Care service description

Leaf Care Service provides care to people in their own homes. The service can provide care for people of all ages and includes supporting people living with dementia and mental health difficulties; as well as physical, learning or sensory disabilities. Since their last inspection Leaf Care Services Ltd developed its services and has divided their home care service into two branches based in Great Yarmouth and Norwich. This inspection was related to the Norwich branch which covers Norwich, Broadland and North Norfolk areas. At the time of our inspection the Norwich office was providing care for 62 people, most of whom were older people.

Leaf has a registered manager. 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.’

Rating at last inspection

At our last inspection we rated the service good. 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. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

Why the service is rated …

People told us they felt safe receiving the care and support provided. Staff understood and knew the signs of potential abuse and knew what to do if they needed to raise a safeguarding concern. People were supported to minimise risks in their home and were assisted to take their medicines safely. The provider used safe recruitment practices and ensured they had adequate staffing levels. Where necessary the service demonstrated they were able to analyse incidents or mistakes and make appropriate improvements.

People said the care provided was effective, with their needs and preferred outcomes appropriately assessed and recorded. The service ensured staff were suitably inducted and received ongoing training appropriate to the care provided; staff competency in key skills was routinely checked. The provider work well with health and social care professionals and supported people to live healthier lives, have a nutritious diet and receive appropriate care and treatment as required. 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.

People told us that they found the care staff to be caring and compassionate, willing to support whenever possible. Staff were skilled in promoting independence and maintaining people’s dignity.

People told us their care was personalised and responsive to their needs. Complaints were usually dealt with effectively and quickly. The provider had skills in providing end of life care but had no recent experience of providing this care.

The provider had a clear vision to provide high quality personalised care and had good governance systems in place to ensure people’s desired outcomes were being delivered. The provider worked well in partnership with health and social care professionals and agencies to build knowledge, develop and promote good practice. The management were open and approachable both to staff and people using the service.

Further information is in the detailed findings below.

Leaf Homecare and Support Services provides care for people in their own homes. The service can provide care for people of all ages including people with a physical disability, special sensory needs and a learning disability. It can also provide care for people who have difficulties with their mental health and for people who live with dementia. At the time of our inspection the service was providing care for 140 people most of whom were older people. The service has its office in Norwich and covers north Norfolk, Norwich, Broadland, Great Yarmouth and surrounding villages.

Staff knew how to recognise and report any concerns so that people were kept safe from abuse. People were helped to avoid having accidents and they were assisted to safely use medicines. There were enough staff to enable most of the planned visits to be completed on time and background checks had been completed before new staff had been appointed.

Staff knew how to care for people in the right way and they had received all of the training and support they needed. People had been supported to eat and drink enough and they had been helped to access any healthcare services they needed.

The registered manager and staff were following the Mental Capacity Act 2005 (MCA). This law is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

People and their relatives said that staff were kind, caring and compassionate. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had received all of the care they needed including people who had special communication needs and were at risk of becoming distressed. People had been consulted about the care they wanted to receive and had been supported to pursue their interests and hobbies. There were arrangements in place to quickly and fairly resolve complaints.

People had been consulted about the development of the service and regular quality checks had been completed. The service was run in an open and relaxed way, there was good team work and staff were supported to speak out if they had any concerns about poor practice. People had benefited from staff acting upon good practice guidance.

At this inspection we found that significant improvements had been made in the way the service was being run and people expressed their satisfaction with the care they received. We spoke with 21 people using the service, or family members. People were satisfied with the service they or their relatives received.

People told us they felt they were involved in planning their care. One person told us they had written their own care plan. Another person said, "When my care plan has to be updated someone comes for a chat to see what needs changing and what I think." One person told us that someone from the office had visited them "...to read through the book then we went over it together."

People felt staff took into account their privacy and dignity. For example, one person described staff as "...very respectful..." Another said, "They are most polite and respectful."

Improvements had been made to staff support and supervision, systems for minimising the risk of spreading infection, and how the quality of the service was monitored. People told us what they thought of the overall standard of the service. One said, "We have had our ups and downs but it has improved over the course of the last year." Everyone expressed their satisfaction with care. People told us that they were very happy with things and had no complaints or concerns. One person said, "I'm very pleased with what's being done. I have no complaints at all." Another said, "I'm more than pleased with Leaf."

We spoke with a sample of people using the service and some relatives. People spoken with raised issues that some carers did not seem to have the training or skills required to meet people's needs before they were allowed to work unsupervised. One person described how a staff member had never seen a 'bath seat' before and that they had to explain how to use it. Two others told us that staff did not know how to manage and change catheter bags.

However, everyone singled out their 'regular' carers as worthy of praise. We received comments describing staff as 'brilliant', 'wonderful' and 'very kind'. One said, "I can't speak highly enough of them". However, a minority of those spoken with (including those who praised their regular care staff) also described specific occasions when the support needed was not provided and where staff were not wholly respectful of people's dignity and privacy.

We found that there were insufficiently robust systems for reducing the risk of infection, for staff recruitment and training and that quality monitoring systems did not identify these shortfalls and how things were to be improved.

During our visit to the office, we collected some comments from people who use the service. They told us that care workers were very good.

We collected the views and experiences of people who use the service from the agency’s own quality review. This analysis showed that the majority of people were happy with the service. People indicated their satisfaction of the service by scoring the outcomes for them, from one to seven. Particularly high scoring was achieved on staff friendliness and people feeling safe, followed by a number of high scoring results on medication, respect for dignity, privacy and confidentiality.

We also checked records of a complaint that the service had investigated and responded to. These records contained communication details between the service and people who complained and showed that both people who use the service and their relatives, care workers and the management of the agency had worked together to resolve problems.