Care service description

Here2care (Medway) provides personal care and support to people in their own homes in Rochester, Chatham, Strood, Gillingham, Rainham and surrounding areas. At the time of the inspection the service was providing care for around 130 people. This included older people, people living with dementia and people with a learning or physical disability.

Rating at last inspection

At the last inspection on 24 and 26 February 2015, the service was rated Good.

At this inspection the service remained Good.

Why the service is rated Good

The service was run by a registered manager who was present on the day of our visit. 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.

People trusted staff and therefore felt safe whilst being supported by them. Staff had received training in how to safeguard people. They knew what signs to look out for which would cause concern and how to report them so the appropriate action could be taken to help keep them safe.

Comprehensive employment checks were carried out on all potential staff at the service, to ensure that they were suitable for their role. People had their needs met by staff that were available in sufficient numbers.

Assessments of potential risks had been undertaken in relation to the environment that people lived and worked in and in relation to people’s personal care needs. This included potential risks involved in moving and handling people, supporting people with their personal care needs and with managing medicines. Guidance was in place for staff to follow to make sure that any risks were minimised.

A medicines policy was in place to guide staff. Staff continued to receive training in the administration and storage of medicines and a system was in place to regularly check they had the knowledge and competence to manage people’s medicines safely.

New staff received an induction which ensured that they had the skills they required, before they started to support people in their own homes. Staff continued to undertake face to face training in essential areas, their practice was observed and they shadowed senior staff to ensure they were competent. People said that staff had the skills and knowledge they needed to support them.

Staff had undertaken training in The Mental Capacity Act (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.

People’s health care and nutrition needs had been assessed and clear guidance was in place for staff to follow, to ensure that their specific health care needs were met. Staff liaised with health professionals when appropriate.

Staff were consistently kind and caring and treated people with dignity and respect. Staff had developed relationships with people and a memory bank had been introduced to gain a more detailed account of people’s life histories.

People’s care, treatment and support needs were assessed and a plan of care was developed jointly with the person which included their likes and dislikes. Individual guidance was in place for staff to follow to meet people’s needs.

People were informed of their right to raise any concerns about the service and were contacted people on a regular basis so they could raise any issues. When complaints had been raised the service had dealt with them appropriately.

There continued to be robust systems in place to assess and monitor the quality of the service, which included asking people about their experiences. The registered manage

Two inspectors visited the agency office; we spoke with the manager and other staff who had visited the office that day. We also contacted other staff for their views by phone. An expert by experience arranged with and spoke to 16 people who used the service; their views were included in this report. We looked at six people’s care files and other records regarding the people who had received a service in their own homes from Here 2 Care.

The provider ensured people’s care and support needs were assessed and recorded. The plan of care and support included risk assessment and information for staff to minimise risk.

Before people received any care or treatment, they were asked for their consent and the provider acted in accordance with their wishes.

People who received support in their own homes said they were very happy with the care they had received from their regular carers. One person told us “My carers are fantastic, we have no problems at all, they go over and above their basic duties, for example today they have hovered around the house for me, as they had some time left”. However, nine of the 16 people that we spoke with told us that when their main carer was off both planned or off sick, staff did not arrive at the agreed times. For example one person explained that they are bed bound and their breakfast call at 8am had sometimes been as late as 11am.

We looked at the way medication was administered/prompted and recorded by staff, we found that the systems were not robust and it was not possible to confirm whether people received their medication as they were prescribed. Although there were systems in place to monitor the provision of care, the management of the agency were failing to improve the quality of that care provision.

The provider had policies and procedures in place that ensured people’s needs and wishes were assessed and recorded prior to them receiving care.

People’s needs and wishes were recorded in a plan of care and these incorporated an assessment of risks to people’s safety. We saw evidence that these were reviewed regularly.

People we spoke to were satisfied with the service they received. One person said, “Staff make me laugh when I am feeling down”. A relative we spoke to said ‘overall we are happy with the service”.

In order to protect the people using the service, there was an up to date safeguarding policy in place. All new staff received safeguarding training during induction. Regular refreshers were in place for all staff.

Staff received ongoing training and support, which provided them with the skills they needed to provide care to a good standard. Spot checks were used to ensure staff carried out their roles appropriately.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires. We saw that the service made changes in response to complaints and one person we spoke to said that they had been happy with the changes that had been made following an issue they had raised with the provider.

People who used the service and relatives told us that they were involved in decisions about their care and support. One person told us, "When they first came to visit me they discussed a lot of my requests. They listened very well".

People told us that they were visited regularly by someone from the agency to discuss their level of satisfaction with the service. People also told us that they kept in touch with the agency by phone and/or e-mail.

People, relatives and social care professionals told us that people's privacy and dignity were respected at all times. One person told us, "They (care staff) have grown to know her as a person".

In last year's annual survey of people who used the service, people said that care staff were, "excellent" in maintaining their dignity and privacy.

The people that we spoke with were extremely happy with the care and support that they or their relative received. When asked if they would recommend the service to another person, everyone responded that, 'yes' they would. One person told us, "I find that they are good girls. They do look after him. They come through the door: it is like a ray of sunshine. I am more than pleased with the service". Another person told us, "The agency is helpful, welcoming and providing a good quality service at a reasonable price".

People told us that the agency was flexible in the way that it delivered care. One person told us, "They are able to accommodate changes……I liked it when they rang back to clarify details". Another person told us, "I just leave a note and they (care staff) will carry out".

People told us that care staff came at the time that they expected them and stayed for the correct length of time. Comments included, "They do everything in the care plan and more"; "They do all that is expected and anything that I ask them to do".

People told us that they received good support from the office. They kept them in touch with the care of their relative and supported them through difficult times. One person told us "I put it in an e-mail and I get a quick response. They will ring me if anything is worrying them about her. They tell me what I need to know".

People told us that care staff understood their individual needs or those of their relative. One person told us, "I walked in when a carer was dealing with her and her voice was so gentle. I sing their praises". Another person told us,

"The carers are lovely with her. They are very gentle and patient and concerned. They always check with me. They go that extra mile".

People told us that care staff had the skills and experience that they needed to support them or their family member. One person told us, "They use their skills to get what she needs. They know how to deal with people with dementia".

People told us that if they had a concern that they would ring the office. They said that they were confident that the staff at the office would resolve their problem for them. The results of the agency's annual survey last year were that everyone was extremely confident that any complaints that they made would be listened to and taken seriously.

The inspection was announced and was carried out on 24 and 26 February 2015 by two inspectors and supported by an expert by experience.

Here2Care (Medway) is a domiciliary care agency providing personal care to people in their own homes in and around Rochester Kent. The service focuses on enabling adults to regain their independence during a period of recovery as well as helping people who need longer term care in the community. Some people using the service live with Dementia, or had learning and/or physical disabilities.

At the last inspection on 09 December 2013, we asked the provider to take action to make improvements to staffing levels and late calls; the management and recording of the administration of medicines; and the monitoring system to assess the quality of service people received. We received an action plan stating that all remedial action would be completed by 31 March 2014. During this inspection we found that this action had been completed.

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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of re-occurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs. There was a new call monitoring system in place that monitored staff’s time keeping and travel time was taken into account. The manager followed safe recruitment practices.

Staff were trained in the safe administration of medicines. Records relevant to the administration of medicines were monitored to ensure they were accurately kept and medicines were administered safely to people according to their needs.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before care was provided and were continually reviewed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

Staff had completed the training they needed to care for people in a safe way. They had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal to ensure they were supporting people based on their needs.

All care staff and management were trained in the principles of the Mental Capacity Act 2005 (MCA) and were knowledgeable about the requirements of the legislation. People’s mental capacity was assessed and meetings were held in their best interest when appropriate.

Staff sought and obtained people’s consent before they provided care. When people declined, their wishes were respected and staff reported this to the manager so that people’s refusals were recorded and monitored.

Staff provided meals when appropriate and ensured they were well balanced to promote people’s health. Staff knew about people’s dietary preferences and restrictions.

People told us that staff communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. People were satisfied with how their care and treatment was delivered.

Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs when they had visual impairment.

People’s privacy was respected and people were assisted with their personal care needs in a way that respected their dignity.

People were referred to health care professionals when needed and in a timely way. Personal records included people’s individual plans of care, likes and dislikes and preferred activities. The staff promoted people’s independence and recovery. They encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed regularly with their participation or their representatives’ involvement. A relative told us, “ We are invited to participate in the reviews of our Mum’s care so our opinion can be taken into account”. People’s care plans were updated when their needs changed to make sure they received the care and support they needed.

The provider took account of people’s complaints, comments and suggestions. People’s views were sought and acted upon. The provider sent questionnaires regularly to people, their legal representatives and stakeholders. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued and supported under the manager’s leadership. There was honesty and transparency from staff and management when mistakes occurred. The manager notified the Care Quality Commission of any significant events that affected people or the service. Comprehensive quality assurance audits were carried out to identify how the service could improve and the manager had an action plan for making the improvements.