Right at Home - Mid Hampshire

Updated 18 November 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was completed by one inspector, an Expert by Experience and a pharmacist specialist. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. We gave the service 48 hours’ notice of starting the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with the registered manager, nominated individual, deputy manager and eight staff across a variety of roles. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed four people’s care and medicines records and four staff recruitment files. We spoke with three people using the service and a further 11 people’s relatives.

Updated 18 November 2021

About the service

Right at Home are a national provider of care and support to people in their own homes. It operates a franchise model and Country Caregivers Limited (referenced throughout this report as the provider) manage one of these franchises called Right at Home - Mid Hampshire. The support provided includes short, or long term, visits to support with personal care, meal preparation, medicines management, domestic support, companionship and live-in care. The service mainly supported older people or older people living with dementia, but also supported younger adults with physical disabilities, including neurological conditions such as multiple sclerosis or motor neurone disease. A small number of people, experienced mental health problems.

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. When we inspected, 58 people were receiving support that included personal care.

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

Despite the challenged presented by the COVID-19 pandemic, staff had continued to prioritise ensuring that people were treated with kindness and respect and given emotional support when it was needed. The caring culture within the organisation continued to be embedded at every level and people continued to tell us that their care workers were exceptionally kind, caring and compassionate and that they had built trusting and meaningful relationships. Staff had exceeded what was expected of them and had often carried out extra, thoughtful acts for those they were supporting. Staff were particularly skilled at supporting people in a way which ensured they retained choice and control over their care. Staff demonstrated a thorough understanding of the importance of providing just the right amount of support to maximise people’s independence.

Staff had an excellent understanding of people’s individual needs and the care remained focussed on providing person-centred care that was achieving good outcomes for people. There was a strong emphasis on providing people with the best continuity of care possible which enabled staff to develop close bonds with people. Staff went out of their way to support people in a way that met their individual needs and preferences and helped them to overcome barriers, regain skills and confidence all of which had made a positive difference to their lives. The service worked collaboratively with health and social care professionals, trying innovative ways to support people with their healthcare needs. Staff supported people to continue to feel involved in their local community and to take part in activities that were meaningful to them. They understood the increased impact that isolation had had on people since the pandemic started and did all they could to compensate for this. Health care professionals told us that the service had developed a reputation for providing outstanding and responsive end of life care. The end of life care was holistic, and person centred, and staff were particularly skilled at providing end of life care with empathy and compassion.

Staff had confidence that the leadership team managed the service well and had provided a nurturing and supportive environment that helped to ensure they were able to perform their role effectively. Overall, there were high levels of satisfaction amongst the staff team, despite the challenges of the last 18 months. Staff mostly reported a positive culture that was enabling, supportive and helped to ensure that they felt valued. Overall, there continued to be effective quality assurance systems in place which helped to ensure that the registered manager and provider had an oversight of the quality of care people were receiving. The service made an active contribution to the local community and worked effectively with health and social care professionals to meet people’s needs.

Overall, people’s medicines were managed safely and the systems in place supported this. There were some areas which could be developed further in line with best practice standards. People told us they felt safe when receiving care. Staff had a positive attitude to reporting concerns. They were confident the registered manager would act upon these. Risks to people and to the care workers supporting them had been assessed and planned for. Overall, there were sufficient staff to provide people with a service that was reliable, provided good continuity and was safe. Staff followed safe infection prevention and control practices. Staff understood their responsibility to report and record safety related events. Opportunities to learn from safety related incidents were not always maximised.

Staff were positive about their induction and training, which was delivered around the needs of people using the service.

We have though made a recommendation about providing more in-depth mental health training for staff.

Supervisions and spot checks had fallen behind the frequency noted in the providers policy, however, overall, staff all felt well supported in their roles and felt able to seek advice or guidance from the leadership team when needed. There was a holistic approach to assessing, planning and delivering care and people described the care and support they received as being very effective at meeting their needs. Staff worked collaboratively to ensure that people’s healthcare needs were met. 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. Staff supported people to have access to food and drink of their choice.

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

Rating at last inspection

The last rating for this service was good (published 27 December 2019).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

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.