About the service:

Home Instead Senior Care is a domiciliary care agency. It provides personal care for people living in their own homes in and around the Bristol area. At the time of our inspection 60 older people were receiving a personal care service.

What life is like for people using this service:

On the day of inspection, we identified that staff were not always safely recruited. Sufficient checks were not always completed before staff started in post. However, actions were taken to address the shortfalls, before the end of the inspection process.

People received personal care from staff who were trained and sufficiently supported in their roles.

People told us they were cared for by ‘lovely’ staff who were punctual and spent sufficient time with them to make sure personal care needs were met. Improvements had been made and when people required support to take medicines, records were accurately maintained.

Quality assurance systems were in place, and improvements had been made to the auditing and monitoring of medicines.

The service met the characteristics of Good in the safe key question and remained Requires Improvement in the well-led key question. Therefore, our overall rating for the service after this inspection has improved to Good.

More information is in detailed findings below.

Rating at last inspection:

Requires Improvement (report published in October 2018).

Why we inspected:

The focused inspection was undertaken because we had received concerns that staff were not safely recruited, insufficient checks were carried out before staff started in post and staff were not being sufficiently trained when they were new in post.

Follow up:

We will continue to monitor information received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

We undertook an inspection of Home Instead Senior Care on the 1, 2 and 8 August 2018. An Expert by experience made phone calls to people and relatives on the 31 July 2018.

The inspection was announced, which meant that the provider and registered manager knew we would be visiting. This was to ensure the registered manager or someone who could act on their behalf, would be available to support the inspection.

The service registered to provide a regulated activity with the Care Quality Commission in October 2017. This was the service’s first inspection since registering and had not been previously rated.

Home Instead Senior Care is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older people. Not everyone using Home Instead Senior Care receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; for example help with tasks related to personal hygiene and eating. At the time of our inspection there were 60 people receiving personal care and support from the service.

A registered manager was in post at the time of our inspection. 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 not consistently safe as medicines records were not always sufficiently detailed and cream charts were not in place. Audits were not fully effective in monitoring and improving the quality of the service provided. For example, shortfalls relating to medicines records had not been identified within the provider’s audits.

People and their relatives felt improvements could be made to the timing of their visits as some people had to wait over an hour some days for their visit. During the inspection one person’s loved one told us how they had experienced the caregiver being late and had to provide personal care and support due to the caregiver not turning up on time. We raised this concern with the Local authority safeguarding team due to the nature of the concern.

People were supported by caregivers who had checks in place to ensure they were suitable to work with vulnerable adults.

People were supported by caregivers who had received training to ensure they were competent in their role. People were not always supported by caregivers who had a good understanding of equality and diversity.

People felt safe and were supported by caregivers who were able to identify abuse and knew who to go to should they have concerns. People’s care plans had environmental risk assessments in place however not all people who required support with their mobility had a risk assessment that confirmed what equipment they required and how caregivers were to support them with this.

Caregivers had an ID badge, and there was an out of hours number for people and caregivers to ring should they require support or assistance after the office had closed.

People’s care plans had important information relating to their likes and dislikes, if they had capacity and their personal situation. Where people lacked capacity, there was a mental capacity assessment and best interest decision in place for most people, however one person required this to be undertaken.

People were supported by caregivers who had received an induction and regular supervision. People were supported by caregivers with their nutrition and hydration.

People felt supported by caregivers who were kind and caring and who demonstrated a positive relationship with the people they visited.

People were happy with their care and felt they had choice and control in the support they received.

People felt able to complain, although they felt improvements could be made to the communication