About the service:

Oxford House Community Care is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults, people with dementia, people with mental health conditions and people with a physical disability. At the time of our inspection 156 people used the service and there were 70 staff employed. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People's experience of using this service:

• The service met the characteristics for a rating of "outstanding" in the well-led key question and "good" in all other key questions.

• The service provided strong vision and leadership to a motivated staff team who felt valued by management.

• The service had robust quality assurance processes to measure, document, improve and evaluate the quality of care.

• The service was always investigating ways to develop and improve the experience of people who used the service.

• People benefitted from the service's connections with other health and social care agencies and community presence.

• People's privacy and dignity was respected by staff.

• Care planning documentation clearly identified people’s diverse needs, preferences and choices.

• The service worked with other agencies to provide support to people at the end of their life in accordance with their wishes.

• People received personalised care which met their individual needs and were supported to express their wishes.

• People and relatives told us the service was compassionate and respected their preferences and decisions.

• Staff were knowledgeable and experienced. They received appropriate training and support to ensure they could carry out their roles effectively.

• More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated Good overall and Requires Improvement in the effective key question (7 April 2015).

Why we inspected:

This inspection was part of our routine scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, high quality care. Further inspections will be planned for future dates.

We carried out this inspection on the 27 November 2014.This was an announced inspection. We gave the provider 48 hrs notice of our visits to make sure we could access the people and information we needed to.

When we inspected Oxford House Community Care in December 2013 we found they met all the regulations inspected.

Oxford House Community Care provides care and support to approximately 215 adults and older people in their own homes. This includes adults with physical disabilities and older people living with dementia. Oxford House Community Care does not provide services to children.

Oxford House Community Care has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Whilst people were positive overall about the quality of the care they received, a number told us they did not always get their visits at the time they expected. They were satisfied care staff stayed for the time they were supposed to. However when there were changes in their regular care staff they were not always told of this beforehand. Care staff reported that whilst in most cases they had full details about people they provided care for, in cases where they went at short notice, this had not always been the case. In those circumstances they had to ask the person concerned or consult the care plan in the home before they were able to provide care effectively.

People’s safety was maintained and protected. Staff received regular training and support they required to provide a high standard of care to meet people’s needs. Care plans set out clearly how people preferred their care to be provided. People were involved in making decisions about their care.

People were supported to eat and drink and take their medicines. Staff received the appropriate training to enable them to do this safely and effectively.

Staff said they felt well supported by the provider and management team. The provider sought feedback from staff, people who received care, their relatives and from professionals responsible for arranging care. They were very proactive in looking at new ways to provide care and were involved in a number of innovative pilot projects in partnership with other providers and local authorities.

People told us they were involved in making decisions about their care. They confirmed they had received information about the care and support options open to them. When we visited people in their own homes, we saw they each had a copy of the service's information pack. This included contact details for the service, a copy of their care plan and information about how to make a complaint. This meant people who used the service were given appropriate information and support regarding their care.

The provider told us the majority of referrals to the service were from local authorities, although in some cases people approached the service on their own behalf. In all but emergency situations, the provider was given a referral assessment with details of the care required. The provider then carried out their own assessment to confirm the level of support required and how it was to be provided safely and effectively.

The people we spoke with said they felt well-supported and safe. They told us they did not have any concerns about their care workers or the support they received. Of the ten questionnaires received, nine people said they always felt safe during care with one person replying 'most of the time.'

We spoke with five people who received care and with three people who were family carers of people who received care. They were all positive about the competence, ability and skill of the staff who supported them or their relatives. Ten people returned questionnaires, the majority said care staff had skills they needed to give them care and support safely and effectively.

We looked at how complaints were managed. We tracked one complaint through and saw it had been recorded at each stage of the process including the outcome. Changes had been made to the individual's pattern of care delivery. The complainant had responded to positively and said they were satisfied with this outcome. This showed the provider took account of complaints and comments to improve the service.

People told us they valued the support of care staff from Oxford House. We spoke to three people who used the service and one family member. They were all very positive about the support provided. One person said “They’re absolutely wonderful”.

People said that the care staff were reliable and that personal care was given in a sensitive, considerate way which enhanced their lives.

People were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. All staff received mandatory training in safeguarding vulnerable adults. People we spoke to told us that the service helped them to feel safe.

Staff received appropriate professional development with supervisions and appraisal systems in place. This meant that people could be assured their care was delivered by competent staff.

There were effective complaint systems in place with support available to people who may need assistance to raise a complaint.

A number of people told us they would not be able to manage to continue living in their own homes without the support of care staff from Oxford House.

People said the care staff were reliable, usually arrived on time, did the work they were required to do (“sometimes more” a couple of people added), and stayed for the amount of time agreed.

A care manager also expressed positive views about the service. The care manager said that the staff were knowledgeable, the agency maintained good communications with the care manager, it was honest, and where required it trained up staff to ensure they had the skills to meet a person’s particular care needs.

A care manager said that overall they had found Oxford House performed well in terms of reliability, timekeeping, staff skills, communication, and meeting people’s needs.