The inspection took place on 23, 24 and 26 January 2018 and was announced. This was our second inspection of the service. At our previous inspection in November 2015 we rated this service good overall. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. Not everyone using Heritage Healthcare - Trafford receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager, management team and office staff were all motivated and clearly passionate about making a difference to people's lives. This enthusiasm was also shared with care staff we spoke with, who recognised they were ambassadors for the company and acted accordingly.
The values of honesty, excellence, approachability, respectfulness and teamwork (H.E.A.R.T.) were at the centre of the company’s ethos and they strived to appoint and retain staff who were able to effectively demonstrate each of these values.
People and their relatives provided extremely positive feedback that demonstrated the service was exceptionally caring, in both approach and practice. Words used to describe staff included ‘wonderful’, ‘amazing’, ‘dedicated’, ‘passionate’ and ‘professional’.
People were empowered, being involved in making decisions about their lives. People's care and support was planned proactively in partnership with them. There was an emphasis on continuous improvement. The views of people using the service were at the core of quality monitoring and helped shape service delivery.
The service was committed at putting the person at the centre of everything they did. People received personalised care and support based on their assessed needs. People and others that mattered to them had been involved in identifying these needs and how these should be met.
The company went to great lengths in ensuring that people and carers were well matched, shared the same interests in life or had similar personality traits. People were given ‘a new lease of life’. Staff were passionate about the role they played in enhancing people’s social lives.
People using the service were introduced to meaningful activities and were given the opportunity to use technology, with assistance. People were given encouragement and support to reach their full potential and live life to the full, assisted by passionate staff responsive to their needs.
People consistently told us they were supported by staff members who had excellent caring skills and an in depth knowledge of their needs. People told us that staff were well trained, were competent in their work and attentive to their needs and that staff went over and above their duties to make sure they were well looked after. People felt safe and comfortable with the level of skill and expertise demonstrated by staff.
People's care was planned and delivered to maintain their health and well-being. The service was proactive in ensuring that any changes to support were communicated to them immediately so that people received care effective to their needs.
The service regarded people as an extended family and this was apparent in the little extras that the company provided. People appreciated the caring nature displayed by the company and its staff and we saw the positive impact this care had on people’s lives.
Staff showed empathy and had an enabling attitude that encouraged and motivated people to challenge themselves. Care workers were committed to putting people at the centre of the care they received and included people in the decision making process. Care workers showed genuine interest in people’s lives and knew people well, their preferred routines and other family members who were important to them.
Staff understood and had a good working knowledge of the key requirements of the Mental Capacity Act 2005. All staff demonstrated a commitment to promoting the rights and choices of people who used the service and ensured people's human and legal rights were respected. We saw that the provider always made best interest decisions in accordance with legislation and people's wishes.
Management had a genuinely open culture and viewed all safety concerns raised of value, and integral to learning and improvement. There were policies and procedures in place protecting people from the risk of service failure due to foreseeable emergencies so that their care could continue.
Management proactively engaged with people, their relatives or representatives and other professionals to assess and minimise risks. All risk assessments were reviewed throughout the delivery of the service to make sure they continued to be relevant and suitable to meet people's needs.
People were confident that staff had the knowledge to recognise and report any actual or suspected abuse and staff confirmed the action they would take to protect people if they had any suspicion of abuse. Staff were knowledgeable and confident as to when to raise concerns.
Staff had been trained to administer medicines to people safely and regular competency assessments ensured their continued ability to administer people's medicines safely.
Mechanisms were in place to ensure people received the right dose, at the right time and were kept safe from harm.
There were sufficient numbers of staff to cover all visits and meet people's needs. People consistently told us they were supported by the same staff who arrived on time and stayed for the whole duration of the visit.
The recruitment process aims to attract and maintain a workforce that is committed and caring, with a positive attitude, reflecting the same values of the organisation. There were extremely robust staff recruitment practices in place and staff employed were suitable to work with people in their own homes.
The induction process was detailed and thorough. The induction pack contained practical examples and in depth information that new carers could take away and keep for future reference. Staff valued the amount and type of training on offer. The service listened to staff and was proactive in sourcing training to meet people’s needs.
There was a proactive support and appraisal system for staff, which recognised that continuous development of skills, competence and knowledge is integral to ensuring high quality care and support. Staff were supported through individual supervision.
Observational checks of staff performance were carried out in people's homes with their consent in the form of spot checks. People thought it was good to see that the staff had regular checks, as this gave them confidence that staff were doing things properly. Staff had the support needed to enable them to develop into their role with the skills and confidence required to support people well.
We were satisfied through the analysis of records and observations of staff that the service sought to deliver care and support in a way that was non-discriminatory and respected personal preferences. People were assured their sensitive information was treated confidentially, carefully and in line with the Data Protection Act.
People knew how to complain and who to complain to, although the service had received no complaints at the time of our inspection. People and their relatives told us that they felt confident they would be listened to if they made a complaint. There had been many compliments received from people and their relatives about the care provided by staff, and for the small gestures afforded by the company.
Systems in place for monitoring the quality of service provision such as monitoring visits and management checks were thorough and robust. Where issues had been identified these were quickly addressed by management. People were encouraged to provide feedback. The company regarded all feedback as positive feedback as it meant that lessons were learned and practice could be improved as a result.
The use of technology was being further explored. Management had also looked at innovative ways of maintaining communication with and for staff who worked in the community, to make sure they were informed of changes and could share views and information with each other.
The company valued their staff and communicated with all staff to provide updates and celebrate team accomplishments. Staff highly regarded the communication and feedback from management and felt valued and appreciated by the company.
The company had fostered good links with the local community and the managing director had an active role on the board of Trafford Carers Centre. Where corporate policies and documents lacked detail the company could evidence action they had taken to strengthen these areas.
The company’s five year Strategic Development Plan highlighted the sustainable growth that had been achieved since registration in 2015 and that planned to 2021. There were six master objectives that the company set out to achieve and we could see from our inspection that a number of these were in progress or nearly met.
There was a consistent team work approach from all employees, from members of the management team to those providing care and support. This ultimately benefitted people using the service and had a positive impact on the lives of those receiving care and support delivered by Heritage Healthcare.