About the service:

This service is a domiciliary care agency. It provides personal care to people living in their own homes in Maidenhead and surrounding areas. It provides personal care to younger adults and older people. On the day of the inspection the service was supporting 50 people with personal care.

People’s experience of using this service:

At this inspection we found overwhelming evidence that demonstrated people received outstandingly responsive support. The significant improvements of people's experiences had been achieved because of excellent leadership provided by the management that had also met the characteristics of the outstanding service.

People received care and support that in their words or in their relatives’ words was ‘life changing’. The feedback we had reflected the service provision had a positive impact not only on people but also on people’s relatives. This was due to an awareness that people received such a reliable, responsive and proactive support which in turn provided piece of mind to the families.

Everyone we spoke with was extremely complimentary about the way the care was delivered. People and relatives described the service using words such as ‘absolutely excellent’, ‘brilliant’ and told us they could not ‘praise them enough’. We saw the service was flooded with compliments from people and their relatives. Again, the wording people used reflected a very high level of satisfaction and included; ‘wonderful’, ‘fantastic’, ‘total legend’ and a ‘cracking job’.

Staff excelled in identifying ways to enhance people’s well-being. The team recognised the importance of people being a part of the local community. The provider, despite being a community-based organisation had gone the extra mile and created additional opportunities for people to benefit from. These enhanced people’s wellbeing and helped with social isolation. People were encouraged to access various activities such as visits to a day centre, accessing local community support groups and various outings.

The registered provider’s ethos behind setting up the organisation was based on a personal experience of a close family member receiving care previously. This had enabled the provider to have an invaluable insight of what quality of support they wanted to provide to people. The management led the team by an example and acted as an active role model for the caring industry.

We found the provider demonstrated strong values and successfully created a service that put people first and empowered staff. The staff continuously considered ideas on how to enhance people’s lives and how to adapt the service delivery to people’s changing needs. The feedback from staff confirmed they were fully involved, felt valued and there was a strong feel of belonging and pride of working for the service reflected through the structure of the organisation.

The provider had excellent quality assurance systems that remained effective and ensured quality of service and ongoing tracked record of compliance. There was evidence available that the delivery of a high-quality service was a shared aim of an entire team working together in a very supportive environment.

The provider reflected how the service could be improved and took appropriate action when needed. For example, since our last inspection they created a new post for a quality manager to ensure an additional support around auditing. The team saw any feedback as an opportunity to reflect and enhance further the quality of the service for people and people said the smallest issues had been promptly addressed.

Rating at last inspection:

Good (report published 13 October 2016).

Why we inspected:

This was our scheduled, planned inspection based on the previous rating.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Right at Home (Maidenhead and Slough District) provides personal care to older adults, some of whom have dementia throughout Maidenhead, Marlow, Windsor and surrounding areas. The office is located in a residential area on the River Thames in Maidenhead, Berkshire. Staff provide care to people within their own homes. Services provided range from assistance in the morning (including helping people get out of bed, wash, get dressed and have breakfast) shopping, preparation of food, medication prompting and assistance with evening care routines.

At the time of the inspection, there was 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.

The service’s previous routine inspection was on 2 September 2014. At the time all five outcomes inspected were found compliant. A full history of the service’s inspections and reports is available on our website. This is the first inspection of the location under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and rating required by the Care Act 2014.

At the time of the inspection, 35 people used the service and there were 32 staff. People received care visits in the morning, at lunch time, at supper and in the evening. The service also operated 24 hours a day, seven days a week and people, relatives, staff and healthcare professionals could telephone the office anytime to receive support. After hours, calls were diverted to the on-call manager’s mobile telephone.

People were protected against abuse or neglect. Staff we spoke with were professional and caring and enjoyed working with people who used the service. People’s and relatives’ opinions of the care provided were overall positive. There were sufficient staff to meet people’s needs and the service appropriately determined correct staff deployment. Feedback from people and relatives indicated that staff were sometimes late to calls, and the service showed us the statistics they recorded for about this. People’s medicines were administered, stored and documented appropriately.

We found staff received induction, training, supervision and performance appraisals. The service utilised Skills for Care’s ‘Care Certificate’ for new carers and there was evidence that staff had successfully completed the 15 modules. However, we found staff did not receive appropriate amounts of training, supervision and performance review. We made a recommendation in the report about staff training and development. Recruitment and selection of new staff members was robust and ensured safety for people who used the service. Consent was gained before care was commenced and people’s right to refuse care was respected by care workers. However consent was not always gained lawfully by the service from the relevant person. We made a recommendation in the report regarding gaining lawful consent.

Staff were kind and caring. People’s comments showed they were satisfied with the care they received. Staff told us they respected people’s privacy and dignity, and ensured people remained as independent as possible. People had regular opportunities to provide feedback to the service and also have a say in their care package.

The service was responsive to people’s needs. People had the ability to share their compliments, concerns and complaints in an open and transparent manner. Where feedback was provided by people or relatives, management would undertake necessary investigations, make changes to their care package and report back to the person. People’s care plans were person-centred and changed as necessary. We found evidence that the care documentation was a good reflection of the person who was cared for.

All of the people and staff we spok

One inspector visited the home and answered our five questions, is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, communicating with three people using the service, four staff, the manager and owner and two commissioners of the service. We reviewed five care plans, five staff files and other relevant records.

Is the service safe?

Care plans instructed staff how to meet people’s needs in a way which minimised risk for the individual. They were detailed and ensured staff cared for people in a safe way.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. We found that the service had trained their staff with regard to DoLS and understood when a DoLS referral may be necessary. No DoLS referrals had been made since the service registered in April 2013.

People were safe in the service because staff had been properly trained and knew how to identify and report all forms of abuse. People told us they felt safe and knew that staff would keep them safe.

We saw that staff were properly supported and trained to make sure they could support people and meet their individual needs.

Systems were in place to make sure that the manager and staff continually monitored the quality and safety of care offered to people.

Health and safety was taken seriously by the service and all the appropriate safety checks had been completed. This reduced the risks to the people who received the service and staff.

Effective?

People’s health and care needs were assessed with them, and/or their relatives, as appropriate. Care plans were detailed and clearly identified people’s needs and how they should be met. We found that staff gave support as described in individual’s care plans.

We saw that the service was supporting people to achieve and retain as much independence as possible. One person told us they: ‘‘really look forward to the carer coming. She is a caring and thoughtful person’’.

Caring?

People were supported by kind, caring and patient staff. We found that care staff were positive, respectful and inclusive.

People described staff as: ‘‘excellent’’.

People's diversity, values and human rights were respected. Care plans were individualised and person –centred. We found that people were treated with respect and dignity by the staff.

Responsive?

Care plans were reviewed regularly and amended, as necessary, to meet people’s current needs. We found that health care was sought in a timely way. The service worked closely with other agencies to achieve the best care for people with special health needs.

The service had a detailed complaints policy and procedure which people who used the service were aware of. It had not received any formal complaints since registration in April 2013, however, we saw a record of concerns and the action which had been taken by the service.

Well led?

Staff members told us that they were supported to do their job well.

The service had some quality assurance systems. We saw records which showed that carers and the care provided was monitored through a range of spot checks, observations and formal reviews. We found that changes of to people’s needs responded to promptly and we saw some examples of changes made as a result of listening to people and their families. This ensured that the quality of the service was being maintained or improved.