About the service: Amphion Home Care Services Limited is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older people and those living with dementia, physical disability or a sensory impairment. At the time of the inspection, they were providing a regulated activity of personal care and support to 159 people.

People’s experience of using this service:

When talking about the service, one person told us, “It’s fantastic. All staff are very good. I haven’t got a bad word to say about them.”

People were protected from avoidable harm and abuse by staff who could identify and report safeguarding concerns. People’s medicines were administered as prescribed and this was closely monitored. Risks were identified and minimised through appropriate strategies whilst respecting people’s freedom. People were supported by appropriate numbers of consistent staff who knew them well. The provider had completed appropriate pre-employment checks, though their records did not always evidence this and their recording process was to be reviewed.

Staff understood people’s needs and provided support in line with people’s preferences. Staff had completed relevant training, received regular supervision and annual appraisals and people were confident in staff skills and knowledge. People’s dietary needs were met and they were supported to access health services in a timely manner.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had received training in mental capacity legislation and understood their responsibilities. They knew how to gain consent before delivering care tasks and ensured people could make their own decisions and choices.

Staff maintained people’s privacy and dignity whilst maintaining their independence. People and their relatives were consistently positive about staff and the quality of the service. Staff respected people as individuals and understood people’s religious beliefs and cultural identity.

Care plans contained personalised information that supported to staff to provide person-centred care. Staff were considerate when providing end of life care and supported people to have pain-free, dignified deaths with the support of relevant healthcare professionals.

People knew how to raise a complaint and were confident their concerns would be addressed. Complaints were addressed in line with the provider’s policy and procedure. Where complaints had been received, information had been used to improve the quality of the service.

The management team were a positive influence on staff and had an open and honest approach which was promoted throughout the service. Improving care was a priority of the registered managers and systems and processes were in place effectively monitor quality. People, their relatives and staff were included in the development of the service.

Rating at last inspection: At the last inspection the service was rated Good (published 14 June 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

Amphion Home Care Services Limited is a domiciliary care agency that is based in Scunthorpe. The service is registered to provide personal care to people who live in their own homes within the local authority area of North Lincolnshire.

This inspection took place on 8 and 11 April 2016 and was announced. This was to enable us to meet the people using the service and to ensure staff would be available to speak with.

The service was last inspected on 21 and 22 May 2014, when it was found to be compliant with the regulations inspected.

There was a registered manager in place for the service. 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 who used the service were protected from harm by staff who had been trained to ensure they knew how to recognise and report potential abuse and who had been safely recruited to ensure they were safe to work with vulnerable people. Assessments about potential risks to people had been completed to ensure staff knew how to keep people safe. Training had been delivered to staff to ensure they knew how to administer medicines safely. People told us they received a service from staff who were consistent and reliable and did not rush.

Staff had been provided with a range of training to enable them to effectively perform their roles. People told us that staff treated them with courtesy and kindness and communicated with them to ensure they were involved and consented to decisions about their support. People’s support plans contained evidence of assistance provided to ensure their health and wellbeing was maintained. People told us they had developed positive relationships with staff who respected their wishes for privacy and supported them to be as independent as possible.

People told us they were happy with the service they received and were confident that any concerns they might have would be appropriately addressed and resolved where this was possible.

The service consulted and actively engaged with people who used the service to ensure their views could help it learn and improve. Systems were in place to ensure the quality of the service was monitored. Staff told us there was a management culture that was open, approachable and positive and which listened to people’s views in order to help the service develop.

We visited the homes of five people who used the service and spoke to them and a relative who was visiting one of them at the time of our visit. We also contacted nine other people by telephone to ask them about their experience of using the agency.

We found that staff listened to people and involved them in decisions about their support. People told us that care staff treated them with consideration to ensure their dignity was maintained and their personal preferences were respected. People said that communication with the office was “Good.”

People told us that care staff were reliable and consistent. One person told us they had “A good routine” and that care staff were responsive to requests, they told us “I only have to ask.”

People told us they felt “Comfortable” with their carer and that they were “Lovely” and “Do everything I need.”

People who used the service told us their carers “Do not rush” whilst other’s said they trusted the service and felt “Reassured and safe” with staff.

We found that staff were supported by an internal training and development department to ensure they had the skills needed to do their work.

People told us that they were confident the provider would take appropriate action to address any issues that were raised. They told us they were “Quite satisfied” with the service and that it was “Very, very good.” Others told us the service was “Marvellous” and that they “Couldn’t do better.”

As part of our inspection we asked people who used the service about their experiences of the service provided by Amphion Home Care Services Limited.

We spoke with a relative who was visiting the office on the day of our visit. We also contacted five people who used the service and two of their relatives via the telephone the day following our site visit.

People told us they were “very happy” with the service provided. People told us staff listened and involved them in making decisions about their support. People told us that care plans were available to help staff support them effectively. People told us that staff respected their individual preferences and wishes about how support was delivered. We were told that staff were punctual and reliable and that this was generally provided by a consistent and regular set of carers. People told us that communication with the office and staff was good. People told us they felt safe using the service.

People confirmed reviews of their support were carried out and that they were “very satisfied” with the service and were aware of the complaints procedure and how to use it, if it was needed.

People told us:

“I really look forward to them coming”

“I have four lovely carers”

“I am very grateful, things work very well”

“I have not had any problems”

People who used the service stated they were very happy with the care they received. Comments included ‘they have never let me down the girls are lovely, they are like family’, 'they are polite and kind’ and ‘the carers are very good’.

They confirmed that the staff arrived on time and they knew who was coming to care for them. They said they have the same care staff and these are only changed during holidays or for sickness. They told us that they feel safe with the care workers who visit them.

They confirmed that they have a care plan and that staff write in this every time they have visited. They said that someone from the office visits them regularly to ensure they are happy with the care they receive and to check the records.

We visited the office of the domiciliary care agency and homes of four people who used the service during this inspection. We subsequently phoned four other people who received personal care from the agency to ask about their experience of using the service and spoke to staff who supported them.

The inspection 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.

Is the service safe?:-

People told us they felt safe and trusted the staff. One person said they, “Feel safe and reassured by service” and that staff, “Don’t take advantage in any shape or form.” Safeguarding procedures were robust and staff understood how to safeguard people they supported.

We saw evidence in people’s records that consent to their support was discussed and explored with them at the commencement of their use of the service. We saw people or their relatives had signed to confirm their agreement with the way this was provided. This helped ensure their rights and dignity was respected.

Systems were in place to ensure managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Staff knew about risk management plans and we were able see examples of how these were followed. People were not put at unnecessary risk and were included in decisions about their support and remained in control of their care and their lives.

Recruitment practice included checks to ensure new staff were safe to work with people who used the service. Policies and procedures were in place to make sure unsafe practice was identified and people were protected.

Is the service effective? :-

People told us they were involved the development of their plans of support and were consulted about their assessment of their health and care needs.

People told us their care plans were reviewed to reflect their needs. One relative told us that support had been recently increased following a change in their needs.

Is the service caring?:-

We spoke with eight people or their relatives who were supported by the service. We asked them for their opinions about staff who supported them. Feedback from people was overall very positive about staff. For example; one person said care staff were, “Reliable” and “Friendly” whilst another said staff were, “Absolutely marvellous” and that they were, “Very satisfied” and “Happy with the service.”

They told us that office staff contacted them about possible changes in their routines of support and that care staff had, “Never missed a call.” We observed office staff arranging alternative cover for a call they were notified about at short notice. We saw this was managed calmly and professionally and were subsequently told this matter was satisfactorily addressed before the end of the shift.

When speaking with staff it was clear they cared for the people they supported. People and their relatives indicated they were regularly consulted about their views concerning the way the service was provided. They told us that where shortfalls or concerns were raised, these were taken on board and dealt with appropriately.

We saw evidence that people’s preferences, interests, aspirations and individual needs were recorded and that care and support was provided in accordance with their wishes and feelings.

Is the service responsive?:-

People told us they knew how to contact the office and raise a complaint if needed. People told us they were confident appropriate action would be taken by the provider to address any concerns they might have. This helped ensure that complaints would be listened to and followed up where required

Is the service well-led?:-

The service has a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.