About the service:

Chesterfield (DCC Home Care) is a domiciliary care service which provides personal care to people living in and around the Chesterfield area. This can be either on a long-term basis or as a short term reablement package, which is designed to assist people regaining independence after a hospital stay, injury or illness. There were 303 people receiving personal care at the time of our inspection.

People’s experience of using this service:

People told us they felt safe with the staff who supported them. Staff had undertaken safeguarding training which was periodically refreshed. They understood their role and responsibility to keep people safe from harm. Care records contained guidance for staff about how to support people safely and minimise risks to people.

Recruitment processes helped the employer make safer decisions when employing new staff. Staff had completed a structured induction and had access to ongoing training and support, to help develop their knowledge and skills. However, not all staff had completed refresher training in a timely manner. Regular support sessions and staff meetings had also taken place.

Medication was administered or prompted by staff who had been trained to carry out this role and whose competency was periodically checked.

There were enough staff employed to ensure people received consistent and timely care. People told us staff usually arrived within the agreed times and did what was expected of them.

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 understood the importance of gaining people’s consent and acting in their best interest.

People were happy with the support they received from staff regarding meal preparation. Staff were aware of people's dietary requirements. Where people were at risk staff monitored their food and fluid intake and shared information with relevant healthcare professionals.

People were very happy with the quality of the care the service provided and how it was run. They told us care workers met their needs and supported them to meet their aims and objectives. People told us their privacy and dignity was always respected and staff were competent in their work, caring, friendly and helpful.

People spoke highly of the staff who provided care and support, as well as the staff based in the office. Staff had built positive relationships with the people they supported. Staff supported people to retain or improve their independence. People were actively involved in planning and reviewing their care. This helped to ensure care was provided in accordance with their wishes.

People were enabled to raise complaints and concerns. People we spoke with said they would feel comfortable raising concerns, if they had any. When concerns had been raised the correct procedure had been used to record, investigate and resolve issues.

There were systems in place to continuously assess and monitor the quality of the service. This included obtaining people’s views and checking staff were following the correct procedures.

Staff provided positive feedback about how the service was run. They told us they enjoyed their jobs and they worked very well together as a team.

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

Rating at last inspection: Good (report published 19 May 2016).

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Chesterfield (DCC Home Care) provides personal care for adults in their own homes. This includes people living with dementia and people requiring short term support on discharge from hospital. There were 350 people using the service for personal care at the time of our inspection.

This inspection took place on 29 January 2016. The service is run from an office in Staveley near Chesterfield and provides care to people in North Derbyshire. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure the manager was available.

In addition we also carried out telephone calls to people using the service on 9 and 10 February 2016.

There was a registered manager at the service. 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 regularly sought and listened to people’s views about their care. People knew how to complain and were confident to do so. However, we found a number of people were not satisfied with the way their complaint had been dealt with.

The service was mostly responsive to people’s needs but some people were concerned about the number of different care staff who called on them, particularly when this did not correspond with the rota they had received.

People received safe care and support and the provider’s arrangements helped to protect people from the risk of harm and abuse. Known risks to people’s safety associated with their care, medicines and support needs were safely managed.

Staff understood their roles and responsibilities for people’s care and safety needs and for reporting any related concerns. The provider’s arrangements for staff training and their operational procedures supported this, although we found most staff were not up to date with some aspect of essential training. The registered manager had started to act on this to ensure staff training was up to date.

The provider’s arrangements for staff recruitment and deployment helped to make sure there were sufficient staff who were fit to work at the service to provide peoples’ care.

Staff understood and followed the MCA, to obtain people’s consent for their care or determine care to be provided in their best interests. The provider’s training arrangements and policy guidance supported this. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff understood people’s personal care needs and associated health conditions. People’s planned care was shared with them, recorded when given and regularly evaluated and reviewed to check its effectiveness. People were satisfied with their care and they were appropriately informed and involved in planning and agreeing this.

People received appropriate support to manage their meals and nutrition when required. This was done in a way that met with their needs and choices.

Staff considered people’s needs and wishes and they supported people in a personalised way. Staff demonstrated they understood the provider’s aims and values, which helped to ensure people’s rights and involvement in their care.

The service was well managed and run and staff understood their roles and responsibilities for people’s care and their expected conduct in this. Regular checks were made of the quality and safety of people’s care, which helped to inform and plan service improvements.

During our inspection we spoke with fourteen people who used the service, five relatives and twelve staff. We saw that people were satisfied with the care and support provided and that their needs were assessed and care and support was planned and delivered in line with their individual care plan.

We found that people were protected from abuse and all staff we spoke with demonstrated their awareness of their role and responsibilities in relation to safeguarding. All people we spoke with who used the service said they felt confident to raise a concern. We were told by one person who used the service: " I would confidently raise any concerns I had as I know I will be taken seriously and will be listened to".

We found staff members felt well supported in their work. One relative we spoke with said: "The staff are so well trained and this really shows, absolute professionals".

We found the provider regularly monitored the quality of service provided. During our visit we saw evidence of audits which had been undertaken and associated action plans which had been developed. We saw how changes had been made to improve the quality of service provision.

We found all care records accurate, held securely and fit for purpose.

One relative we spoke with said: "I cannot think of one negative comment and I can not put into words how much this service has done for me, my family and relative".

As part of our inspection we spoke over the telephone with one person who used the service and the relatives of another person. One person told us that 'they look after me well. I have no complaints, my carer is very good. I know that I can ring Julie if I have any issues. I am very happy, I couldn't get better service anywhere. My lady is very helpful to me, nothing is too much trouble. Very, very good.' The relative of another person told us that 'I am quite happy with the care, I have no issues. Any problems are sorted out quickly. I know how to complain if I needed to.'

We also spoke over the telephone to two members of the care staff. One member of staff told us that 'I am happy that I have time to care. I am very well supported by the team. If I am concerned about anything the team will help to deal with the situation. I have just undertaken a short course on the care of people with altzheimers disease and it has been very useful. I have been trained in safeguarding and I know how to report any issues. I am confident that my manager would deal with anything I report.' The other member of staff we spoke to told us 'I am confident that any issues I reported would be dealt with properly, I love my job and am happy working here.'

We reviewed the care records of four people who use the service. We also reviewed the providers policies and procedures and found that comprehensive policies were in place to support the delivery of care.

As part of this inspection we spoke by telephone to 12 people who were supported by the Homecare Service and saw groups of staff at every locality office. We also spoke with the organisation’s operational managers and Domiciliary Service Organisers (DSO) at the locality offices and senior officers at the Adult Social Care Department’s headquarters; they all gave us a perspective about their work.

All of the people we spoke to expressed very positive relations with the staff who provided support and care, and good relations with the agency’s office based coordinator and management staff. They told us that staff worked sensitively and carefully and that ‘I don’t have to remind them they just get on with the job’ and that ‘although some work at things better than others and we sometimes have to show the new ones, they are all friendly and helpful.. We were also told about the flexibility of the arrangements being made and how the agency was responsive to requests to change things. Staff told us that ‘we are now committed to the ideas of re-ablement and that particular change in the way we do things is a very positive one’ and that ‘the principle of client choice is re-establishing itself and we have to be more efficient’.

People told us in general terms about their confidence in the agency’s staff to work safely and the staff that we spoke to all told us that they had received proper training about abuse of vulnerable people and they demonstrated an understanding about their responsibilities to report any concerns.