The inspection took place on the 19 October 2016 and was announced. The provider was given 48 hour’s notice because the location provides a domiciliary care service. We wanted to be sure that someone would be in to speak with us.Ascot Care is a domiciliary care service which provides personal care and support services for a range of people living in their own homes. These included older people and people living with dementia. At the time of our inspection 46 people were receiving a care service, with an age range between 36 to 99 years old.
The service had two registered managers. 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 was last inspected on 28 October 2015. We found areas of practice which required improvement. This was in relation to concerns around care staff had not received training on the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). There was not a robust quality assurance framework in place. The provider was unable to demonstrate how they internally monitored, reviewed and assessed the quality of the agency. The provider drew up an action plan as to how they would address these issues. We looked at the improvements made as part of this inspection. At this inspection we found the provider had followed their action plan, improvements had been made and issues identified had been rectified.
People told us they felt safe, that staff were kind and the care they received was good. One person told us “Absolutely feel safe. From the beginning they are really good. I consider (staff names) to be someone I can thoroughly trust. They both are”.
There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The registered manager made sure there was enough staff at all times to meet people’s needs.
The provider had arrangements in place for the safe administration of medicines. People were supported to receive their medicine when they needed it. People were supported to maintain good health and had assistance to access health care services when needed. One person told us “If I need to go to the dentist or the optician they will take me”.
Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded.
Staff felt fully supported by the registered managers to undertake their roles. They were given training updates, supervision and development opportunities. One member of staff told us “We have regular training and updates. One of the managers holds training sessions in our team meetings. We recently went over medication again”.
People’s needs were assessed and regularly reviewed and they received care based upon their needs and preferences. Staff were proactive in recognising and supporting changes in people’s needs. We found the care plans to be person centred and details recorded were consistent.
People and relatives told us that staff were kind and caring. Comments included “They are intelligent, nice caring people and very conscientious” and “I’m absolutely delighted with them, they really are first class”. People confirmed staff respected their privacy and dignity. Staff had an understanding of respecting people within their own home and providing them with choice and control. People were supported at mealtimes to access food and drink of their choice if required.
People and relatives said they were happy with the management of the service. People’s comments included “It’s excellently managed” and “Always seems well managed to me”.
There were clear lines of accountability. The service had good leadership and direction from the registered managers. Staff comments included “It is very well managed, I get nice compliments from my manager which is nice” and “Best employer I have ever worked for and they think about the staff’s welfare”.
Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.
The registered managers monitored the quality of the service by the use of regular checks and internal quality audits to drive improvements. Feedback was sought through surveys which were sent to people and their relatives. Survey results were positive and any issues identified acted upon. People and relatives we spoke with were aware of how to make a complaint and felt they would have no problem raising any issues.