At Home-Specialists in Care Ltd

At Home – Specialists in Care Ltd is a domiciliary care agency providing personal care to people living in their own homes. The service predominantly supported older people. Not everyone who used the service received the regulated activity ‘personal care’. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection there were 53 people who received personal care support.

People’s experience of using this service and what we found

Medicines records were not completed fully or in line with best practice guidance. This presented a risk people would not receive their medicines correctly. Whilst some risk assessments had been completed, these did not provide sufficient detail to guide staff and mitigate potential risks. There was a lack of oversight of accidents and incidents for people who used the service.

Safe recruitment practices help to ensure only people of suitable character are employed. Whilst most elements of the recruitment process was safe, new candidates did not provide a full work history in accordance with legislation. Staff felt there was insufficient travel time between calls which impacted on the support they provided. We found staff were not always staying the full duration of peoples’ care calls.

Services complete checks and audits to monitor safety and quality. Issues highlighted at this inspection were not picked up through the audits and led to breaches of regulatory requirements. Some similar issues were highlighted at this inspection and the previous one.

Staff were familiar with the people they cared for and spoke about people with respect and warmth. People who used the service and their relatives told us they felt safe with the carers and gave us generally positive feedback. A person who used the service told us, “I get on very well with all the carers. They are really good company for me. They treat me with respect, and I am happy with my relations with these carers. We have chats and I look forward to them coming to see me. I am very happy with the care I receive.”

There were safeguarding policies in place to guide staff should a person be at risk of harm or abuse. Staff had access to PPE and undertook infection prevention and control training to ensure they had the required knowledge in this area. Staff practice was continually monitored and included observations and spot checks of their practice.

Questionnaires were used to seek people’s feedback about the service and this was reviewed to see if there was any learning to be applied from this. Team meetings were held however actions were required to ensure this was a positive, cohesive experience for all staff. The service worked with partner agencies to holistically support people. People felt able to share any concerns they had with the office and felt these would be addressed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (report published 12 June 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations and the service remains rated requires improvement.

Previous recommendations

At our last inspection we recommended the provider review their recruitment practices to ensure they were consistently following their policy and best practice. At this inspection we found they had not made the necessary improvements in this area.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at a previous inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for At Home – Specialists in Care Ltd on our website at www.cqc.org.uk.

Enforcement

At this inspection we have identified breaches in relation to safe use of medicines, management of risk and governance of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At Home - Specialists in Care is a domiciliary care agency that was providing personal care to 49 people living in their own homes. The service was primarily supporting older people at the time of our inspection. It can also provide care to younger adults, people with a learning disability or autistic spectrum disorder, people with physical disabilities, mental health, sensory impairment and people living with dementia.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found:

People received support from caring staff who were appropriately trained, but improvement was required to make call times more consistent for people. People were not always supported to take their medicines appropriately, sometimes due to call scheduling issues. Staff were aware of risks to people’s safety and well-being and acted to minimise these risks. However, some risk assessments needed more detail to ensure the guidance for staff was sufficient and clear. We have made a recommendation about staff recruitment practices.

The provider had a quality assurance system. This included regular spot checks, audits and feedback surveys. These processes had not identified and addressed some of the issues we found during the inspection. Where issues had been identified in audits, these had sometimes not been dealt with as promptly as they could have been. Improvement was required to make quality assurance systems more effective.

There had been significant management and staffing changes during the year prior to our inspection. This had impacted on staff morale and service consistency. However, care staff felt things had improved over recent months and told us they felt supported. The provider had made changes and improvements in some areas, such as care plans. They were keen to make further improvements and were taking action to address the issues in relation to call times consistency.

People were generally satisfied with the service they received. They felt able to raise any concerns and were confident these would be acted on. People and relatives confirmed staff always wore personal protective equipment (PPE).

People were safeguarded from the risk of abuse and staff knew how to raise any issues. The provider worked with other agencies and professionals to meet people’s needs.

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 Good (published 30 April 2019)

Why we inspected:

This inspection was prompted by our monitoring data and intelligence which indicated potential risks. In particular, concerns had been raised in relation to staffing, infection control and late care visits. As a result, we undertook a 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 from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

The provider took action straightaway in response to our feedback. They sent a further update shortly after the inspection about progress they had made to address the shortfalls identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for At Home – Specialists in Care on our website at www.cqc.org.uk.

Enforcement:

We have identified a breaches in relation to governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People's experience of using this service: People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

People received safe care and support because systems and processes in place ensured any risks were safely managed by staff, and their needs met with minimal restrictions in place.

Staff understood the importance of providing person-centred care and had developed positive relationships with people.

Staff were recruited into their role with appropriate checks in place before they commenced independent duties with people in their own homes.

Staff had received training and clear guidance was followed to help people to understand how to remain safe from avoidable harm and abuse.

People received help with their medicines as assessed. Records confirmed people had received their medicines as prescribed.

People were involved in their care planning. Records were person-centred and regularly reviewed.

Staff received appropriate induction, training, and support and applied learning effectively in line with best practice. This led to good outcomes for people and supported a good quality of life.

Staff were friendly and polite. Staff took time to get to know people. They had a clear understanding of, and how to support, people's individual and diverse needs.

People and their relatives told us they were confident if they had any complaints the registered manager would address them appropriately.

Everybody spoke positively about the staff and management of the organisation. The manager was responsive to any concerns we raised; implementing immediate corrective actions. They were clearly passionate about providing people with care and support that improved their lives and helped them to remain in their own homes.

The provider had good relationships with people, other organisations and used feedback to help drive improvements.

.

Rating at last inspection: Requires improvement. (The last report was published on 10 May 2018.)

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At the time of our inspection there was a registered manager at the service. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection on 12 November 2015 and 15 January 2016 we found that care and treatment was not provided in a safe way. This related to training for staff on medication administration. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities). We also found that checks were not in place to ensure fit and proper persons were being employed. This related to staff starting work unsupervised before all checks were in place. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities).

During this inspection we reviewed actions the provider told us they had taken to become compliant with the breaches identified at the last inspection. We looked to see if improvements had been made in respect of the breaches. We found the breach of Regulation 12 had been fully met but the breach of Regulation 19 had not. We also found a breach of Regulation 17 in relation to good governance.

This is the second consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

Recruitment checks needed to be more robust to ensure the safe recruitment of staff before they worked independently in people’s homes.

The registered manager had not informed CQC and the local safeguarding authority of all significant events as required by regulation. We have written to the provider about this.

Care records for people had not been accurately maintained and some were incomplete. We have made a recommendation about care plan reviews.

There was a positive culture within the service; people were treated with dignity and respect. People received person centred care.

People were supported to make their own decisions; this was encouraged and reflected in their care plans. Care plans demonstrated that the principles of the Mental Capacity Act (MCA) 2005 had been applied.

Staff had access to an induction period and on-going training. The management carried out competency checks and spot checks to ensure staff were competent in the role they were carrying out.

Staff understood what action to take to safeguard people from abuse.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. The management completed investigations into incidents and accidents. However the registered manager recognised the need for a more robust system of recognising and recording of accidents, incidents and complaints.

People were protected from the risks of infection through the provision of personal protective equipment.

People’s nutritional and hydration needs were catered for. Staff supported people with their choice of meals.

We found the management and administration of people's medicines were safe. Recent improvements had been made to help reduce the risk of any medication errors.

There were quality audits in place completed by the care coordinator and the registered manager. However, checks in relation to care planning and recruitment needed to be more robust.

All of the people we spoke with told us they felt the service was well-led and that they could approach management with any concerns.