Home Instead Senior Care (Warrington) is a registered domiciliary care agency based in Cheshire that provides personal care to people in their own homes. The service is part of a network of Home Instead Senior Care franchises. At the time of the inspection 41 people were receiving a regulated activity from the service.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

The service met all relevant fundamental standards.

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.

The majority of people spoke positively about the management of the service and the approachability of senior staff. However, there were a small number of concerns raised about the quality and timeliness of communication by some people using the service.

The service had a clear structure and performance framework which helped to define roles and responsibilities. A substantial and regularly updated set of policies and procedures provided guidance to staff regarding expectations and performance. We saw evidence that staff had been challenged when their performance did not meet the required standards.

Staff and managers spoke with clarity and enthusiasm about their roles and demonstrated a mature and transparent approach when questions were raised during the inspection.

The service had used safety and quality audits to identify and address issues relating to; staff conduct, medication errors and late calls. Information had been used effectively to improve practice and to inform further development.

People and their relatives told us that the service was safe, and the service maintained effective systems to safeguard people from abuse. Staff were aware of what to look out for and how to report any concerns.

Individual risk was fully assessed and reviewed. Positive risk taking was encouraged to improve people’s skills and promote their independence.

Staff were safely recruited and deployed in sufficient numbers to provide safe, consistent care and support. The employment records for staff were maintained to a high level and showed clear evidence of employment histories, photographic identification, references and checks.

Staff were trained in the administration of medicines and had their competency checked. Medicines were stored and administered in accordance with best-practice guidelines. Where an error had been identified, the service had taken immediate action to improve practice.

The service trained staff to a high standard in appropriate subjects and supported with regular supervision and appraisal. Training was subject to regular review to ensure that staff were equipped to provide care and support. Staff had been provided with additional, specialist training where necessary. New staff completed the Care Certificate to ensure that they were competent to deliver care before they were offered a permanent contract.

We saw evidence of staff working effectively in partnership with healthcare services to deliver positive outcomes for people. People were also supported by staff to maintain their health and wellbeing through access to a wide range of community healthcare services and specialists as required. For example, local dementia services and the stroke association.

The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA). It was clear from care records and discussions with people that their consent was always sought in relation to care and treatment.

People told us that staff treated them with kindness and respect, and it was clear from our discussions that staff knew people, their needs and preferences well

People using the Warrington Care Service (Home Instead Senior Care) confirmed that they were treated with respect and their dignity was maintained. People also told us that they were satisfied with the standard of care provided and were of the opinion that staff understood their needs.

For example, comments received included: “I have every confidence in the service”; “I have found Home Instead to be very reliable”; “I’ve been very pleased with the care I’ve received. I get the same carer who is reliable and very good”; “I’ve no concerns or complaints. I am treated very well and would highly recommend the agency”; “I’ve received a survey and get asked my opinion on the service I received” and “Home Instead provide me with much needed care and support. I have always been treated respectfully by my carer.”

Systems were in place to offer protection to the people who use the service from abuse and people spoken with confirmed that they felt safe and had no concerns regarding the care provided.

People who use the service and / or their representatives confirmed they were given appropriate information and support regarding their care. Comments received included: “The staff treat me very well”; “The service is perfect in my opinion. I’m so impressed with the agency and I have nothing but praise for the care I receive from staff” and “I have always been treated respectfully. They review the service I receive and send out annual questionnaires also.”

People spoken with confirmed that care and support was planned and delivered in a way that ensured their safety and welfare. Comments received from people using the service included: “The standard of care I receive is very good”; “The carers are always on time, reliable and professional” and “I am treated very well.”

Likewise, a relative reported: “My mother has received a good service from Home Instead. The staff spend as much time as is necessary to assist her in various ways.”

People using the service told us that staff were attentive to their needs and confirmed they were of the opinion that staff understood how to deliver care, and support effectively. Comments received included: “The management and staff are very approachable people”; “The carers understand me and my needs” and “The staff help me with various tasks and they are always carried out to a satisfactory standard.”

No concerns, complaints or allegations were received during the visit.

This inspection was unannounced and took place on the 9 March 2015. A second day of the inspection took place on the 10 March 2015 in order to gather additional information.

The agency was previously inspected in April 2013 when it was found to be meeting all the regulatory requirements which were inspected at that time.

(Warrington Care Services Ltd /Ta Home Instead Senior Care) is a domiciliary care service. The agency provides personal care to people with a range of care needs within their own homes. The agency is managed from offices based within Warrington Business Park near the centre of Warrington. At the time of our inspection the service was providing the regulated activity of ‘personal care’ to approximately 43 people.

The Warrington local office is operated on a franchise basis and is part of a network of other local offices of Home Instead Senior Care that operate in Great Britain and beyond.

At the time of the inspection there was a registered manager at Home Instead Senior Care. 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.

Home Instead Senior Care had a registered manager in place that had been in post for approximately two years. The registered manager (also the owner of the franchise) was present during the two days of our inspection and engaged positively in the inspection process, together with other members of the office management team and staff.

People who used the service were of the opinion that the service was caring and that their care needs were met by the provider. Comments received included: “The carers are trained very well”; “If ever I had a concern I would speak to the staff”; “You could not replace the girls [staff]. They do what they have to and more besides. They have made my life better”; “We trust them and they [staff] are very supportive”; “They are very flexible. I can leave them and if there is a problem they will deal with it. This gives me peace of mind”; “The carers do more than enough”; “The carers meet my father’s needs” and “The consistency of staff is excellent.”

Records showed that the needs of prospective service users had been assessed prior to using the agency. Care plans and risk assessments had also been completed to ensure staff understood how to meet individual needs and keep people safe.

Staff had access to induction, mandatory and other training that was relevant to their roles and responsibilities. Staff spoken with also confirmed that they had received formal supervision at regular intervals.

Systems had been established to obtain feedback from people using the service and staff via annual surveys, quality assurance visits and supervisor spot checks. The national office of Home Instead also undertook internal auditing to monitor and review the standard of service delivered by the agency.

The provider had developed a ‘complaints policy and procedure’ and people using the service and relatives spoken with told us that in the event they needed to raise a concern they were confident they would be listened to and the issue of concern acted upon promptly.