About the service:

Cheshire East Domiciliary Care Service provides reablement support and care to people living in their own homes in the community following planned hospital discharges or in emergency circumstances. At the time of our inspection there were 38 people using the service, however this number changes daily depending on the level of need for the service.

People’s experience of using this service:

Everyone we spoke with said they felt safe receiving a service from Cheshire East Domiciliary Care Service. Medication was managed safely, and risks to people’s health, safety and wellbeing were assessed and reviewed during their package of care. Staff were recruited safely and incidents and accidents were logged and analysed. There was enough staff to be able to support people safely.

Staff had completed all training which the registered provider had deemed as ‘mandatory’ and there was a comprehensive induction in place for staff who were new to the organisation. People were supported to manage their food and fluid intake and were supported to make their own meals where possible. The registered manager was knowledgeable about the Mental Capacity Act (MCA) 2005, and associated legislation. Consent was clearly recorded in people’s care plans.

People were complimentary regarding the caring nature of the staff. Care plans evidenced involvement. People were signposted to local advocacy agencies if needed.

People received personalised care which was largely focused on their individual needs and outcomes. The staff worked alongside people and families to ‘enable’ them to regain their independence following a stay in hospital, and we saw care plans reflected this.

There was a complaints procedure in place and people we spoke with told us they knew how to complain.

The registered manager was driven to continuously improve the service they provided, and they worked alongside another registered manager to share good practice and create a range of audits to identify improvements. The organisation worked in partnership with the local hospitals, discharge teams, and other health and social care providers to ensure people had access to care which was right for them and met their needs. The registered manager notified us any reportable incidents.

Rating at last inspection:

Rated good, reported published September 2016.

Why we inspected:

This was a planned inspection in line with our inspecting schedule.

Follow up:

Ongoing monitoring

The inspection was announced and took place on 12 and 18 July 2016.

The service was last inspected on 30 January 2014 where it was found to be compliant in all the areas that we looked at.

Cheshire East Domiciliary Care Service provides short term care and support, usually when there has been a health and/or social crisis, to enable people to gain confidence, independence and maintain links within the community. It also aims to promote recovery and independence following an illness or accident. The agency operates from an office within Macclesfield Town Hall.

Cheshire East Domiciliary Care Service has 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. At the time of our inspection, they were providing services to 48 people, 42 of which were in receipt of personal care.

Everyone we spoke with was extremely positive about the service and the carers. People who used the service and their relatives were consistently positive and spoke of the kindness, professionalism and caring attitude of the staff. We gained the impression from everyone that they thought people received the best possible service from an excellent staff team. Comments included, “my carer is the most wonderful caring person I could hope for” and “they are brilliant, I know they really care for me and look after me”.

The service had been nominated and won internal awards for their commitment to helping residents using their service. This was in relation to ensuring people were safe by continuing to ring into the service whilst the new real time monitoring system was being implemented and their teamwork ensuring people were safe during a period of localised flooding.

There was a bespoke real time monitoring system called staff plan in place which enabled people to be confident that their visits would be carried out on time and medication would be administered at the correct time. It operated in conjunction with the office and enabled information to be instantly sent to staff phones so that everyone was aware of any changes in care immediately. Alerts were sent to the office immediately if visits or medication were not carried out and there was a backup duty system where senior care staff could complete the visit if necessary. Visits could not be booked onto the system without taking account of travel time as it was linked to an electronic mapping system. All visits were carried out in full and people reported that staff were never rushed. This meant that staff were confident that they were doing everything they should be and that they were not rushed in their roles and people using the service were confident that they were safe as they would receive all their visits and their medication would not be missed. This meant that there were no missed calls and medication was taken at the right time.

The manager was passionate about the service and constantly looking for ways to ensure that it ran as smoothly as possible and people received a consistently high standard of care. She led the project to commission the staff plan system, attending working conferences so she was up to date with the latest software available and what this could deliver for her organisation. She has sourced additional training resources for staff to supplement the eLearning that is on offer with the provider to deepen staff’s understanding of issues and to test competencies in each area.

Arrangements were in place to protect people from the risk of abuse. We spoke to staff about their understanding of safeguarding and they knew what to do if they suspected that someone was at risk of abuse or they saw signs of abuse. Relatives of the people who used the service told us that t

Care records contained enough information to show how people were to be supported and cared for. We spoke with three people using the service and with one relative. They were complimentary about the staff and the care and support provided. Comments made included, “They are looking after me very well and are helping me to regain my independence” and “They are supporting me to get well, the staff are excellent, every single one of them”.

We saw that systems were in place to help prevent and control infection within people's homes. The documents we looked at showed that staff were appropriately trained in infection control procedures.

The system in place for managing medicines in people's homes was safe. This helps protect the health and welfare of people using the service.

Arrangements were in place to ensure that people using the service were cared for by staff who were safely recruited. Management gathered relevant information and carried out checks on people who had applied to work for the agency. All the relevant checks were in place prior to people commencing work.

People benefited from a well-managed agency that had systems in place to monitor the quality of the service provided.

During our visit to the service we spoke with four people who were receiving reablement support. All said that they were treated with dignity and respect, their views were taken into account in the type of support they wanted to receive and they were being helped to increase their independence. For example one person said; “I got the opportunity to say what I needed. My views were taken into account”. Another said; “The carers are very friendly and treat me how I like to be treated. Another said; “The workers have completely maintained my privacy and dignity and help me feel at ease. My support plan addresses helping me gain independence”.

They also told us care was delivered in line with their care plans and staff were reliable and on time. All were happy with the service they received and told us staff were kind and caring and looked after them well. For example one person said; “I am very happy with the service. The carers help me as much as they can”. Another said; “Nothing is too much trouble for the carers. The quality of care is second to none. They respond to any concerns and help sort things out”. And another said; “They have helped me gain confidence and independence and make me feel there is a life outside”.

Two people said that sometimes they did get a number of different carers supporting them. However, they said this was not a problem as all staff were of very good quality and always knew what had been going on.