Background to this inspection
Updated
30 December 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of an inspector, who attended the site visit and an assistant inspector who contacted people who use the service and staff to ask their views. An expert by experience carried out phone calls to people using the service and their relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced before our visit. Inspection activity started on 11 November 2020 and ended on 25 November 2020. We visited the office location on 11 November 2020.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection process we spoke with 13 people and four relatives to seek their experiences of using the service. We also spoke with 10 staff members.
During the inspection
We spent time with the registered manager who is also one of the directors at the office location. Along with the head of care and a second director. We reviewed a variety of records relating to the management of the service, including policies and procedures.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data, survey results, staff scheduling and quality assurance records.
Updated
30 December 2020
About the service
Axe Valley Home Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone using Axe Valley Home Care Limited receives a regulated activity, CQC only inspects the service being received by people provided with 'personal care', help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.
At the time of our inspection 127 people were being supported with personal care by this service.
People’s experience of using this service and what we found
We received mixed responses from people about their experiences of using the service. Everyone praised the care staff and the care they received. However, some people were not happy about changes the provider had recently made. People were not happy that they were not always having their regular carers and did not know who would be undertaking their visits.
The provider had been making changes to the staff routes by putting in place clusters to minimise the distance staff travelled between visits. They had developed small teams of staff in each cluster, so there would be continuity. This had been successfully rolled out in Seaton but was causing anxiety for people in Exmouth where it was being rolled out.
The provider told us at the beginning of the pandemic they had considered the best use of the office team. They had decided not to send out weekly care rota’s in order to prepare staffing time and resilience for managing the service in the pandemic. They had written to everyone using the service setting out the time of their visits as commissioned and naming the locality supervisor and key worker.
The provider recognised that they could have improved their communication with people about the changes. They had restarted sending out their monthly newsletter in October 2020 which advised people, they had taken onboard the need to improve communication, particularly in terms of visit times.
Staff did not always speak positively about staffing, the way visits were scheduled, and the changes communicated about their rotas. The provider said they were in regular communication with the staff through newsletters and staff supervisions. However, they had recognised staff were under additional pressure during the pandemic and the changes being made and had increased their visibility in the community to support staff.
Improvements had been made to ensure that systems and processes were operated effectively to ensure people were protected from abuse and improper treatment. They were ensuring the providers policy to safeguard vulnerable adults was being followed.
The provider had a business continuity plan which set out how they would operate in extreme conditions. They had risk assessed each visit people received to prioritise visits in case they needed to implement their business continuity plan. They also employed rapid response staff to cover staff absences to help ensure people received their visit.
Medicines continued to be safely managed and people told us staff wore the correct PPE during their visits. The service had implemented a number of additional infection control measures in response to the coronavirus pandemic.
People were given the opportunity to provide feedback to the service about their experience of the care received. Quality monitoring calls were completed on a quarterly basis to speak with people to ask about the service they receive and if they had any concerns.
We have made a recommendation that the provider continues to look at their communication methods and ensure the new systems they have put in place are fully embedded so improvements continue and are sustained.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: The last rating for this service was Requires improvement (published 18 March 2020).
Why we inspected
The inspection was prompted in part due to concerns about missed and shortened visits to people and a negative culture between office and management staff and care staff. A decision was made for us to inspect and examine those risks. We also looked at a breach of legal requirements which had been found at the unannounced comprehensive inspection in January 2020. The provider had completed an action plan after the inspection to show what they would do and by when to ensure systems and processes were operated effectively to ensure people were protected from abuse and improper treatment. This focused inspection checked they had followed their action plan and to confirm they now met legal requirements.
We undertook an announced focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed Requires Improvement to Good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Axe Valley Home Care Limited on our website at www.cqc.org.uk.