training which had been arranged for staff working to support one service user with specific needs. This had included advice and guidance from speech and language therapists and physiotherapists. This meant that care was being planned to include professional advice and was being developed with the person using the service.

Is the service responsive?

There were arrangements in place to deal with foreseeable emergencies. The provider had a business continuity plan in place to deal with any foreseeable emergencies. This included plans for adverse weather conditions, staff illness and damage to people’s homes through fire, floods or damage. When we read people’s care plan’s we found that staff had confirmed working smoke alarms were in people’s homes and any identified escape routes were clear. This meant that arrangements were in place to deal with foreseeable emergencies.

Is the service well led?

Staff working directly with people using the service told us that their managers had visited them to observe their work directly. We read the written records of these observations and found that managers had checked staff arrived on time, knocked before entering the person’s house, wore their uniform and ID badge and observed how well staff communicated with their client. We found daily records made by staff were audited by managers. The audit checked records had been made correctly and included appropriate information. The manager confirmed any areas identified for improvements were communicated to staff in their supervision so they could improve. These processes reduce risks to people and help the service to continually improve.

There were 48 people receiving a service from Agrade Community Care Services at the time of our visit. We spoke with ten people about the care they, or their relative, were receiving. Everyone we spoke with was happy about the care and support they were receiving and in particular, people told us that staff were very capable and trustworthy. People told us, “They have more than exceeded my expectations, staff are punctual and very capable” and, “They’ve never let me down and always let me know when there are changes to my rota which is important to me.”

We looked at the care plans for six people and found that they considered whether other providers were involved in that persons care, such speech and language therapists (SALT), physiotherapists and stroke support groups. We found that the provider worked in co-operation with others in order to protect people’s health, safety and wellbeing.

We found that staff received regular supervision with a senior member of staff and an annual appraisal. Staff told us that their colleagues were approachable and that they felt comfortable asking questions if they were unsure of anything.

We found that people’s complaints were fully investigated and resolved, where possible, to their satisfaction. People we spoke with were aware of how to make a complaint and told us that they would feel comfortable in raising any concerns with their care staff or the senior management team.

We spoke with two people receiving care from Agrade Community Care Service and the relatives of two other people. People we spoke with told us “I’ve had no problems, they are extremely co-operative” and “they are the most professional group of people I’ve had caring for me”.

We looked at the care plans for four people and they all showed input by the people themselves and / or their relatives. There were specific risk assessments in place to support people with different aspects of their care including medication, manual handing and transport. We saw that care plans included guidance for staff on promoting people’s independence and allowing risk taking.

People told us that they felt safe with the carers; they said “I absolutely trust them, I’ve no concerns” and “I definitely feel safe with them in the house, I trust them completely.”

There were effective recruitment and selection processes in place and the provider had introduced the Skills for Care 12 week induction programme for staff it had employed in the six months prior to our visit.

The provider was in the process of completing a survey which involved people receiving care and their relatives, at the time of our visit. We found that there was regular quality monitoring of documentation completed by the care staff including the call logs and medication charts from people’s homes.

We were informed that the service is flexible and very accommodating. One relative informed us that even in bad weather they made sure visits were completed and if staff phone in sick then the managers themselves will visit.

One relative told us that the same staff visit and they felt this consistency was helpful and beneficial to the person receiving care.

We were told staff were always introduced to people by people who were already known to the person receiving care.

Relatives felt that they were kept well informed and that they were consulted about the care of their relatives.

People using the service and relatives told us they would feel confidant to contact the manager if they concerns and they were professional and helpful.