Alternative Means is domiciliary (home care) service providing personal care to people in Pulborough and surrounding areas. Some people had additional services offered by the provider including domestic, recreational and companionship help. This inspection took place on 9, 10 and 14 November 2017. 72 hours’ notice was given as the service is small and we needed to be sure the registered manager would be available when we visited the agency offices. This time also enabled the registered manager to arrange home visits. This allowed us to hear about people’s experiences of the service.

At the last inspection in June 2015, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

At the time of the inspection, the service was providing personal care to 20 people.

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. 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.

People and their relatives told us staff were caring and kind. Staff demonstrated kindness and compassion for people through their conversations and interactions. People’s privacy and dignity was promoted. People were actively involved in making choices and decisions about how they wanted to live their lives. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated.

People received care which was responsive to their needs. People and their relatives were encouraged to be part of the care planning process and to attend or contribute to care reviews where possible. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans were personalised and guided staff to help people in the way they liked.

Risks associated with people’s care and living environment were effectively managed to ensure their freedom was promoted. People were supported by consistent staff to help meet their needs. People’s independence was encouraged and staff helped people feel valued by engaging in everyday tasks where they were able for example peeling vegetables. The registered manager and provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken. People’s medicines were managed safely.

People received care from staff who had undertaken training to be able to meet their unique needs. People’s human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA). People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing.

Policies and procedures across the service ensured information was given to people in accessible formats when required. People were treated equally and fairly. Staff adapted their communication methods dependent upon people’s needs for example simple questions and information was given to people with cognitive difficulties and information about the service available in larger print for those people with visual impairments.

The service was well led by a registered manager and provider and supported by a small, dedicated team. There were quality assurance systems in place to help assess the ongoing quality of the service, and to help identify any areas which might require improvement. Complaints and incidents such as medicine errors were learned from to ensure improvement. The registered manager and provider promoted the ethos of honesty and admitted when things had gon

This inspection took place on 25 June 2015 and was announced.

Alternative Means is a domiciliary care service that provides support to people in West Sussex, including Pulborough, Storrington, Petworth, Bury, Amberley and Chichester. At the time of our visit the service was supporting 19 people with personal care.

The service had 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 agency prided itself on providing a tailored service to enable people ‘to maintain an excellent quality of life’. People spoke highly of the care they received. They told us that the service they received was friendly, reliable and flexible. One person said, “They take note of each individual”.

The culture of the service was open. People were able to raise any issues directly with the management and were assured of a quick response. Staff felt able to raise any concerns. One said, “If I have a problem, I just ring them up and they’re there ready to help us out. They’re pretty quick”.

People received a safe service. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. Risks to people’s safety were assessed and reviewed. The service had contingency plans in place to deal with emergencies such as a failure of equipment or severe weather. There were enough staff employed and the rotas were managed effectively. People received their medicines safely and at the right time.

People had confidence in the staff who supported them. Staff received training to enable them to deliver effective care. They were supported in their roles and professional development by a system of supervision. People were able to determine the care that they received and staff understood how consent should be considered in line with the Mental Capacity Act 2005. Staff supported people to prepare meals and to eat and drink if required. They ensured that people at risk of malnutrition received adequate nutrition and hydration. The service worked with community professionals to ensure that people’s health needs were met and that they had the necessary equipment to support them in their independence and to maintain their safety.

People were involved in planning their care and were supported to be as independent as they were able. The service had systems in place to allocate calls and to ensure consistency of staffing so that the staff visiting people understood their needs and knew how they liked to be supported. People spoke warmly of the staff and told us they had good relationships with them. They said that the staff were kind and helpful and that they treated them respectfully. One said, “I’m very happy with the care. It’s a lovely group of staff”. A relative said, “I couldn’t recommend them more highly”.

When there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support. People were asked to review their care and had an opportunity to raise any concerns or make suggestions. People, relatives and staff all confirmed that the management team listened to them and responded quickly. Complaints had been responded to appropriately.

The registered manager was new in post in January 2015. Improvements had been made to the content of people’s care plans, to medicines management and in bringing staff supervision up to date. The registered manager said, “We are trying to make things work a bit better, communication is such a massive thing”. Staff told us that communication had improved and that they felt valued. One said, “They are lovely to work for”. There was a system to monitor and review the quality of care delivered. Where improvements had been identified, prompt action had been taken.

We spoke with six people who use the service, or their relatives, and they all spoke highly of the quality of care received. One relative said that the “carers were fantastic” and particularly in an emergency “after mum had her fall, they went above and beyond”. Another relative said that “all the carers have their strengths and weaknesses” but overall “they are kind and caring”. One relative said “I cannot fault them, it is a great service and nothing is too much trouble for them”.

Two of the relatives we spoke with also said that sometimes the administration and management is a challenge and “little things” could be improved such as letting us know when a member of staff is delayed or somebody is unavailable at short notice. A relative said “we have to be realistic and we would not change to a different agency”

Some of the relatives we spoke with also said that they appreciated that the service was small and friendly and one said that it was good that “we can deal with one person who understands our needs”. A relative said that they had benefited from the flexibility and said “we can step up the level of care when we need to” and “we feel we have great support”. The agency was linked to the Anchorage residential care home as they shared the same provider.

We spoke with five people who used the agency and found that they were all very complimentary about the service that they were receiving. They said that care workers treated them with respect and that they felt safe with the care and support they received.

Everyone said that they had been given a copy of their care plan, and that they had regular contact with the Manager to review their care.

Everyone who we spoke with said that care workers arrived on time for visits and that their care workers stayed for the agreed length of their visit time.

Most of the people we spoke with told us that they received the same staff on a regular basis and that this had helped them to build up a relationship of trust with their care workers.

One person said, "They are absolutely marvellous, I cant talk highly enough about them".

Another person said, "The Manager is brilliant, always on the phone checking that everything is alright, and coming round every now again to check that I am happy with everything".