Home Instead East Lancashire is a domiciliary care service. This service provided care and support to people so that they could live in their own home as independently as possible. There was 19 people using the service on the day of our inspection.

This inspection took place on the 05 November 2018 and was announced.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People who used the service told us they felt safe. Staff had undertaken training in safeguarding and knew their responsibilities to report any concerns. Safeguarding and whistleblowing [reporting poor practice] policies and procedures were in place and accessible to staff.

Risks to people’s health and wellbeing had been assessed and risk assessments put in place to keep them safe. These were reviewed to ensure they remained current.

The service had a recruitment policy and procedure in place. Robust recruitment processes were followed by the registered manager.

Not everyone required support with their medicines. However, we found for those people who did require support, their medicines were managed safely by the service. Only staff who had undertaken medicines training were able to support people with their medicines.

The service had an infection control policy and procedure in place. Staff had received training and understood their responsibilities.

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. The registered manager had a good understanding of the Mental Capacity Act and associated applications before the Court of Protection.

Staff we spoke with told us and records we looked at confirmed that staff received an induction when they commenced employment. We saw staff had access to training courses which met the needs of people using the service.

We did not have the opportunity to observe staff interactions, however, the staff we spoke with spoke about their role and the people they were supporting with compassion, respect and sensitivity.

Staff we spoke with were aware of the need to ensure people’s privacy and dignity was respected at all times. Those staff we spoke with were able to give us examples of how they promoted people’s privacy and dignity.

We saw people had person centred support plans in place which they had been involved in. These were in-depth and covered many aspects of the person’s life. People had signed to confirm they were involved in this process.

We have made a recommendation that the service considers current best practice around end of life, such as enhanced training and care planning.

All the staff we spoke with were very complimentary about the registered manager and office staff. They spoke of feeling well supported in their roles and their being an ‘open door’ culture within the service.

There were monitoring systems that ensured that responsibilities were clear and that quality performance, risks and regulatory requirements were understood and managed. People who used the service, staff and others were consulted on their experiences and shaping future developments.

The service was meeting all relevant fundamental standards.

Further information is in the detailed findings below.

We spoke with three people who used the service (two with a family member present), the registered manager and the provider during this inspection. We also looked at records and quality assurance systems. This helped answer our five 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 who used the service or their relatives said "The staff are trustworthy. We feel safe and they leave the property secure", "As far as I am concerned they are trustworthy and reliable. You can get hold of them in an emergency" and "They are reliable. I get the same staff more or less so I know who is coming. I have no doubt to judge their honesty". People felt secure with the staff who looked after them.

People who used the service or their relatives said, "I am aware I can talk to the owner about any issues and I am sure he would listen", "If I had any concerns they would listen to me. We don't have any complaints" and "I could contact the office and do if I need to but it's not to make a complaint. I don't have any". Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations.

Staff files showed staff were robustly recruited to work with vulnerable adults in their own homes.

Is the service effective?

Staff files showed that staff had been trained in mandatory topics such as health and safety, first aid, food hygiene, fire awareness, safeguarding, moving and handling, infection control and the administration of medication. Further training was available such as dementia and diabetes care, end of life care and a nationally recognised qualification in health and care such as a diploma or NVQ. Staff were sufficiently trained to deliver effective care.

People who used the service told us, "The owner came a few times before we used the service. He explained what they provided. They gave us enough information before we used the service so we knew what we were getting", "They gave us a lot of information before we used the service" and "I had all the information I needed before I used the service. It's in my folder". People were given sufficient information to make a choice to use this agency.

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs. People we spoke with were very satisfied with the care they received.

People who used the service lived in their own homes but were encouraged to become independent if their condition allowed it.

Systems were in place to make sure that managers and staff learn 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.

Is the service caring?

People who used the service or their families told us, "The care staff and service is very good. They sit and talk to him. The owner is excellent and will come himself if he needs to", "The care staff look after me very well. They take me shopping. They are very good and look after me" and "The staff are all lovely". People were supported by kind and attentive staff.

People who used the service, their family, friends and other professionals were asked about their views of the agency. One person told us, "Sometimes they come to talk to me to see how I am doing and if my care is OK". This included an annual survey which we looked at and saw the positive results. Part of the survey asked all concerned what they thought the service could do to improve. The provider used the comments and surveys to improve the service.

Is the service responsive?

People who used the service had a wide range of interests and hobbies. People completed a range of activities in and outside the service regularly. This included going out shopping, visits to places of interest and life skills in the home.

The service conducted audits with people who used the service on a regular basis to ensure they received the care they needed. Staff were 'spot checked' to ensure they arrived at the right time and documentation, for example, the care plan was audited by managers to make sure the care and plan was accurate.

Is the service well-led?

We saw that the service worked well with other agencies and organisations. Some specialist organisations provided possible 'clients' because of the way the agency looked after people.

The service had quality assurance systems in place and records showed that people who used the service and other organisations were happy with the service provided. All the people we spoke with were very satisfied they could talk to management and were aware it was a twenty four hour a day service. Staff felt supported. As a result the quality of the service was continually improving.

Staff had access to a handbook and the skills for health and social care codes of conduct. This gave staff the information to know what was expected of them.

With the permission of one client we visited them at home to discuss the care they received from the provider.

Care givers we spoke with discussed appropriate procedures to take if clients refused to give consent for any activity. One person said, “If they refuse I won’t force them but explain to them and make sure they understand. I would call the office and record it”.

Care givers demonstrated knowledge of the signs and symptoms of abuse and what actions they would take if they suspected abuse had taken place. One care giver told us, “I would report it, record it and fill out a body map”.

Clients we spoke with were happy with the care they received. Some comments received were, “Carers (care givers) are very good; they are thoughtful and respectful and do exactly what is required. I have never had carers before but would hope they would all be like this”.

The two staff we spoke with confirmed they had received regular supervision and spot checks when delivering care. One care giver told us, “I am very well supported”.

We spoke with two clients who gave us positive feedback. One person told us, “X is very good. She helped me out at the right at the beginning when I was in a desperate situation”.

We received positive comments from clients. Some of these included, “In my opinion this is by far the best care agency I have ever experienced. I had carers for my X and a few for myself and by comparison Home Instead has demonstrated the best care all round”.

Home Instead East Lancashire Limited is a Domiciliary Care Agency. The offices are based in Blackburn Lancashire. People who use the service like to be referred to as clients, staff like to be referred to as care givers.

The service were last inspected on 17 September when they met all the regulations we inspected.

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.

Staff were aware of and had been trained in safeguarding procedures to help protect the health and welfare of people who used the service. All the people who used the service said they felt safe.

Risk assessments for health needs or environmental hazards helped protect the health and welfare of people who used the service but did not restrict their lifestyles.

Plans of care were individual to each person, showed staff had taken account of their wishes and were regularly reviewed. People signed their consent to care and treatment daily to say staff had followed the plan and the records they had written were accurate.

Although people who used the service lived in their own houses and chose what they ate staff were trained in nutrition and safe food handling to give advice to people about their meals. Where necessary staff supported people to eat and drink. Some people also received support to do their shopping.

The agency asked for people’s views around how the service was performing and we saw evidence that the registered manager responded to their views.

There was a suitable complaints procedure for people to voice their concerns. The people we spoke with said they did not have any concerns but knew how to contact the office if they did. People were also given information about how to contact other services such as age concern or the advocacy service to get further support.

We observed a good rapport between people who used the service and staff. We saw that staff appeared to know people well and understand their needs.

Staff were recruited using current guidelines to help minimise the risk of abuse to people who used the service.

Staff were trained in medicines administration and supported people to take their medicines if it was a part of their care package.

Staff received an induction and were supported when they commenced work to become competent to work with vulnerable people. Staff were well trained and supervised to feel confident within their roles. Staff were encouraged to take further training in health and social care topics.

Management conducted audits to ensure the service was performing well or devised an action plan for any area they found lacking.

The office was suitable for providing a domiciliary care service and was staffed during office hours and out of hours for people to contact.

People who used the service thought mangers were accessible and available to talk to.