Quality

About Inspections

Trinity Homecare was a registered Domiciliary Care Agency under the Care Standards Act 2000. We abided by the National Minimum Standards for Domiciliary Care Agencies based on the requirements of the Act. Under the Health and Social Care Act 2008, which came into effect in October 2010,  introduction agencies like Trinity Homecare were not required to re-register.

Under the annual inspection regime in force until October 2010 we were asked to supply a list of clients with their contact details and at the same time to write to our clients and carers alerting them that they may be contacted by the inspector. The inspector then made contact with a sample of clients and carers to find out about how the agency is performing and to check the level of satisfaction with outcomes. Clients and carers could also contact the inspector at any time if they wish to.

Our last inspection was an unannounced visit made to the agency when the Registered Manager and members of staff were questioned and documentation inspected.

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The Summary page of our last CQC report is set out below.  “Excellent” .  A copy of the full report is available on request.

Care Quality Commission

Key Inspection Report

Name of Inspector: Emma Dove.     Date 7th April, 2010.

We review the quality of the service against outcomes from the National Minimum Standards (NMS).  Those standards are written by the department of Health for each type of care service.

The quality rating for this domicilliary care agency is: three star excellent service.

The quality rating is our assessment of how well an agency is meeting the needs of the people who use it.  We give a quality rating following a full review of the service.  We call this full review a "key inspection".

Summary

How we did our inspection:

This key unanounced inspection was carried out over three hours on 7th April, 2010 by one regulation inspector.  We spoke with the registered manager and looked at records.

Surveys were sent to people who use the service and their relatives or representatives and carers.  We received seventeen completed surveys, comments from these are included throughout this report.

We received the annual quality assurance assessment (AQQA) from the manager when we asked for it.  This gave us good information about the service, what it does well and areas for development over the next year.

We looked at other information received since the last inspection in April 2007.

What the agency does well:

Trinity Homecare introduces people who use the service to good live in carers.  Comments from people sho use the service and their representatives included: "thanks to Trinity, my relative enjoys a quality of life which would be impossible without the high quality of care received"; "I have nothing but praise for the agaency and the carers they recruit"; "they select quality carers"; "they introduce excellent live-in carers" and "they are quick to respond if there is a problem".  The manager told us they select carers with appropriate attributes to meet the needs of clients and provide carers with the tools to manage placements.

Carers told us they feel supported, said they have enough relevent training and feel communication between them is very good.

Information provided to people who use the service and carers is more than that required by an introduction agency.  Records  maintained are more detailed than the requirements for introductory agencies.

What has improved since the last inspection?

The service has continued to provide more information and keep reords that are not required by introduction agencies.  The agency keeps updating and reviewing information provided.  The manager told us communication between agency and people who use the service has improved. People who use the service and carers confirmed that there are good systems in place for regular communication.  The agency has developed a carer's guide to dementia, to help carers provide more person centered appropriate care.

What could they do better:

The agency does more than introduction agencies are required and continues to look at ways of improving and developing the service.  The manager told us they are still looking at recruitment, whre to advertise and how to get more carers.

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Annual Quality Assurance Review for 2011

Under the Care Standards Act 2000, all domiciliary care agencies were required to review annually their quality assurance process and make the results known to their clients. Under the Health & Social Care Act 2008, introduction agencies like Trinity Homecare were no longer required to be registered.  However, we regard many of the features of the original act, including the quality assurance review, to be good practice; and so we have continued this tradition.  The review for the calendar year 2011 covers the following four Standards for Quality Assurance adopted by the agency:

Provide information about the service and the agency

We continually review the information we send to prospective, as well as existing, clients.  Existing clients are sent copies of our current Terms of Business, Fee Rate Schedule and Clients' Briefing Notes, with mention of changes in an accompanying Newsletter, when we review our rates each October.  We invariably have a few new clients who say there is too much information, but in our view live-in homecare is a complicated and difficult area, especially for people who have never had carers before.  We believe that all the information we give our clients is relevant and that not providing it would be a dereliction in our duty.

 

Understand clients’ needs so that suitable carers may be selected

 

In the past we have faced situations where new clients were not taken on because, in accordance with agency policy, they did not have a representative who would be able to make decisions on their behalf.  The Directors consider that this policy should continue, as this aspect is deemed vital for the smooth running of care for clients and to protect the interests of clients, carers and the agency. 

 

The Directors are satisfied that clients’ needs are understood sufficiently to recruit suitable carers, given the agency’s status as an “introduction” agency.  Extensive information about each client’s situation is maintained, and kept current, not only so as to understand clients’ needs, but also in order to select and brief  the next carer.

 

Recruit carers suited to the needs of clients

 

The agency tries very hard to place suitable carers, and in most cases we succeed.  In the few cases when we do not, we will replace the carer if requested.  It should be borne in mind though, that the more time we are given to select someone, and the better we know our client, the better able we are to choose the right person. 

 

Clients do have the opportunity to report on their carers as we send them a Client Satisfaction Form for each placement, and the responses to these give us some measure of how well we are selecting the carers.  The carers are rated according to the following criteria: Appearance, Attitude, Reliability, Conscientiousness, Initiative, Ability with Personal tasks, Ability with Household tasks. We ask clients to rate the carers 1 to 5 (5 being excellent) under these headings.  During the year we had 65 (124 in 2010) responses from clients.  Of those 29 or 45% (57 or 46% in 2010) gave their carers all 5s.  A further 14 or 22% (21 or 17% in 2010) got 5s in at least 5 out of 7 categories.  The rest were 4s (good) and some 3s (average).  Bearing in mind that the awarding of these scores are subjective and that some people just do not award 5s on principal, we are happy that we have been able to maintain our high standards.

 

Some comments received in letters from clients and their representatives in 2011 are set out below.

 

Respond to clients’ concerns and complaints

 

The number of clients who responded by completing their Client Satisfaction Forms has declined for the second year running, which is disappointing. We ask clients to rate the agency 1 to 5 (5 being excellent) under the following headings:

In 2011, 52 forms out of 65 (100 forms out of 124 in 2010) were returned with the ratings for the agency filled in.  71% of them gave us the highest rating (5s) for all categories (2010, 75%). 5 clients included a score of 3 or below in their ratings: one for Acceptability of Carers and all five for Clarity and Comprehensiveness of Documentation.   As most people use different criteria for awarding ratings we are happy that most of our clients are very pleased with the service that we provide. 

 

 

Some clients made written comments about the agency.  Some compliments are:

 

 

“I always find the agency extremely helpful.”

 

“I really have nothing to complain about! I only wonder if it is possible to keep up the high standard!”

 

“Very responsive, flexible and above all helpful.”

 

“Marissa (Care Co-ordinator) was very friendly and efficient”

 

“I very much hope that you can arrange a similar Australian girl to take over when Sarah must leave me.”

 

“I can only say that I take every opportunity to recommend Trinity to other people - and will continue to do so. They have been extremely good in every way”

 

“We are very pleased with the service we receive from the agency.”

 

“Thanks so much for the trouble that you take with your choice of girls, every single person that has come down to help my parents has been delightful and we look forward to meeting Sharon.”

 

“Michelle is a delight, my mother adores her and she is calm and efficient and a really nice girl. As I've said before you do so well getting very nice and helpful girls. Thank you.”

 

 

“I'd like to say in passing that Caryl is absolutely brilliant in every way - and also that I have no doubt at all that Anni would have been equally suitable by the looks of the confidential notes you send through about her.

Additionally, I'd like to thank you and Abi for the most professional, concerned and caring way you seem to run your operation and, if we ever need such services again, we will certainly contact you.”

 

“I am most grateful  to you for the care and help you have given us over the last 9 years. The carers have been wonderful and it has been especially good that so many have stayed a long time. Adi and Victoria were particularly helpful during her last illness.”

 

“On behalf of my late mother,  my brother and sister, I would like to thank you, Abigail, and all the staff at Trinity Homecare as well as the great number of your carers for the wonderful service you gave us over the last 5 years of our mother's life.

Unfailingly, consistently you supplied a steady stream of high quality, professional carers who took great pride in doing a good job. They took our mother from being a frail, elderly (and sometimes difficult!) person, to being completely dependent and requiring a high level of nursing care. In our conversations around her care, particularly latterly, you were always concerned to do the best for her, which meant that we were free from anxiety and confident about our decision to help keep her in her own home until the end. The last carer, Thea, was particularly heaven-sent.

Dare I say, we hope our children may look to you when our time comes? What greater recommendation could that be! Joking apart, we will always be more than happy to recommend you to anyone else we know in similar circumstances. Our mother and we were fortunate in having come across you. We wish Trinity continued success in the future.”

 

“Thank you all for your efficient help, I have been asked by many friends for your contact details after they have heard my words of praise - even  some of our age who are thinking ahead for their own care in old age!”

 

“I can only say that I take every opportunity to recommend Trinity to other people - and will continue to do so. They have been extremely good in every way.”

 

 

 

 

 

 

 

We do occasionally have comments from clients that they thought that our fees were too expensive and didn't understand why they should continue to pay the agency fee on a continuing basis. We don't deny that the fees are expensive, but we have our costs to cover and our fees are in the middle of our peer group of competitors. Generally in the recruitment field it is usual for fees to represent 20% to 30% of the appointee's annual salary. In the case of homecare, where clients' situations can change very suddenly it would clearly be unfair to make such an up-front charge, especially when the carers only stay for two to three months. Effectively, the cost of recruitment is charged over the time periods the benefit is received, though our fee structure is based on a one-off placement fee, which is invoiced in instalments.

This year we have had a few comments about the volume of information in our documentation.  We have been conscious of this and have tried to make it as simple as possible.  But there is a lot to consider when placing live-in carers and we are satisfied that all the information is relevant.  One client did ask if more information could be given about a new carer joining.  It is in fact our practice to tell clients about new carers.  It is apparent that on this occasion we slipped up, for which we have apologised.  To those of our existing clients reading this, please do call us with any queries you have.

The Directors are satisfied that clients concerns are addressed in a timely manner. We are very pleased that the inspector from the Commission for Social Care Inspection, who last inspected us on 7th April, 2010 recognised this in her report.