Archived: A1 Quality Homecare Limited

A1 Quality Home Care Limited is a domiciliary care agency. The agency provides care, support and personal care to people living in their own homes. At the time of the inspection, care was being provided to 56 people. Most people were older and some were 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 told us that they felt safe when staff were in their homes. Assessments were carried out to identify risks and these were reviewed regularly. People, relatives and professionals were involved in the review process. People generally had regular staff looking after them and they got to know them well. The agency employed enough people to meet people’s needs and care calls had not been missed. Staff were recruited safely and had a good understanding of safeguarding and what procedures to follow if they had concerns. Some people were supported with medicines and staff were trained to do this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Everyone told us that staff had a good understanding of their care and support needs. Some people received help with eating and drinking. Staff had completed food hygiene training. People were supported to make choices about their care and had access to health and social care professionals. Staff had regular supervision and spot checks to ensure continued good care and support for people.

People were treated with compassion, respect and dignity. Staff knew people well and knew about their care and support needs. People’s privacy was respected and their health and social wellbeing was promoted. A relative told us, ‘We feel supported by A1, they are brilliant.’

Staff knew how to communicate with people who had different needs. Staff had had dementia training and were able to tell us how they help people communicate and make choices about their support needs. A complaints policy was in place and a copy was placed in everyone’s homes. There was a robust system for dealing with complaints and incidents.

People, relatives, staff and professionals told us that the service was well run. A person told us, “Overall it’s very satisfactory, I’m happy with everything.” A relative said, “I do feel the care is to a good standard yes and I would say so if it felt otherwise.” A member of staff told us, “It’s well organised. I actually enjoy coming to work.” The service had established links within the local community.

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 (published 27 September 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We found no evidence during this inspection that people were at risk of harm.

Follow up

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

Not everyone using A1 Quality Homecare Limited received the 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 our last inspection in April 2017, the service was rated 'Requires Improvement' in risk assessment, medicines management, care plans and quality assurance. At this inspection, we found the provider had made most of the required improvements. However, we also found different areas of practice that required improvement. This is the second inspection where the service has been rated Requires Improvement.

The service was not always well-led. Quality assurance processes had not identified the concerns people had raised around call times, lack of communication from office staff and staffing rotas. People had access to a complaints process, and said they would be happy to raise a complaint if they ever needed to. There had been some recent complaints about call times, and the registered manager had resolved these on an individual basis. However, other people continued to raise concerns regarding call times and rotas, as the registered manager had not taken action to resolve this issue for everyone who used the service. People’s views were sought but not always acted on to improve the service.

People were safe and had the support they needed. As far as possible, people were protected from harm and abuse. Staff knew how to recognise the signs of abuse and what they should do if they thought someone was a risk. People had risks to their safety properly assessed and managed. Medicines were safely managed. People were supported to eat and drink enough, and were supported to access the healthcare they needed to remain well.

People experienced care that met their needs, and were supported by kind and caring staff. People had their privacy and dignity respected, and staff knew what to do to make sure people’s independence was promoted. People experienced person centred care and were able to make their choices and preferences known.

Staff were supported with training, supervision and appraisals to make sure they had the skills they needed to provide good quality care. There were enough staff to support people to stay safe and meet their needs. Recruitment checks had been completed before staff began work, including disclosure and barring service (DBS) checks. Staff knew how to report incidents and accidents, and these were properly investigated.

People had their care needs assessed, and all of the relevant people were involved in care reviews. People experienced care and support that was in line with current guidance and standards.

People were asked for their consent before any care was given, and staff made sure they always acted in people’s best interests. The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA).

The registered manager had notified the CQC of events that were reportable. The rating of ‘requires improvement’ was displayed at the service and on the provider’s website. However, the service has not met all the fundamental standards and we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

A1 Quality Homecare Limited is a domiciliary care agency, which provides personal care to people living in their own houses or flats in the community.The registered office is in Worthing however the service provides personal care to people across West Sussex including Worthing, Pulbourough and Southwick. It provides a service to older people, people living with dementia, people with a physical disability and those with a sensory impairment. At the time of our visit, they were supporting 81 people with personal care in the community.

The service had a registered manager in post. They were registered in September 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 lack of robust and accurate risk assessments available for staff to refer to, to enable them to carry out consistent or safe care when supporting people. This was an area which required improvement. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not always managed safely. This included a lack of information and guidance for staff regarding prescribed medicine’s they administered to people. We made a recommendation to the provider to ensure care was reviewed for all people who were supported with their medicines. The provider was able to share the improvements they would make to how medicines were managed on behalf of people.

We found there were inconsistencies within care plans. Some care plans needed to be developed further to ensure they contained people’s preferences, likes and dislikes. We made a recommendation to the provider regarding this. The provider was able to share the action they were taking to ensure care records were accurate and reflected people’s current needs and wishes.

Mostly people spoke positively about the support they received from care staff and that there were sufficient staff to meet their needs. However, they also shared frustrations over staff not arriving at the preferred or agreed times, not knowing in advance which staff were attending and a lack of contact from the office when this happened.

The service had quality assurance monitoring tools in place which were not always effective in improving the service provided to people. We made a recommendation to the provider to ensure audits identified the areas we highlighted on our inspection regarding risk assessments, medicine management and care plans. The provider was able to share the action they were taking to improve their quality assurance systems.

Accidents and incidents were responded to by staff without delay and the appropriate medical professionals were contacted for advice and support when required. Staff were able to speak about what action they would take if they had a concern or felt a person was at risk of potential abuse or neglect. The service followed safe recruitment practices.

People's consent to care and treatment was considered. Staff understood the requirements under the Mental Capacity Act 2005 and about people's capacity to make decisions. Some people received support with food and drink and they made positive comments about staff and the way they met this need. Changes in people's health care needs and their support was reviewed when required. If people required input from other healthcare professionals, this was arranged.

We observed staff spoke kindly to people and had a caring approach. Staff involved people with their care provided and promoted their independence. People were treated with dignity and respect. People and their relatives knew who to approach when they had a concern or complaint about the service.

People and relatives views about the quality of the service were obtained informally through discussions with the registered manager and other members of the management team through care reviews and questionnaires.

At this inspection we found the registered manager open to feedback and enthusiastic about improving the service. The registered manager had made changes to the office management team to provide consistency in the delivery of care and an additional link between the office and people being supported in their own homes.

Since the inspection the provider has given us an action plan of what they have implemented to improve the care experience for people using the service. This included improvements in how risks for people were managed, guidance available for staff within care plans and how medicines were managed.