This inspection took place between 01 and 07 November 2018 and was announced.

This service is a domiciliary care agency. It provided personal care to people living in their own houses and flats in the community. The service supported older adults who were living in the Trafford and Wythenshawe areas of Greater Manchester. At the time of our inspection, the service was providing support to 177 people, of whom, 71 received support with the regulated activity ‘personal care’. All people using the service either fully or part funded their own care.

Not everyone using Home Instead Senior Care received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where people receive such support, we also take into account any wider social care provided by the service.

We last inspected Home Instead Senior Care in January 2016 when we rated the service good overall and in all key questions other than well-led, which was rated outstanding. At this inspection we found the evidence continued to support the rating of good, and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

The registered manager had recently resigned, and finished working their notice during this inspection. We saw the provider had recruited a new manager who had accepted an offer of employment and was working their notice in their current 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.

People received a reliable service from staff who attended their calls in a timely manner. There had been no missed calls to people receiving a regulated service in the past year, and people told us staff turned up on time. The provider had systems in place to monitor staff availability when deciding whether they had capacity to accept new care packages.

Staff assessed risks to people’s health, safety and wellbeing. Whilst some risk assessments were limited in detail, we found staff were aware of appropriate steps to take to keep people safe. Risks were also reduced as people received support from consistent staff teams.

Staff provided the support people needed to take their medicines as directed. However, in one case, we found staff had not followed safe procedures, and the provider’s own policy in relation to the administration of over the counter medicines. We saw the provider was introducing a new medicines administration policy at the time of our inspection that staff were receiving training in. The director confirmed this covered requirements in relation to the administration of over the counter medicines.

People’s needs were assessed prior to staff starting to provide a service. People felt that Home Instead Senior Care had a good understanding of their needs and preferences. People were supported to access other services to meet their health and social care support needs. However, we found some assessments were limited in detail and had not always been updated promptly following changes in people’s needs.

Staff received support and an induction that prepared them to undertake their job roles. People told us they were confident that staff had the skills and experience needed to meet their needs. We saw the provider carried out staff spot-checks and competency assessments. Reviews of people’s service also considered whether staff required any additional training to meet people’s assessed needs.

People were asked to sign forms to different aspects of their planned care and handling of records and information. However, we found shortfalls in this process. For example, one person had sig

We carried out an inspection of Home Instead Altrincham on 13 and 18 January 2016. This was an unannounced inspection. Home Instead Altrincham is a domiciliary care service that provides personal care and support to people living in their own homes. At the time of the inspection Home Instead Altrincham was supporting 130 people within the local community. We last inspected the service on 14 November 2013 where we found the provider was meeting the required standards at that time.

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.

People told us they received safe care, which was reliable and consistent. The service had sufficient staff to meet people’s needs, and people were given the time they needed to ensure their care needs were met. We saw that people were protected from avoidable harm. During the inspection we checked to see how the service protected vulnerable people against abuse and if staff knew what to do if they suspected abuse. There was an up to date safeguarding vulnerable adult’s policy in place. Risks to people were assessed and risk management plans were in place. We found that the staff we spoke with had a good understanding of the principles of safeguarding.

People confirmed that staff arrived on time and stayed for the length of time allocated. People also confirmed that visits were rarely missed and that a manager was always available. There had been no formal complaints received over the last twelve months.

Staff had the skills, training and support they needed to deliver effective care. All of the staff we spoke with told us they were well supported by each other and the management team.

The service was working to the principles of the Mental Capacity Act 2005, which meant that care staff supported people to make their own choices about their care. Before any care and support was provided, the service obtained consent from the person who used the service. We were able to verify this by speaking with people who used the service, checking people’s files and speaking to staff.

The managing director had robust recruitment processes in place which included the completion of pre-employment checks prior to a new member of staff working at the service. This helped to ensure that staff members employed to support people were deemed suitable and fit to do so. People who used the service could be confident that they were protected from staff that were known to be unsuitable to work with vulnerable adults.

The recruitment manager and the franchise owner with responsibility for recruitment had developed a recruitment process alongside the main recruitment policy which incorporated the agency’s core values of rapport, empathy and attitude.

We saw evidence of a comprehensive induction pack, with appropriate training provided for roles and responsibilities, along with competency testing. Staff also signed to confirm they had read policies and procedures and that they were aware of the provider's requirements in respect of data protection and confidentiality.

At the time of the inspection the service had recently introduced ‘people planner’ which is a computer software programme specifically produced for the care and support sector to assist them in organising the deployment of staff.

All care staff were given a ‘caregiver’ manual that included policies and procedures, which were discussed with the staff member as part of the induction process. Staff received supervision and appraisal from the registered manager. These processes gave staff an opportunity to discuss their performance and identify any further training they required.

People were supported with a range of services which enable

We found there were appropriate systems in place to ensure consent to provide care and support was obtained.

A relative of a person who used the service told us; “They talk to my X, the girls take their time to explain what needs to be done such as helping my X to dress. Things are explained to my X fully. The carers understand her and have fun with her and do things in a happy way and a wonderful relationship has developed.”

We looked at a sample of eight care files of people who used the service. Care was planned and delivered in a way that was intended to ensure people’s safety and welfare.

A relative said “The staff have a fantastic relationship with my X, the carer who looks after my X has been an absolute star”.

We found that staff had appropriate training for their roles and responsibilities.

One member of staff told us “What I like is that the staff are fully supported by the team in the office. They really support me on the ground.”

We found that the provider had systems in place to monitor the quality of the service they provided.

We found that regular ‘spot checks’ had been undertaken to monitor the quality of the service provided by staff.

We found the provider had effective systems in place to record, respond and investigate any complaints made about the service.

A person said “If I had real concerns, I feel I could easily voice those concerns and I have confidence they would address those concerns.”

We spoke with three people who either received care from Home Instead Senior care or whose relative received care. They all spoke very positively about the service. We were told that all their needs were met by competent care workers who treated them with respect. Comments included “[The care workers] are very understanding and the whole service is marvellous” and included “All the girls are lovely and will do anything that is asked of them”.

People told us that they always knew the care worker who went to their home, and staff confirmed they were introduced to new people and given time to get to know them and find out about their needs.

All staff had been through a thorough recruitment process and had received mandatory training, including safeguarding training, prior to them starting work.

We saw that the manager regularly checked people were receiving a high quality service, and people had the opportunity to give their opinion of the service and make any comments at least every three months.