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Age Concern DS0000045530.V368883.R01.S.doc Version 5.2

DOMICILIARY CARE AGENCY

Age Concern

109 Thorne Road Doncaster South Yorkshire DN2 5BE

Lead Inspector Valerie Hoyle

Key Unannounced Inspection16th September 2008 09:00


The Commission for Social Care Inspection aims to:

• Put the people who use social care first • Improve services and stamp out bad practice • Be an expert voice on social care • Practise what we preach in our own organisation

Reader Information Document Purpose Inspection Report Author CSCI Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright This report is copyright Commission for Social

Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI

Internet address www.csci.org.uk


This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this agency are those for Domiciliary Care. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop

This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection.


SERVICE INFORMATION

Name of service

Age Concern

Address

109 Thorne Road Doncaster South Yorkshire DN2 5BE

Telephone number

01302 812345

Fax number

01302 812813

Email address

[email protected]

Provider Web address

Name of registered provider(s)/company (if applicable)

Age Concern

Name of registered manager (if applicable)

Jane Dickinson

Type of registration

Domiciliary Care Agencies


SERVICE INFORMATION Conditions of registration:

1. Registration granted for the following categories: Older people People with physical disabilities People with sensory loss including dual sensory impairment People with learning disabilities People with mental health problems Personal carers

Date of last inspection

5th September 2006

Brief Description of the Service:

Age Concern Doncaster is a registered charity and was formed in 1974. The location of the office is in a residential area, near to the centre of Doncaster within a large Victorian house. The registered manager and locality managers are based here. Their role is to allocate and support care workers to deliver care to people who use the service. There are facilities at the office to provide training and supervise staff. There is parking for several cars at the rear of the property. The range of services currently provided by Age Concern Doncaster includes domiciliary care, day care, domestic cleaning, community development and advice and information. The agency is registered to provide services to adults and most of the people are over 65 years of age. Information gained during this visit indicates that people are referred to the service from the local authority, although some people choose to purchase their care package privately direct from the agency and their package is calculated on the service provided. The last inspection report is available on request from the office, and all people are provided with an information pack about the services available prior to commencement of their care package.


SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means that the people who use this service experience excellent quality outcomes. This unannounced inspection took place over one and a half days (6 hours on first day (9.00am to 3.00pm) spent at the agency’s Doncaster office and 2.5 hours on second day (9.30am to 12.00pm). Three people who use the service were visited in their own homes. Two people were contacted by telephone to gain their views on the services provided. Recruitment, safeguarding adults and complaints policies were looked at to assess the agency’s ability to protect people who use the service. The office premises were looked at to ensure people’s records were stored safely. The Statement of Purpose and Service User Guide were looked at to assess the quality of information provided to people who use the service. Three people’s care plans were looked at to assess how they were supported in their own homes. Two members of staff were interviewed. Their views are included throughout the report. Six staff recruitment and training records were examined to assess how people were protected. The agency provides care and support to approximately 450 people who receive individual care packages. People can purchase their care privately; others have their care arranged by Doncaster Metropolitan Borough Council. The Primary Care Trust (PCT) also purchase care on behalf of some people. Approximately 110 staff are employed at the agency; they have the required skills and experience to provide the care and support to people who use the service. The registered manager, Jane Dickinson has the required experience and qualities to run the agency. The AQAA was returned to us on time, which demonstrates responsiveness and cooperation. An annual quality assurance assessment (AQAA) is a self-assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The AQAA also provides us with statistical information about the individual service and trends and patterns in social care. The inspector would like to thank everyone who agreed to be interviewed as part of the inspection process, and the friendliness of staff.


What the service does well: The agency makes sure people were assessed prior to receiving a service. The assessment is used to formulate care plans which were used by staff to deliver the care. People were very complimentary about the service all said it was flexible and described the agency as excellent. They said they were fully involved in what was written about them and were comfortable with staff that provided their care. Procedures to safeguard people who use the service were excellent and they ensure staff received regular training to recognise signs of abuse. People said they feel safe in their home and staff mostly turn up when they were due to arrive and always staff for the length of time they were suppose to. People said that the agency was very good at informing them if the carer was going to be late and if the carer was not going to be their regular carer. The agency was excellent in the way they employ their staff to make sure the right staff work with people who use the service. People said their carers were very good. They always treated them with respect and always maintained the privacy and dignity. One person described the staff as their extended family, while another said the service was flexible and professional. Training provided to staff was excellent; staff said they feel supported and able to call on their line manager for advice and help at any time. The training ensures staff has the right skills and competencies and people said staff had instruction on how to move and transfer her relative safely. Comments from people who use the service included: “Carers are smashing, I have never had any reason to complain, but I would tell Jane Dickinson if I had a problem”. “I have had the same carer for two years and she knows me very well, and she is very good”. “I am very happy with most of the staff that comes to me, the service is wonderful. They deserve all the praise they get”. “I think the service is flexible and meets my needs”. “When new staff comes to my home they are always accompanied by a regular carer until they know my needs”. “I like to be kept informed about changes to my care, I sometimes get anxious when staff are late, but they usually phone to tell me and that’s OK”. “My social worker arranged for Age Concern to provide my care when I was in hospital and they are great, they help me to fasten my buttons and put my socks and shoes on”. What has improved since the last inspection? Since the last inspection the service an ASR (Annual Service Review) was carried out on the service on 7th January 2008. The outcome of the review confirmed people continued to receive an excellent level of service.


Since the last inspection the agency has improved the frequency of visits to people in their own homes by team leaders. The purpose of the visits was to assess staff working in people’s homes, and to review the care provided to individuals. People visited confirmed this and said they had also been asked for their comments about their service. The agency have provided training to staff on the implementation of the Mental Capacity Act which will ensure staff understand how they may act in the best interests of people who use the service. They have listened to what people said about the service and have implemented a business continuity plan. This should ensure people will receive their care from a core number of staff. They have demonstrated that they want to provide an excellent service by achieving ISO9001 accreditation. The award is a recognised quality kite mark which is given to excellent services. What they could do better: The agency continues to develop ways to make the service more accessible to people who use the service. They told us they will help people to develop individual budgets and continue to review and monitor how care is delivered. They will develop teams to deliver a more specialised service and the manager is hoping to complete a dementia care course which will help with the process. Please contact the provider for advice of actions taken in response to this inspection.

The report of this inspection is available from [email protected] or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request.


DETAILS OF INSPECTOR FINDINGS

CONTENTS User Focused Services (Standards 1–6)

Personal Care (Standards 7-10)

Protection (Standards 11-16)

Managers and Staff (Standards 17-21)

Organisation and Running of the business (Standards 22-27)

Scoring of Outcomes

Statutory Requirements Identified During the Inspection


User Focused Services The intended outcomes for Standards 1 – 6 are: 1. Current and potential service users and their relatives have access to

comprehensive information, so that they can make informed decisions on whether the agency is able to meet their specific care needs.

2. The care needs requirements of service users and their personal or family carers when appropriate, are individually assessed before they are offered a personal domiciliary care service.

3. Service users, their relatives and representatives know that the agency providing their care service has the skills and competence required to meet their care needs.

4. Each service user has a written individual service contract or equivalent for the provision of care, with the agency, except employment agencies solely introducing workers.

5. Service users and their relatives or representatives know that their personal information is handled appropriately and that their personal confidences are respected. In the case of standards 5.2 and 5.3, these do not apply to employment agencies solely introducing workers.

6. Service users receive a flexible, consistent and reliable personal care service. In the case of standards 6.3 and 6.4 these do not apply to employment agencies solely introducing workers.

The Commission considers Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service.

Services were centred on the needs, wishes and views of people who use the service. EVIDENCE: The agency undertakes comprehensive assessments for each person prior to receiving the service. A number of the completed assessments were looked at and discussed with the manager. The assessment covered all aspects of daily living including personal care and well-being and personal safety and risks. It described the equipment (hoists) that was to be used to move people safely. There was a clear referral process to ensure the person was at the centre of


information gathered. People said they were involved in the assessment process and were aware of the information contained in the service delivery log (care plan). The agency can show how it is flexible to the various needs of users, for example, specific service packages for specific needs. People’s privacy, dignity and lifestyle choices were respected in all areas. One person said “their care package was complicated but the agency had been very responsive and had changed visiting routines to fit in with their needs”. The agency ensures information was stored securely in people’s own homes, staff had a good understanding about maintaining people’s confidentiality. Staff said they would feel confident to pass on information if there were any issues regarding safeguarding, or changes to the person’s care needs.


Personal Care The intended outcomes for Standard 7 – 10 are: 7. The care needs, wishes, preferences and personal goals for each

individual service user are recorded in their personal service user plan, except for employment agencies solely introducing workers.

8. Service users feel that they are treated with respect and valued as a person, and their right to privacy is upheld.

9. Service users are assisted to make their own decisions and control their own lives and are supported in maintaining their independence.

10. The agency’s policy and procedures on medication and health related activities protect service users and assists them to maintain responsibility for their own medication and to remain in their own home, even if they are unable to administer their medication themselves. In the case of standards 10.8 and 10.9, these do not apply to employment agencies solely introducing workers.

The Commission considers Standards 8 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 People who use the 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 health and personal care, which a person using services receives, is based on their individual needs. The principles of respect, dignity and privacy were put into practice. EVIDENCE: A person centred approach to care plans ensures people’s wishes, and preferences were reflected in the documentation. Three service delivery logs (care plans) were looked at and discussed with staff at the agency’s office. Care plans were also looked at in people’s own homes. This confirms information was consistent and reviewed. People said they had been fully involved in writing the plan, which described where support was needed. They were written with clear instructions where risks had been identified.


Environmental risk assessments ensure staff was able to support people safely in their own homes. Staff’s induction and foundation training was looked at, the agency had improved the induction programme which was excellent. Discussion with staff confirmed this. Privacy, respect and protection were promoted throughout the training. People said staff always respected their privacy and dignity, and always wore the correct wear to prevent cross infection. Staff said they were confident to report any changes (health and welfare) to their line managers who would organise a review with the local authority. The care plans looked at confirmed that reviews take place on a regular basis (every 16 weeks or more frequent if required), and the person was able to read and agree their plan of care. The agency had clear policies and procedures to ensure staff understand parameters and circumstances for supporting people with their medication. There was clear evidence on people’s support plans that determine the level of support needed with this task. People visited confirmed that they managed their own medication, although staff may prompt as a reminder to take their medication.


Protection The intended outcomes for Standards 11 - 16 are: 11. The health, safety and welfare of service users and care and support

staff is promoted and protected, except for employment agencies solely introducing workers.

12. The risk of accidents and harm happening to Service Users and staff in the provision of the personal care, is minimised, except for employment agencies solely introducing workers.

13. The money and property of service users is protected at all times whilst providing the care service, except for employment agencies solely introducing workers.

14. Service users are protected from abuse, neglect and self-harm, except for employment agencies solely introducing workers.

15. Service users are protected and are safe in their home, except for employment agencies solely introducing workers.

16. The health, rights and best interests of service users are safeguarded by maintaining a record of key events and activities undertaken in the home in relation to the provision of personal care, except for employment agencies solely introducing workers.

The Commission considers Standards 11, 12 and 14 the key standards to be inspected at least once. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 14 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.

People who use services are safe, secure and feel confident that their welfare and safety needs are always promoted. EVIDENCE: The agency has comprehensive policies and procedure in relation to health and safety and staff said they had received training to ensure their safety whilst working out in the community and would feel confident in dealing with any emergency events whilst supporting service users. Accident records were looked at, these are analysed to identify and prompt further risks to people


who use the service and staff. The registered manager and training manager have undertaken training in safe handling techniques to enable them to cascade the training to staff to ensure people’s manual handling needs can be met. Staff said they were confident in the use of moving and handling equipment, and had received regular updates when supporting new people. Risk assessments for people, and for the environment they live in, were carried out so that risk of potential accidents were reduced. A number of risk assessments were looked and they were comprehensive. Staff working with individuals was aware of risk assessment and how to follow them and keep them updated. The agency ensures staff have the required skills and competencies to undertake risk assessment by providing excellent training. They attend the Chartered Institute of Environmental Health Risk assessment course. Staff had recently attended a course on the Mental Capacity Act to raise their awareness of issues relating to peoples capacity to make decisions. There was a comprehensive Adult Safeguarding and Whistleblowing policy and staff follow the procedures to those standards. The registered manager would investigate fully any allegations of abuse and would follow the necessary procedures if any were substantiated. The AQAA confirmed that a number of referrals had been made to Adults Safeguarding managers, they had been appropriately reported, which demonstrate a commitment to keeping people safe. Staff said they had a good understanding of potential indicators of abuse and what to do if they became aware of an allegation of abuse. They confirmed they had received training in safeguarding adults. The training manager was able to provide evidence of the protection of vulnerable adults training, which was comprehensive. She has responsibility to also provide training to other organisations including the local social services staff. Two staff confirmed that they were fully aware of their responsibilities regarding the security and safety of people in their own homes. They were fully aware of the protocols with regard to I.D badges and gaining access to people in their own home. They said everything relating to health and safety was detailed in their staff handbook, and regularly discussed at team meetings and supervision.


Managers and Staff The intended outcomes for Standards 17 - 21 are: 17. The well-being, health and security of services users is protected by the

agency’s policies and procedures on recruitment and selection of staff. 18. Service users benefit from clarity of staff roles and responsibilities,

except for employment agencies solely introducing workers. 19. Service users know that staff are appropriately trained to meet their

personal care needs, except for employment agencies solely introducing workers.

20. The personal care of service users is provided by qualified and competent staff, except for employment agencies solely introducing workers.

21. Service users know and benefit from having staff who are supervised and whose performance is appraised regularly, except for employment agencies solely introducing workers.

The Commission considers Standards 17, 19 and 21 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 17, 19, 21 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.

The service makes sure the right staff was employed to look after vulnerable people. This means that people were safeguarded by the robust employment practices of the agency. EVIDENCE: The agency has a thorough robust recruitment and selection process to ensure people were safe and protected. A number of recruitment files were looked at and they contained all the required employment checks including a satisfactory CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) checks and two written references. The inspector was able to discuss with the human resources manager, how staff are recruited into the organisation, and a new member of staff confirmed how they were recruited into the agency.


The agency ensures staff have the necessary competencies and skills to enable them to work with people in their own homes, by providing an excellent induction programme. The inspector was able to examine a completed induction document which had been further developed since the last inspection. Each staff member had an individual training and development file that clearly showed a commitment to both specialist and mandatory training. Staff spoken to confirmed that they felt well trained and supported. The agency has demonstrated a commitment to continuous staff development with 78 staff members (110 employed) achieving NVQ Level 2 awards in care, and a further 17 members of staff who were working towards the award. Staff said they had achieved the award and it was worthwhile course which had given them the skills to carry out their roles within the agency. The staff are commended for their efforts towards training and providing an excellent service for the people who use the service. The registered manager said she has achieved the RMA (Registered Managers Award) and has expressed an interest to develop her knowledge further by attending a course on Dementia Care. She was commended for achieving a high standard of service. People were visited by team leaders to ensure the staff were providing appropriate support. Structured supervision of staff also takes place at the main office, and monitoring visits also take place when staff are working with people in their own homes. Staff said that supervision gave them an opportunity to discuss issues relating to their roles and responsibilities and also to discuss their own development and training. Since the last inspection of the service the agency has improved the frequency of on the job staff supervision, and people confirmed that managers had visited while staff was providing care to them. They said they had been given the reason for the visit which was to improve the service provided.


Organisation and Running of the Business The intended outcomes for Standards 22 – 27 are: 22. Service users receive a consistent, well managed and planned service. 23. The continuity of the service provided to service users is safeguarded by

the accounting and financial procedures of the agency. 24. The rights and best interests of service users are safeguarded by the

agency keeping accurate and up-to-date records. 25. The service user’s rights, health, and best interests are safeguarded by

robust policies and procedures which are consistently implemented and constantly monitored by the agency.

26. Service users and their relatives or representatives are confident that their complaints will be listened to, taken seriously and acted upon.

27. The service is run in the best interests of its service users. The Commission considers Standards 22 and 26 the key standards to be inspected at least once. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 26 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.

Managers and staff make the best use of resources to deliver a good quality service. EVIDENCE: The agency operates and manages its services from appropriate premises that were accessible from Doncaster town centre. There were clear lines of accountability with the registered manager having responsibility for all services provided. She was involved in the business and financial planning for the agency including budgets and quality audits. The registered manager said they had improved the way the agency monitored late calls and continuity of care (number of staff people can expect to deliver their care) to ensure the service was flexible and people led. The agency has also been accredited with a quality kite mark (ISO 9001) since the last inspection. The award is given to organisations that operate at a high standard.


The premises provide suitable storage to ensure personal files and other confidential documents were secure. A number of documents were looked at including accident and incident records, and a number of the organisational policies and procedures. They had been reviewed to ensure they reflected the changes within the organisation. The inspector was able to look at documents stored in people’s own homes, and the people said staff always explained what was recorded about them and discussed any changes with them before making the changes. The manager said the organisation reviews packages of care every 16 weeks to make sure peoples care needs were up to date. The agency has a robust complaints procedure. An accessible version of the complaints procedure was available for people and their families in a leaflet contained in the information pack. The AQAA confirmed that 20 complaints had been received over the last 12 months; most were from relatives of people who use the service. The AQAA confirmed that all 20 had been upheld and action had been taken as a result of the complaint. A random selection of concerns/complaints over recent months was looked at. A number were resolved immediately, whilst others were dealt with in the timescales stated in the procedure. All letters in response to complaints were kept together to ensure the policy is followed to a conclusion. All people visited and contacted confirmed that they were aware of how to raise concerns and were confident that their concerns would be dealt with swiftly.


SCORING OF OUTCOMES

This page summarises the assessment of the extent to which the National Minimum Standards for Domiciliary Care have been met and uses the following scale. 4 Standard Exceeded (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (Major Shortfalls)

“X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable

User Focused Services Managers and Staff

Standard No Score Standard No Score 1 X 17 4 2 3 18 X 3 X 19 4 4 X 20 X 5 X 21 4 6 X Personal Care Organisation And Running Of

The Business Standard No Score Standard No Score

7 3 22 4 8 3 23 X 9 X 24 X

10 3 25 X 26 3

27 X Protection

Standard No Score 11 3 12 3 13 X 14 4 15 X 16 X


Are there any outstanding requirements from the last inspection?

No

STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Domiciliary Care Regulations 2002 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales.

No. Standard Regulation Requirement Timescale for action

RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out.

No. Refer to Standard

Good Practice Recommendations


Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: [email protected] Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI

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