Archived: Augusta Care Limited

At the time of this inspection care was provided to 46 people who live with a learning disability and who may also have mental and physical health needs.

This comprehensive inspection took place on 14 June 2016 and was announced.

The provider is required to have a registered manager as one of their conditions of registration. A registered manager was not in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission [CQC] to manage the agency. 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. There was a manager operating the service and they had applied to be registered and was waiting for the CQC to consider their completed application.

People were kept safe and staff were knowledgeable about reporting any incident of harm. People were looked after by enough staff to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service. People were supported to take their medicines as prescribed.

People were supported to eat and drink sufficient amounts of food and drink. They were also supported to access health care services and their individual health and nutritional needs were met.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA 2005] and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. The provider was aware of what they were required to do should any person lack mental capacity. People’s mental capacity was assessed and care was provided in their best interests. Staff were trained and knowledgeable about the application of the MCA. Arrangements were in place for external agencies to make DoLS applications to the Court of Protection [CoP], if these were required. The outcome of these decisions was pending.

People were looked after by staff who were trained and supported to do their job.

People were treated by kind staff who they liked. They and their relatives were given opportunities to be involved in the review of people’s individual care plans.

People were supported to increase their integration into the community; they were helped to take part in recreational and work-related activities that were important to them. Care was provided based on people’s individual needs. There was a process in place so that people’s concerns and complaints were listened to and these were acted upon.

The registered manager was supported by a team of management staff and care staff. Staff were supported and managed to look after people in a safe way. Staff, people and their relatives were able to make suggestions and actions were taken as a result. Quality monitoring procedures were in place and action was taken where improvements were identified.

Is the service caring?

People we spoke with who used the service made positive comments about the support and care they received. They told us that the support staff gave them helped them maintain their independence. One person told us that the support was, “Really good.”

We looked at the care records held in the provider’s office for three out of the 28 people who used the service. These records showed us that people were supported to live as independent a life as possible with the assistance of staff members. We noted that people's individual equality and diversity needs were recorded. Staff we spoke with demonstrated to us their knowledge of the people they supported and cared for.

Is the service responsive?

People told us that their support and care had been provided in accordance with their wishes. One person said, “They (staff) do a lot for you and help nicely.” All of the people we spoke with told us that staff respected their choices about how care was to be delivered.

The care records we looked at indicated to us that the provider worked well with other social and healthcare services to make sure that people using the service received care and support that met their current needs.

Is the service safe?

In the care records we examined we saw that risk assessments regarding people’s individual care and support needs were carried out and that measures were in place to minimise these risks.

On examination of Medication Administration Records (MARs) we saw evidence of accurate documentation to ensure that people were protected against the risk of misinterpretation by staff members and the potential for medication errors.

The provider advised us that, at the time of our inspection, none of the people using the service had a Court Protection, Deprivation of Liberty Safeguard (DoLS) in place. However, the provider may find it useful to note that we were not able to find robust evidence that people had been either assessed or legal advice sought by the provider to ensure that they were not at risk of their liberty being deprived.

Staff files indicated to us that staff received training to ensure that they delivered care and support safely. However, the staff files we looked at did not provide robust evidence to demonstrate that staff had attended training in both the Mental Capacity Act 2005 (MCA) and DoLS. Staff we spoke with indicated to us varying levels of knowledge of this. However, we were unable to find robust evidence that staff members had access, if required, to policies which referred to MCA and guidance in respect of DoLS.

Is the service effective?

People we spoke with told us how staff assisted them with the care and support that they had agreed to.

People’s care and support needs were effectively met. People had positive comments to make about how the support and care they had been given enabled them to stay living in their own home.

Is the service well led?

Improvements had been made on the number of staff who had supervision since our previous inspection, which we carried out on 14 October 2013. However, the provider was unable to provide us with robust evidence that staff members had received an appraisal. We have asked the provider to tell us how they will make this improvement.

Quality monitoring systems were in place so that people were listened to and were safe from the risk of unsafe and inappropriate support and care.

People and relatives of people who used the service were asked for their feedback on the service provided.

Staff received additional training relevant to their role; however, staff did not receive appropriate support from the provider in the form of regular supervisions and appraisals.

There were appropriate systems in place to monitor and improve the quality of the service.

There was a detailed complaints procedure in place and staff were able to help people to raise a concern or complaint if they wanted to.

During our inspection visit of 28 January 2013 we found that the provider had made improvements and changes to people's plans of care to include records and outcomes of incidents. People's plans of care were person centred, reviewed regularly and ensured as far as practicable that people's independence was respected where this was safe to do so.

People could be confident that should they have any safety or health care concerns that staff would support them and report the concern to the relevant authorities. Training records we reviewed demonstrated to us that staff were provided with regular and up-to-date safeguarding of vulnerable adults training.

Since our previous inspection of February 2012 the provider had made improvements and ensured that staff only commenced work with the service after Criminal Records Bureau (CRB), photographic identity and previous employment checks had been satisfactorily completed.

The provider sought the views of people who use the service and staff to ensure that the quality of care provided was to the correct standard. Information was provided to people on how to complain.