Here2care (Dartford) provides personal care and support to people in their own homes in Dartford, Gravesend and surrounding areas. At the time of the inspection the service was providing care for around 200 people. This included older people, people living with dementia and people with a learning or physical disability.

At the last inspection on 12 and 13 March 2015, the service was rated Good.

At this inspection on 10th May 2017, the service remained Good.

The service was run by a registered manager who was present on the day of our visit. 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 trusted staff and therefore felt safe whilst being supported by them. Staff continued to receive training in how to safeguard people. They knew what signs to look out for which would cause concern and how to report them so the appropriate action could be taken to help keep them safe.

Comprehensive employment checks were carried out on all potential staff at the service, to ensure that they were suitable for their role. There was on-going recruitment to ensure staff were available in sufficient numbers.

Assessments of potential risks had been undertaken in relation to the environment that people lived and worked in and in relation to people’s personal care needs. This included potential risks involved in moving and handling people, supporting people with their personal care needs and with managing medicines. Guidance was in place for staff to follow to make sure that any risks were minimised.

A medicines policy was in place to guide staff. Staff received training in the administration and storage of medicines and a system was in place to regularly check they had the knowledge and competence to manage people’s medicines safely.

New staff received an induction which ensured that they had the skills they required, before they started to support people in their own homes. Staff continued to undertake face to face training in essential areas, their practice was observed and they shadowed senior staff to ensure they were competent. People said that staff had the skills and knowledge they needed to support them.

People said staff asked for their consent before supporting them with their care. Staff had undertaken training in The Mental Capacity Act (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.

People’s health care and nutrition needs had been assessed and clear guidance was in place for staff to follow, to ensure that their specific health care needs were met. Staff continued to liaise with health professionals when appropriate.

Staff were consistently kind and patient and treated people with dignity and respect. Staff had developed relationships with people and involved them in decisions about their care and support.

People’s care, treatment and support needs were assessed and a plan of care was developed jointly with the person, which included their likes and dislikes. Individual guidance was in place for staff to follow to meet people’s needs.

People were informed of their right to raise any concerns about the service and action was taken to investigate and endeavour to resolve them to people’s satisfaction.

There continued to be robust systems in place to assess and monitor the quality of the service, which included asking people about their experiences. The registered manager had sustained an open and positive culture and staff knew how to put the aims and values of the

Overall summary Here2Care (Dartford) provides care and support to adults in their own homes. It provides personal care to mainly older people and some younger adults.

When we visited 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 and shares the legal responsibility for meeting the requirements of the law with the provider.

The service had systems in place to keep people safe. However we saw that although some risks associated with people’s care and support had been identified during assessments, there was not sufficient guidance in place for staff, to help make sure these risks were managed safely and consistently.

People told us they received their medicines safely and when they should. However there were shortfalls in the management of medicines.

People had been involved in developing their care plan. However although care plans showed the tasks staff were required to undertake, they lacked information about people’s choice, preferences and independence skills in relation to their personal care routine, to help ensure people received a consistent and safe approach to their care and support. Some people received care and support from a very small number of regular care workers, others did not. Some people told us when they did not know the care worker this could make them feel uncomfortable particularly during personal care.

People we spoke with told us they were able to make their own day to day decisions about their care and

We looked at ten care plans and found that these contained information staff would need to know to be able to support a person’s needs.

We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us, “My carer is excellent, they listen to me”, the support and care I receive means I can stay in my own home” and “my care workers have a good understanding of my disability, I have always felt valued & safe”.

We saw that care plans were person centred and detailed support needs. We spoke to eight members of staff who confirmed that there was a care plan for each person they visited. These staff also confirmed that a brief overview of the support required was given on each person’s rota.

Other people who used the service told us “I am a very nervous person due to having had several falls in the past and I can only walk with a frame but the carers are understanding and helpful, patient in giving me time to move around.” Others said “Here2Care were very good in the hot weather, with regular phone calls to ensure my mum was drinking and was well” and “The care workers treat my wife with respect and always make her laugh and talk to her as soon as they walk in, the care agency staff are always so polite if they phone me, or if they visit."

We found that there were effective recruitment and selection processes in place. The provider kept satisfactory documentation for all staff to evidence relevant qualifications and a full employment history with satisfactory written explanation of any gaps in employment.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

People’s needs were assessed and they were consulted and involved in the planning of their care plans and service delivery.

People told us that they were very happy with the care and support that they or their relatives received, staff were reliable, supportive and flexible. People who used the service were treated with respect and dignity. One person said "The carers are excellent, very caring and professional."

Another person said “I am very happy with the carers and I am very involved in the care planning process on behalf of my relative who receives the service."

We observed telephone conversations within the office where staff answered the phone promptly and spoke to the caller in a polite and courteous way. One carer told us that the staff in the office were very approachable, polite and helpful.

We spoke to a relative of a person who uses the service and they told us that they had been made aware of the complaints policy and how to make a complaint. They stated that they have raised concerns in the past and they were always dealt with swiftly and to their satisfaction.

Staff we spoke to told us that they received regular supervision and that the senior team are available for advice and support. One person said "The senior staff are approachable and very supportive. We saw that staff received regular training appropriate to the needs of the people they support.

At the time of our inspection the service was providing care and support to approximately 280 people. We arranged to speak with people who used the service and their relatives over the telephone. They told us that they were happy with the care and support that was provided by the service. Comments included “The care is fantastic” and “I don’t know what I would do without the service, they have made a real difference and help stop my family worrying.” People told us that they were visited by regular care staff who understood their needs. They told us that staff were “Superb” “Caring” and “Wonderful”. The people we spoke with told us staff were mostly on time and always stayed for the agreed amount of time. Some people we spoke with told us that they did not always have regular care staff at the weekend and that they would prefer the allocation of staff at the weekend to be more consistent. We saw that the service was working to try and resolve this. We found that relatives and people who used the service had been kept involved in their care. One relative told us “They undertook a full assessment at the beginning to understand what we needed. They have worked with us to make sure we are happy.”

People told us that they were involved in decisions about their care and support. They were visited every three months by someone from the agency. In these meetings they had the opportunity to discuss their level of satisfaction with the care that they or their relative received.

People told us that their privacy and dignity were respected at all times. Comments about the care staff included, "she is very thoughtful"; "they do not rush"; "they are very respectful".

People told us that care staff stayed for the correct length of time. They checked their plan of care and carried out all the tasks that were recorded in it. Comments included, "The staff do everything that is necessary"; "They take great care of x"; and "Nothing is too much trouble".

People told us that care staff understood their individual needs or those of their relative. Comments included;

"X gets agitated….they calm x down…They know x well and are used to each other. Communication is difficult, but they seem to know what x wants".

"They (care staff) get x to laugh which is a big thing".

"She (care staff) rings me if there are any problems with x, which is very reassuring".

"She (care staff) makes a difference".

Some people told us that care staff supported them or their relative to take medicines. They told us that care staff made sure that they received their medicines as it was intended by their GP.

People told us that if they had a concern they would ring the office. They said that if they called outside of office hours, that someone got back to them.

People said that they felt in safe hands when they or their relative used this agency. They said that they would recommend the agency to other people.

The inspection was announced and was carried out on 12 and 13 March 2015 by two inspectors and supported by two experts by experience.

Here2Care (Dartford) is a domiciliary care agency providing personal care to people in their own homes in and around Rochester Kent. The service provides support for people in their own homes in the Dartford and Gravesham areas. The people using the service are older people, people living with dementia, physical and learning disabilities or mental health difficulties.

At the last inspection on 06 May 2014, we asked the provider to take action to make improvements to people’s care plans; the management and recording of the administration of medicines; and the monitoring system to assess the quality of service people received. We received an action plan stating that all remedial action would be completed by 07 November 2014. During this inspection we found that this action had been completed.

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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of re-occurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs. The manager followed safe recruitment practices.

Staff were trained in the safe administration of medicines. Records relevant to the administration of medicines were monitored to ensure they were accurately kept and medicines were administered safely to people according to their needs.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before care was provided and were continually reviewed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

Staff had completed the training they needed to care for people in a safe way. They had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal.

All care staff and management were trained in the principles of the Mental Capacity Act 2005 (MCA) and were knowledgeable about the requirements of the legislation. People’s mental capacity was assessed and meetings were held in their best interest when appropriate.

Staff sought and obtained people’s consent before they provided care. When people declined, their wishes were respected and staff reported this to the manager so that people’s refusals were recorded and monitored.

Staff provided meals when this was part of the support needed and ensured meals were well balanced to promote people’s health. Staff knew about and provided for people’s dietary preferences and restrictions.

People told us that staff communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. People were satisfied with how their care and treatment was delivered.

Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs when they had visual impairment.

People’s privacy was respected and people were assisted with their personal care needs in a way that respected their dignity.

People were referred to health care professionals when needed and in a timely way. Personal records included people’s individual plans of care, likes and dislikes and preferred activities. They encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed regularly with their participation or their representatives’ involvement. People’s care plans were updated when their needs changed to make sure they received the care and support they needed. A person told us, “A care advisor comes out and goes through the care plan with us, it is very detailed and I am very happy with this. She makes any changes that are necessary”.

The provider took account of people’s complaints, comments and suggestions. People’s views were sought and acted upon. The provider sent questionnaires regularly to people, their legal representatives and stakeholders. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued and supported under the manager’s leadership. There was honesty and transparency from staff and management when mistakes occurred. The manager notified the Care Quality Commission of any significant events that affected people or the service. Comprehensive quality assurance audits were carried out to identify how the service could improve and the manager had an action plan for making the improvements.