All Care (GB) Ltd - Southampton Branch

All Care (GB) Southampton Branch is a domiciliary care service providing personal care and support to people with a range of physical and health conditions living in their own homes. At the time of the inspection 290 people were receiving care and support. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People were provided with safe care. Staff understood their responsibilities to safeguard people and had raised concerns where necessary. Risk to people's health and safety had been assessed and measures had been put in place to mitigate those identified. There were sufficient numbers of safely recruited staff deployed to meet people's collective needs. Staff managed people's medicines safely and ensured infection control policies and procedures were followed.

People were provided with effective care. People's physical, mental and social needs were assessed and understood. The agency had developed an electronic recording system which helped them to monitor the service more effectively and which helped staff to respond quickly to any changes in people's assessed needs.

Staff were well supported and training provided ensured staff understood health and safety protocols. More specific training also helped staff to care for people's particular health needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The agency worked cooperatively with other agencies to ensure people's needs were met.

The service was caring. Staff knew about people's preferences and wishes and people were invited to express their views about how they wished to receive their care. Privacy and dignity were respected.

The service was responsive. Care planning was personalised and people's communication needs were assessed. Information could be provided in an accessible format. The agency worked hard to support charities and to include people, especially if they were socially isolated, in community events. Complaints were addressed in line with company policy. Staff worked alongside health care professionals to provide good support to people at the end of their lives.

The service was well managed and well led. There was an open and inclusive culture and the registered manager led by example. There was a clear management structure and staff were clear about their roles and responsibilities. Robust quality assurance processes helped to ensure the service provided a good standard of care and improvements were made when any shortfalls had been identified.

Rating at last inspection

The last rating for this service was Good (published 10 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

we will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme . If we receive any concerning information we may inspect sooner.

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

There was an experienced 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.

The agency was last inspected in March 2015. There were no breaches of legal requirements then and we did not identify any breaches in legal requirements during this inspection.

Overall people were very satisfied with the agency. People told us they felt safely cared for. Staff were trained in how to recognise potential abuse and knew what procedures to follow to keep people safe. Environmental risks and risk to people's health or wellbeing were assessed and action was taken where necessary to ensure people were provided with safe care and support, for example equipment was requested to ensure staff could help people to move safely.

There were sufficient numbers of staff employed to meet people's needs and staff recruitment procedures were robust to help ensure only suitable staff were employed. New staff received a thorough induction and were supported by more experienced and senior staff to help them to understand their role. Established staff continued to receive regular training and support to ensure their skills and knowledge remained up to date.

People's health, medicines and nutritional needs were known and staff followed guidance in people's care plans to ensure they provided effective and consistent support. People were consulted about their care and support needs and were involved in the planning and review of their care. People's wishes and preferences were respected as much as possible and staff had a good understanding of the principles within the Mental Capacity Act 2005 which helped to protect people's rights.

Staff were kind and caring.They treated people with respect and understood the importance of maintaining confidentiality. Care planning was flexible and staff encouraged people to be as independent as possible.

The agency listened to people's views. Any comments or complaints were taken seriously and were responded to quickly. The agency was well structured and staff were clear about their own and other's role and responsibilities. Staff and managers clearly took a pride in their job.

There were effective quality assurance processes in place to help to ensure the service was delivered to a consistently good standard

We looked at ten staff recruitment files and saw all necessary checks and information required about staff had been obtained and was included in the files. For example, we saw a form entitled 'compliance information' which included information such as; personal details, health status, eligibility to work, proof of identification, copies of training certificates and registration details. A form entitled 'Interview form' contained information such as; references, curriculum vitae, drivers licence, media policy, staff handbook and induction workbook. Files we looked at contained a selection of five longstanding members of staff and five new members of staff. This process enabled us to compare and evaluate the level of improvements made.

Relevant staff had been re-trained in recruitment procedures and requirements relating to workers and two new post had been created to deal entirely with staff requirements. The new posts were entitled 'Recruitment manager' and 'Compliance manager' and between them dealt with all aspects of staff recruitment and retention including; making sure staff vehicles were regularly maintained, staff training was regularly monitored, interviews were carried out appropriately, all necessary personnel security checks had been made and appropriate documentation had been obtained.

The manager told us staff supervisions took place on a rolling rota basis and were continual throughout the year, appraisals were held annually and spot checks were carried out randomly at six monthly intervals. New members of staff received at least three spot checks within the first three months of their employment in order to monitor progress and provide additional support. The manager told us spot checks were carried out by suitably qualified members of the staff team such as team leaders.

Records we reviewed showed area staff meetings were held each month. We saw meetings were recorded in detail and included an agenda and attendance list. The last meeting recorded was held on the 17.03.2015 and topics discussed included; contracts, new members of staff, business report and allocations.

Policies and procedures we looked at were dated August 2011. The manager told us policies and procedures were reviewed annually, but only relevant sections were updated. The manager showed us examples of where updates had been made. At the time of our inspection a matrix was being developed to track and record all future policy and procedure updates and reviews.

We brought forward our planned inspection of the agency because we had received information of concern that alleged the welfare of a person had been compromised. We found no evidence to substantiate this.

Our inspection took place over three days 26, 27 and 28 August 2014. On the first day we visited the agency's office and looked at documentation such as care plans, visit schedules, policies and procedures, training records, staff records, surveys and audit material. We met with the agency's managing director and registered manager. We also met and spoke a care coordinator, assistant manager, team leader and two administrative staff. The latter had responsibilities that included ensuring staffing issues such as recruitment, training, spot checks, annual appraisals complaints and audits were carried out properly.

On our second day accompanied by the assistant manager we met with seven people and their relatives in their homes. They told us about the service they received.

On our third day we telephoned and spoke with people who received a service from the agency or their relatives and also with care workers. We spoke with 22 of the former and 14 of the latter. This was in order to hear about their experiences of either using the services of the agency or working for it.

We also took the opportunity when planning our inspection to speak with two local authority mangers who gave us their opinions about the agency.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service caring?

The service is caring. All the people we spoke who received a service from the agency told us they or their relative had the support and help they required to meet their needs. The majority of people spoke highly of the care workers who visited them and particularly of care workers who visited them regularly. Care workers were described as excellent, fantastic, proficient, reliable, brilliant and very good.

We spoke with two local authority managers who had on occasions arranged for the agency to provide a service for people. They were both complimentary about the agency. One manager said, 'I have found them to be very good. They are very professional. They are willing to work positively with us if there are problems and they support and care for people some people with very complex needs'.

Another person told us that on one occasion their regular care worker arrived to help them and their relative was unwell. They said the care worker first made sure their relative's needs were addressed and then helped them. They told us the care worker prepared their breakfast which was usually a task carried out by their relative. They said this showed their care worker, 'Went the extra mile.'

Is the service responsive?

The service is responsive. People we spoke with or their relatives told us people's needs were reviewed either when people required more help and support or less, or if things remained unchanged, at least annually. One person we spoke with said, 'When I started they gave me half an hour in the morning to get me up and give me a shower. I can't move very fast and the half hour was not enough. The carers told the office and so they came and saw me and gave me 45 minutes and now it works alright'. Another person said, 'I needed two visits a day at first, but now I have improved I only need one'. A third person said, 'They pop in periodically to see if I need any extra help.'

We noted the agency's policies and procedures were prepared for them by another organisation and we had seen them used by other services we inspected. We drew the attention of the agency's managing director to some weaknesses and omissions in a procedure about the management of medication. They immediately took action to include additional information and remove unnecessary and erroneous details.

Is the service safe?

The service is not completely safe. Recruitment and selection processes were not sufficiently robust as all information required to show people were suitable to carry out their work had not always been obtained.

We saw assessments had been carried out to identify potential risks to people's welfare such as mistakes with prescribed medication and falls due to impaired mobility. We also saw that nationally recognised assessment methodology had been used to identify the risk of people developing pressure ulcers and malnourishment. We noted that where risks had been identified there were corresponding care plans in place to manage them.

Is the service effective?

The service is effective. People were asked for their consent before they received any care or treatment and their wishes were respected and where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People's needs were assessed and their care and support planned and delivered in accordance with their individual care plans, in a way that ensured their safety and welfare.

Is the service well led?

The service is well led. The provider had effective systems in place to regularly check and monitor the quality of their service people received and to identify, assess and manage risks to the health, safety and welfare of people using the service and others.