About the service:

Paradigm is a domiciliary care agency proving care and support to people in their own homes in the community. The service provides support to predominantly older people, including people living with dementia, mental health needs and physical disabilities.

At the time of our inspection 54 people were using the service.

People’s experience of using this service:

People told us they were safe. The providers processes and practices protected people from abuse. There were enough staff to ensure people’s needs were met. Recruitment procedures followed safe practices. Staff told us they were given time to provide care and support that was unrushed. People’s medicines were managed safely. Risks assessments were in place and risks were managed in a way that did not restrict people’s freedom. People were protected by the prevention and control of infection.

Staff supported people to make their own decisions and choices. Staff we spoke with were knowledgeable and understood the principles of the Mental Capacity Act 2005.

Peoples nutritional needs were met. People who required support with their diet had their needs met by staff that understood their dietary requirements. Staff received effective training to fulfil their roles and responsibilities and were well supported and supervised.

People spoke very positively about the care and support they received. People we spoke with told us staff were kind, caring and considerate. People also confirmed that staff maintained their dignity and respected them. People and their relatives said the staff were dedicated and passionate about providing good standards of care and support.

People received personalised care that was responsive to their needs. Care plans were detailed and developed with the people who used the service. The care and support plans included people’s decisions and choices. People were supported appropriately at the end of their lives.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. The registered manager kept detailed records of concerns that evidenced any issues were actioned promptly and satisfactorily.

People told us they were listened to and had opportunity to raise concerns if required. People we spoke with said they had no concerns at the time of this inspection. They said the service was excellent and if they had any issues no matter how small they were dealt with immediately by staff.

People’s feedback was used to make changes to the service.

The service had a registered manager who conducted a range of audits in areas such as, medicine management, health and safety, care plans and daily records documentation. We saw the monitoring identified areas for improvement and any actions raised as part of the audits were addressed.

More information is in the detailed report.

Rating at last inspection:

The service was last inspected in 2016 and was rated good.

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Our inspection took place on 16, 17 and 18 August 2016 and was announced. We last inspected this service on 15 April 2014. During our last inspection we found the provider was meeting the standards required. This was the location’s first ratings inspection under the new methodology.

Paradigm Health and Social Care Limited provides personal care to people living in their own homes. At the time of our inspection the service was supporting sixty three people.

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.

People were supported by staff who could recognise potential signs of abuse and were confident reporting concerns regarding people’s safety. People were supported by sufficient numbers of staff who had been recruited safely. Risks to the health, safety and well-being of people were identified, managed and regularly reviewed. Staff had a good understanding of how care and support should be provided in order to keep people safe and were able to tell us about people’s individual risks and how to manage them. Accidents and incidents were recorded and investigated and we saw the provider was using this information to ensure risks of re-occurrence were reduced. People received their medicines on time and as prescribed. There were regular medicines administration checks being completed to ensure people received their medicines safely.

People told us they mostly received their support calls on time and were informed if for any reason their call was going to be late. People we spoke with told us they had never had a missed call.

People were supported by staff who had the required skills to perform their duties of personal care. People consented to their care and support and people were supported by staff who understood the principles and application of the Mental Capacity Act. People received food and drink when required and dietary and nutritional needs were identified and appropriately managed. People who required support to eat and drink received this support when required. People were supported to maintain good health and had access to healthcare when required.

People were supported by staff who were caring and treated people with kindness and respect. People’s individual needs and preferences were understood and met by staff and people were involved in making decisions about how their care and support was provided. Staff supported people in a way that maintained their privacy and dignity and promoted their independence.

People and their relatives felt involved in the assessment, planning and review of their care and support needs. People and their relatives knew how to raise a concern or complaint and told us that concerns and complaints were acted on.

People and their relatives knew who the registered manager was and were happy with the service. People and their relatives told us that the registered manager and the directors were approachable and supportive. Staff and the registered manager felt supported in their roles and understood their responsibilities. There was an open and honest culture within the service. The registered manager had systems in place to monitor the quality and consistency of care, this included carrying out care visits to ensure people were happy with the care and support they were receiving and spot checks on staff. People, relatives and staff were encouraged to give feedback on the service and information from audits, surveys and quality checks was being used to drive improvement.

People shared positive experiences of the care and support they received. Comments included, "I have no complaints and I am very well looked after by very friendly staff". "It's a pleasure to have the staff in my home and I feel quite safe".

People considered they had the same staff to meet their current needs, which they liked. They said, "We know who is coming and are never left waiting for them to arrive". People considered staff were well trained to do their job and one person said, “They are a special type of people”. People considered the service would be responsive to their changing needs.

People told us they were regularly asked if their service was satisfactory. They confirmed formal surveys were in place to gain their views about their care or how the service was run.

The provider had systems in place that enabled them to identify problems swiftly and act upon them to keep people safe at all times. This meant that the service was well led.

We spoke to four people who used the service, two staff and visited the provider at the agency office. We reviewed feedback forms from people who used the service conducted by the agency.

People who used the service said the agency always explained details to them in a way they could understand. They said they had their needs monitored closely by the staff involved with their care. People commented that they were consulted about how they liked tasks to be done. People told us their privacy and dignity was respected.

People and their relatives said they were treated as individuals and any change to their care was communicated to the care workers speedily which ensured consistent quality care. People said the agency often asked them their views about the service and were keen to rectify any problems.

The agency had assessed the staffing compliment required to meet the needs of the people they served in their own homes. Staff were matched to people according to skill, experience and care needs. People told us that staff always arrived promptly and calls were never missed. People said that the staff were competent and always acted professionally.

People who used the service and their relatives said they felt able to raise any issues they had with the staff. People told us that they felt safe in their home when staff were present. One person said, “Staff seem competent to do their job.”

We conducted this review because of concerns raised about the recruitment practice of the provider. We also considered if this had had any impact on the care and welfare of people who used the service.

People who used the service told us that staff had a caring nature and they were kind to them. They told us that they were involved in a discussion about their care needs and decided how they liked their care to be provided and when. They said staff were very respectful and had a good understanding of their preferences.

People who used the service said they felt able to raise any issues they had with the manager or one of her staff. People told us that they felt safe. One person said “Staff seem competent to do their job. I think they are given the kind of training they need so they can be confident to care for people”.

Care records we reviewed showed that people had a good assessment before they received a service. People's preferences, wishes and differences were all taken into account in planning their care.

Recruitment records showed that staff had been subjected to the necessary checks before commencing working with vulnerable people.

Paradigm Health and Social Care Limited in Telford provides domiciliary support to people who live in their own homes in the community.

The staff had received training on how to recognise signs of abuse and possible harm and they knew what to do if they had any concerns. People told us they could speak with the staff about any concern and were confident these would be addressed.

The staff knew how to identify signs of abuse and knew how to raise any safeguarding concern. Where concerns had been raised the provider had worked with other professionals to ensure people were safe and were not placed at risk. This meant people could be confident that staff knew how to act to reduce the possibility future harm occurring.

People were involved with the development of their support plan and could tell the staff how they want their care delivered. People told us that staff were kind and courteous and delivered their care in the way they wanted. Where personal needs changed, we saw support plans were reviewed and staff were alerted to any changes. This meant the care provided matched how people wanted to be supported.

The provider was responsive to individual circumstances and support required and there were enough staff to provide the agreed care. Where additional support was identified this was only agreed when the provider could deliver the additional staff support. People we spoke with told us they received their care from a small group of staff who they trusted. This meant people could be confident that they would receive consistent care from staff they knew well.

People told us the staff were respectful and provided dignified discreet care. People using the service said they had confidence that the staff had the skills necessary to meet their needs and were caring and compassionate. Staff received specific training to meet the needs of people using the service and support was provided after staff had been assessed that they were competent and safe to provide this. This meant people received support from staff who were suitably trained.

Systems were in place to ensure the service was monitored. People using the service were consulted about the management of the service which meant they could influence the service delivery. We saw where some improvements to the service were identified, the provider had not always addressed how these could be made, to ensure people’s views were addressed. This meant improvements were needed to ensure the views of all people were used to improve the service delivery.

We found that systems weren’t in place to monitor the exact time people received their support visit and how long staff provided this support. Some support visits did not allow for any travelling time between visits although people told us they were satisfied with the support provided.

The service had 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. There were clear management structures offering support and leadership. Records showed that CQC had been notified, as required by law, of all the incidents in the service that could affect the health, safety and welfare of people.