We carried out an announced inspection of Home Instead Senior Care Wirral on 26 April and 02 May 2016. Home Instead Senior Care Wirral provides care and support to people living in their own homes on the Wirral. Home Instead Senior Care is part of a franchise that delivers care to people in many areas of the United Kingdom. The service offered includes personal care such as assistance with bathing, dressing, eating and medicines. At the time of our visit, the service was providing support for regulated activities for 81 people.

The service had a registered manager who had been in post since 2007. 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.

Home Instead Senior Care Wirral refer to all care staff employed by the service as CAREGivers, this is a trademarked term and used throughout the providers services. People spoke highly of the quality of care provided by the CAREGivers. Nobody expressed any concerns about any of the care provided. People received their medicines on time and in a safe way.

The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults. All CAREGivers said they were confident enough to be able to whistle blow within the organisation due to the open culture promoted by the service.

The care records we looked at contained good information about the support people required and recognised people’s needs. All records we saw were complete, up to date and regularly audited. We found that people were involved in decisions about their care and support.

We found that good recruitment practices were in place which included the completion of pre-employment checks prior to a new member of staff working at the service. CAREGivers received a comprehensive induction programme and had regular training to enable them to work safely and effectively.

Staff were supported and had opportunities for development. All staff said they were fully supported and valued by the management and office based team. They spoke positively about communication and how the management team worked well with them, encouraged team working and an open culture. There was a programme of training and one to one supervision that enabled staff to keep their skills up to date in order to support people appropriately.

The provider had developed four different initiatives, these included delivering dementia workshops in the local community for family and friends of people with dementia and had developed a one day end of life training session for all health and social care workers across the Wirral. This was to ensure that those living with dementia were able to live their life to their fullest potential whilst being supported in their own homes. They had also worked closely with a Teaching Hospital and a hospice and were in the process of developing a fraud awareness initiative.

The providers demonstrated an excellent understanding of the importance of effective quality assurance systems. There were procedures in place to monitor quality and understand the experiences of people who used the service.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report.

This is a summary of what we found:

Is the service safe?

We looked at ten staff recruitment files for support workers. There were effective recruitment and selection processes in place. We responded to information a person had made to the Care Quality Commission that “Staff are not trained and don’t know what they are doing.” Eight of the nine people who were supported by the agency with whom we spoke, told us “Staff are knowledgeable.” During our inspection we saw the way staff were recruited and trained was safe.

All nine people told us they felt safe in their own homes with staff caring for them.

Due to insufficient information in people’s risk assessments the provider could not be certain that they were protecting people from harm. The lack of detail meant staff were inadequately informed of people’s needs and how to maintain their safety whilst providing care. Although the provider informed us they had not had any accidents as a result and were obliging to review all risk assessments.

Is the service effective?

All people who were supported by the agency told us that staff help them maintain their independence. One person told us “If it wasn’t for the agency helping me remain independent I would have to live in a nursing home.” We saw the way in which people were cared for was effective in keeping them living independently at home.

We saw and heard complaints made about the consistency of the staff from comments made by people and in the service reviews and when we asked people during the inspection. The provider may wish to note, three out of the ten care files revealed that roughly twelve different staff had visited these people in a two week period. We saw the service could be more effective and consistent when allocating and scheduling staff.

Is the service caring?

We were told staff went “Above and beyond” from their caring duties and would do tasks that were not always their responsibility, like feeding their pets and buying pet food.

Eight of the nine people who were supported by the agency with whom we spoke, told us they were very happy with the care. All nine told us care staff do not rush and are always on time. People told us staff were “Friendly” and “Polite”.

Is the service responsive?

One person told us they had complained and it was all dealt with and resolved in a timely manner.

We saw in some appraisals staff had told the employer the only other training they would like was a dementia course. We saw the provider had recently employed a registered mental health nurse to provide training to all staff on dementia and it was a four day course. Staff told us that this was “Really useful and interesting.” We saw all appraisals had been completed annually and most supervisions had been completed.

All the service reviews we looked at had been completed in the past six months. People told us staff came out at least once a year to review the package of care. In the care files we saw evidence that all ten people had said they were happy with the service. One person had said they would prefer more consistent staff members and two people had said they would prefer new care staff to be introduced to them first before they start working for them. When asking people about this they said all matters had been resolved and that the staff were mindful of being more consistent. One person had commented that “Young care staff do not engage”. There was no evidence or documentation of any follow up on this occasion.

Is the service well-led?

All of the people we spoke with told us they knew the manager well and had confidence in their management of the service. They told us they would have no hesitation in speaking with them. They told us they had no concerns over the management of the service and they felt the manager would deal with any concerns in a prompt manner. They all felt the manager was “Approachable” and “Easy to talk to”.

Prior to visiting Home Instead Senior Care, Wirral we spoke with people on the telephone who used the service and also spoke with relatives. People we spoke with said they were extremely happy with the service they received and their relatives told us they had "peace of mind". One person said "The carers were very good and understanding when my wife began to deteriorate - they treated her with dignity and did the best they possibly could". A relative told us "They have been absolutely fantastic - it has changed my life as well as my mum's".

Assessment and care plan information together with daily journals were recorded at each person's home and a copy of the initial assessments and updated care plans were also held in a corresponding file at the office. There was a further electronic version containing records of all telephone calls and incidents relating to each person. The CAREGivers view and record information in the client file in the home and the remaining two systems are used for additional information for management and office support staff.

We found that Home Instead Senior Care, Wirral continually monitored themselves to ensure that people received a good service from appropriately trained staff. Staff understood the needs of the people they supported and people told us they felt safe and well cared for in their own homes.