What the agency does well:
The carers' induction was in line with the Skills for Care Common Induction Standards, which introduces the caring role by promoting the values of individuality, rights, choice, privacy, dignity, independence, respect, and equality and diversity for the clients. Four clients, who returned surveys, confirmed that they felt the home carers always respected their privacy and dignity. One commented, 'the carers are polite, caring and respectful.1 The agency was committed to enrolling new staff, who had not already achieved a National Vocational Qualification at level 2 or above in Health and Social Care to complete this training, within six months of employment. Staff commented that, 'the agency provides a very good induction and training programme and a lot of useful information.' The agency welcomed complaints and compliments, 'as an opportunity to work towards meeting our aim of continuously improving our service'. Comments from clients on what the agency does well included, 'the agency does a good job', 'the carers are punctual, kind and efficient', 'an excellent agency', 'presentable, punctual, polite, caring, respectful carers are always willing to do that extra little thing that makes all the difference.' The three care workers, who returned completed surveys, commented, 'Lillyfields Care manages time very well so that care staff always have time to get from client to client, without being late or having to rush, and ensuing the time is right for the client', 'it's a lovely agency and I'm so happy to be working with them. I feel that they really care about the quality of care to be given to the clients, which is so important to me and makes me enjoy working for them'.
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What has improved since the last inspection?
This is the first key inspection report of a new service.
What they could do better:
No requirements or recommendations were made as a result of this report.
If you want to know what action the person responsible for this agency is taking following this report, you can contact them using the details on page 4.
The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535.
User focussed services
These are the outcomes that people using domiciliary care agencies should experience. They reflect the things that people have said are important to them:
People are confident that the agency can support them. This is because there is an accurate needs assessment, which they, or someone close to them, have been involved in. This tells the agency all about them and the support they need and is carried out before they are offered a personal domiciliary care service.
People and their relatives can decide whether the agency can meet their support needs. This is because they, or someone close to them, have got full, clear, accurate and up to date information about the agency. People know that the agency can meet their needs because staff have the skills and experience to give them the care they need. If they decide to use the agency they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the agency that includes how much they will pay and what the agency provides for their money. People are confident that the agency handles information about them appropriately. This is because the agency follows their policies and procedures. They get a consistent, and flexible care service from reliable and dependable staff members.
This is what people using this domiciliary care agency experience:
Judgement:
People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.
Full, clear and up-to-date information is supplied to inform prospective customers, their relatives and representatives about the agency so they can decide if it can meet their needs. A needs assessment is carried out to enable the agency to complete a plan of care to meet the support needs of prospective clients.
Evidence:
The agency supplied a comprehensive Statement of Purpose and Clients Guide, to help prospective service users to decide if this was the right service for them. These documents were printed in clear, bold type to enable people with visual impairment access them more easily. Detailed extracts from the agency's brochures were also provided on their web site, in addition to other useful information with respect to community services, finding an advocate and links to the Local Authority and to the
'•r
Evidence:
Care Quality Commission. The agency promised prospective clients they would be treated as unique individuals and that all the staff in this 'family' run business .regarded, 'being invited to provide quality care and support to clients in the comfort and safety of their own homes, as a privilege'. The agency's aims included, providing an agreed plan of care, which includes the wishes, aspirations and feelings of the client in addition to their practical needs, maximising clients' capabilities and promoting their self-confidence in their independence in their own homes and in the community, promoting clients' privacy, dignity and right to self-determination, to listen to and act upon concerns, wishes and feeling of clients and to safeguard them from abuse and neglect. The four clients, who returned completed surveys, confirmed that they had been given a written plan showing how the agency is going to meet their needs.
The manager stated that she carried out the client assessments and also requested a copy of assessment documentation and care plans from care management where the local authority was involved. The assessment documentation of two clients was sampled. Information with respect to equality and diversity, including the prospective client's ethnicity, and religious and cultural needs was collected, to ensure consideration in the individual client's care plans. Information collected included the clients' medical history and health professional's involvement, emergency contact details, lifestyle preferences and hobbies. A full environment risk assessment and an assessment of the working environment had been carried out. The client's abilities and need for support with respect to carrying out personal care and the tasks of daily living independently had been assessed and the level of support required recorded.
Personal care
These are the outcomes that people using domiciliary care agencies should experience. They reflect the things that people have said are important to them:
Each person is treated as an individual and the agency is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. Their right to privacy is respected and the support they get from workers is given in a way that maintains their dignity. If people take medicine, they manage it themselves if they can. If people cannot manage their medicine, the agency supports them with it in a safe way. People's needs and goals are met. The agency has a plan of care that the person, or someone close to them, has been involved in making. They are able to make decisions about their life, with support if they need it, as the staff promote their rights, choices and independence.
I
This is what people using this domiciliary care agency experience:
Judgement:
People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.
The clients' needs are recorded in a personal plan of care and they are treated with respect and dignity by the staff. Safe arrangements are in place to support clients, who cannot manage their own medication, to take their medication with support.
Evidence:
Two client's care plans were sampled and both contained clear instructions to the carers on how support was to be given to enable them to retain as much independence as possible. Care plans included details of client's preferences, likes and dislikes, and interests so that carers would be able to relate to them as individuals. Care plans had been signed by clients or their relatives to confirm acceptance and all the clients, who completed surveys, confirmed that the agency staff do all the things recorded in their care plan. The agency's computer programme was designed to alert them when review dates were due to ensure that care plans and risk assessments
i were appropriately kept up to date. One of the care plans viewed had already been reviewed because the client's needs had changed. The AQAA recorded, 'carers are
^expected to read the care plan at the start of each visit and we have included an adjustment/changes sheet at the front of each care plan that documents clearly any
Evidence:
changes that have occurred, a carer can then see at once if there have been any amendments since their last visit'.
Records confirmed that the carers' induction was in line with the Skills for Care Common Induction Standards, which introduces the caring role by promoting the values of individuality, rights, choice, privacy, dignity, independence, respect and equality and diversity for the clients. Four clients, who returned surveys, confirmed that they felt the home carers always respected their privacy and dignity. One commented, 'the carers are polite, caring and respectful.' The manager wrote in the AQAA, 'all new carers to a client's home are briefed before meeting with them, and made fully aware of the importance of treating them with dignity and respect, and that they are a guest in our clients homes'.
The agency's medication policy and procedure gave instructions to the staff on their responsibilities with respect to the prompting or assisting with medication, and of the limitations of their involvement. Records were kept of medications prompted, including the name of the medication, dosage, time taken, and the signature of the carer. Only one of the four clients, who completed surveys, recorded that they received help from the agency staff with their medication. The three carers, who completed surveys, recorded that they were being given training that gives them enough knowledge about health care and medication.
Protection
These are the outcomes that people using domiciliary care agencies should experience. They reflect the things that people have said are important to them:
People using the agency are safeguarded. This is because the agency follows health and safety procedures, keeps records appropriately and ensures their staff follow policies and understand the importance of assessing risks. The agency safeguards people from abuse, neglect and self harm and takes action to follow up any allegations.
People are confident that their property and money will always be safe as the agency follows the right procedures. Their health and rights are safeguarded as the staff keep an accurate record in their home of all the support they give them.
This is what people using this domiciliary care agency experience:
Judgement:
People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.
Policies, procedures and staff training with respect to health and safety issues are in place to promote and protect service users and risk assessments ensure accidents and harm to service users will be minimised. Policies and staff training are in place to protect service users from abuse, neglect and self-harm.
Evidence:
The AQAA confirmed that the service had relevant, up-to-date policies on health and safety and the subject was also covered in induction training. A poster indicating the organisational and individual responsibilities with respect to health and safety was posted on a notice board for all to see. The staff Handbook included important information from the agency's policies and procedures, to inform the staff and provided links to the full versions, which could be accessed on line and printed off if necessary. 'On call' arrangements included having a senior member of staff available at all working times to take telephone calls from the staff and to give advice. The policy was clear on reporting incidents and accidents and appropriate forms were available for recording this information. The three carers, who completed surveys recorded that they knew about the agency's policies and procedures on handling client's money, working in their homes and using their keys, getting emergency support and safeguarding adults and children from abuse. Client care plans sampled,
Evidence:
contained moving and handling risk assessments, where appropriate, which specified the number of staff required, the level of risk, and precautions to be taken by the staff to reduce the risks involved. The equipment used was recorded with details of the company responsible for servicing the equipment and the most recent servicing date. This confirmed that the service took the responsibility for ensuring that moving and handling equipment was safe for the staff and service users to use. Full environmental risk assessments had been completed, and the working environment, fire safety and medication had also been risk assessed for the protection of the clients and the staff. The agency provided the carers with protective clothing to prevent the spread of infection to clients when receiving personal care.
A copy of the local authority safeguarding adults policy and procedure was available at the office to inform the staff of the action to take should a safeguarding referral need to be made. The Protection of Vulnerable Adults training was included in the training schedule and proposed updates planned on a two yearly basis to ensure the staff would be kept up to date. The registered manager had attended the local authority safeguarding training.
Managers and staff
These are the outcomes that people using domiciliary care agencies should experience. They reflect the things that people have said are important to them:
People have confidence in the staff at the agency because checks have been done to make sure that they are fit to do the job. Their needs are met and they are supported as the staff get relevant training, support and supervision from their managers.
People have safe and appropriate support because the staff providing their care are qualified and competent. They are confident that the staff that provide their support are clear about their roles and responsibilities.
This is what people using this domiciliary care agency experience:
Judgement:
People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.
Clients have confidence in the staff provided to work in their homes because recruitment checks have been carried out to confirm they are safe and suitable to provide personal care. The provision of relevant induction, mandatory and specialist training, and supervision from managers, supports the staff to deliver a personal service, which caters for the diverse needs of the clients.
Evidence:
The AQAA recorded that all the care workers had received satisfactory pre-employment checks and the three care workers, who completed surveys, confirmed that their recruitment had been done fairly and thoroughly. The two staff personnel files sampled, contained application forms, which had been completed, giving a full employment history with any gaps explained, reasons for leaving employment where vulnerable adults or children had been cared for, and a signed declaration of no criminal convictions, to ensure that only suitable candidates would be considered for employment. Equal opportunities monitoring forms had been completed, to confirm the process was fair, and interview notes had been included, with written answers completed by candidates to various questions about the caring role. Files contained a photograph of the staff member, for identification, and an audit sheet, recording the dates references had been sent out and received, the Protection of Vulnerable Adults First (POVAFirst) check and Criminal Record Bureau (CRB) numbers. The manager confirmed that she was always available to support and supervise newly recruited
Evidence: staff Records were kept f a structured induction process in line with the Skills for Care Common Induction Standards, which introduces new staff to the caring role, and promotes the clients' rights to be treated as an individual, and have their equality and diversity needs respected. Newly recruited carers completed workbooks over the first twelve weeks of employment, to confirm their understanding of these principles. A minimum of fifteen hours were spent shadowing more experienced care workers, prior to working alone with clients, and the probationary period was of six months duration. The three carers, who completed surveys, confirmed that the induction covered everything they needed to know to do the job when they started, very well. One commented, 'the training and induction were very good and provided me with a lot of useful information.
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The agency was committed to enrolling new staff, who had not already achieved a National Vocational Qualification at level 2 or above in Health and Social Care, to complete this training within six months of employment. Mandatory training was completed over five days and included Moving and Handling (practical and theoretical), Infection Control, Health and Safety, Food Handling and Hygiene, the Protection of Vulnerable Adults and Handling Medications. The manager stated that information was provided with respect to the specialist needs of clients with conditions such as Motor Neurone Disease, Multiple Sclerosis, and Dementia and specialist training sought to ensure carers were fully informed.
The three carers, who completed surveys, recorded that they were being given training, which is relevant to their role, keeps them up to date with new ways of working, and helps them to understand and meet the individual needs of the clients with respect to equality and diversity issues. All the carers also recorded that their manager gives them enough support and meets with them to discuss how they are working. The four clients, who returned surveys, confirmed that the carers always listen and act on what they say.
The manager qualified as a level 1 Mental Health Nurse in 1985 and has many years of experience of working in the community, predominately with older people and people with mental health issues. She keeps herself up to date professionally by attending seminars, training and networking with social care professionals. Recent training includes the Mental Capacity Act and the Deprivation of Liberty Safeguards, Safeguarding Vulnerable Adults and Health and Safety. She intends to enrol to complete a relevant qualification in Management in the near future to support her in her role.
Organisation and running of the business
These are the outcomes that people using domiciliary care agencies should experience. They reflect the things that people have said are important to them:
People get consistent and planned support from the agency because the manager runs it appropriately with an open approach that makes them feel valued and respected.
People using the agency are safeguarded because it follows financial and accounting procedures, keeps record appropriately and ensures that their staff follow policies. If people have concerns about the agency they, or people close to them, know how to complain. Their concern is looked into and action taken to put things right.
This is what people using this domiciliary care agency experience:
Judgement:
People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.
Clients benefit from a well-managed and planned service, which is run in their best interests and welcomes complaints and compliments from clients, their relatives and representatives, regarding them as a positive lever for the continuous improvement of the service.
Evidence:
The office is located at the provider/registered manager's home on the outskirts of Petersfield town, and is central to the catchment area for clients, which extends from Waterlooville in the south, West Meon in the west, Midhurst in the East and Headly in the North. The manager stated that the intention was to have no more than ten to fifteen minutes travelling distance between clients, which is included in the carers scheduled time, and that a mileage allowance is also provided. Car parking is provided to the front of the house and disabled access is possible through a separate entrance and via the provider's domestic accommodation. The secure office is separate from the owner's own living accommodation. The office is well-equipped with two encrypted computers, lockable filing cabinets, a scanner, a photocopier and two telephones. A specialist computer software programme has been invested in to facilitate the running of the agency.
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Evidence: The office consists of one room, and the manager stated that a small space for private one to one meetings is available within her home or at the local community centre. Venues for training, with suitable facilities for practical moving and handling training, and staff meetings have been located in the local community. Refreshment and toilet facilities are provided in the manager's own accommodation. Plans are in place to move to a commercial venue in Petersfield town, to make visiting the office easier for clients, when the business has expanded sufficiently to support the move.
The management structure consists of the registered manager, an administration manager and one senior carer and the manager is aware of the need to increase the management support as the agency expands to ensure sufficient support for the carers.
The service had also engaged the services of a certified trainer.
The complaints and compliments procedure gave clear guidance to support the clients, their relatives and representatives in making a complaint or giving a compliment and assured them that, 'none would be victimised for making a complaint1, and welcomed complaints and compliments, 'as an opportunity to work towards meeting our aim of continuously improving our service.' The policy included timescales for responding to the complainant and the contact details for the Care Quality Commision (CQC). The AQAA recorded that there had been no complaints over the previous six months of registration. Two of the four clients, who completed surveys, confirmed that they knew how to make a complaint if they were not happy with the service they received. The three care workers recorded that they knew what to do if a client, their relative or
representative had concerns about the agency.
The Annual Quality Assurance Assessment completed by the registered manager gave clear and relevant information on how the service had improved over the previous six months, of the plans in place to continue this improvement over the next twelve months, and was supported by appropriate evidence. The manager wrote in the AQAA, 'Lillyfields is not a solely commercial venture, other than to cover its operating costs. We are in this for the long haul and will develop our reputation so that quality staff will want to work with us, clients will trust us and health and social care professionals will see us as honest partners.'
Quality assurance questionnaires had been developed for the clients, staff and other stakeholders, but the agency had been in operation for only six months, so they had not yet been completed. The manager stated that she had been making customer satisfaction follow-up calls to give clients the opportunity to discuss any concerns
Evidence:
about the care provided, and that all the current clients had expressed satisfaction with the service.
Regular telephone contact was also maintained. The four clients, who returned completed CQC surveys, commented on what the agency does well. Comments included, 'the agency does a good job1, 'the carers are punctual, kind and efficient, 'an excellent agency', 'presentable, punctual, polite, caring, respectful carers are always willing to do that extra little thing that makes all the difference.' The three staff, who returned completed surveys commented, 'Lillyfields Care manages time very well so that care staff always have time to get from client to client, without being late or having to rush, and ensuing the time is right for the client', 'it's a lovely agency and I'm so happy to be working with them. I feel that they really care about the quality of care to be given to the clients, which is so important to me and makes me enjoy working for them'.
Requirements and recommendations from this inspection: Immediate requirements:
These are immediate requirements that were set on the day we visited this domiciliary care agency. The registered person had to meet these within 48 hours.
No' Standard Regulation Requirement Timescale for
action
NONE
Statutory requirements
These requirements set out what the registered person must do to meet the Care Standards Act 2000, Domiciliary Care Agencies Regulations 2002 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No- Standard Regulation {Requirement Timescale for
action