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Inspection carried out on 25 October 2017

During a routine inspection

We undertook an announced inspection of Aquaflo Care Barnet on 25 October 2017.

Aquaflo Care Barnet is a domiciliary care agency registered to provide personal care to people in their own homes. At the time of our inspection, the service told us that they were providing care to 53 people.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The last comprehensive inspection we carried out in October 2016 found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection in October 2017, we found that the service had taken appropriate action to improve on the breaches of regulation we previously identified.

People and their relatives informed us that they were satisfied with the care and services provided by the service. People told us they felt safe around care staff and were treated with respect and dignity. Relatives of people who used the service said they were confident that people were safe around care staff and raised no concerns in respect of this.

Our previous inspection in October 2016 found that a significant proportion of risk assessments contained limited information and some areas of potential risks to people had not been identified and we found a breach of regulation in respect of this. During this inspection in October 2017, we found that the service had made improvements and new format risk assessments were in place for all people. We found that the majority of risks had been identified. However, we found that in some people’s care plans there was a lack of information about the action to take to reduce risks. Following the inspection, the registered manager sent us evidence to confirm that they had added necessary information in the risk assessments we discussed and said that they would ensure that this was done with all risk assessments.

There were processes in place to help ensure people were protected from the risk of abuse. Our previous inspection found that some care workers were unable to describe the process for identifying and reporting safeguarding concerns. During our inspection in October 2017, the registered manager confirmed that staff had received safeguarding refresher training since the inspection. Care workers we spoke with during this inspection were all aware of the process for identifying and reporting safeguarding concerns.

There were arrangements to manage medicines safely and appropriately. Records showed care workers had received medicines training as part of their induction and their level of competency was tested. Medicines policies and procedures were in place. Our previous inspection in October 2016 found unexplained gaps in some Medication Administration Records (MARs) and also found that these gaps were not identified by the service. During this inspection in October 2017, we found some gaps in MARs that we looked at. However, we noted that the service had a comprehensive audit system in place and had identified all of the gaps and taken action.

The service used an electronic system for monitoring care worker's timekeeping and whether they turned up on time or were late. We looked at a sample of people’s timekeeping records and found with one exception, care workers attended to people within 30 minutes of their allocated time. We noted that reviews of care and feedback indicated that punctuality was not a significant concern of people. The majority of people and relatives we spoke with told us that generally care workers were on time and they raised no concerns regarding this.

We looked at the recruitment process to see if the required checks had been carried out before staff started working with people who used the service. We looked at a sample of recruitment records of staff and found background checks for safer recruitment including, enhanced criminal record checks had been undertaken and proof of their identity and right to work in the United Kingdom had also been obtained. Two written references had been obtained for staff.

Care workers we spoke with told us that they felt supported by the registered manager. They told us that management were approachable and they raised no concerns in respect of this. Records showed that care workers had undertaken necessary training. There was evidence that care workers had received regular supervision sessions and this was confirmed by care workers we spoke with. We also saw evidence that staff had received an annual appraisal about their individual performance and had an opportunity to review their personal development and progress.

Our previous inspection in October 2016 found that people’s care records lacked information about their mental health and their levels of mental capacity to make decisions. During our inspection in October 2017, we noted that the service had made improvements in respect of this. Details of people’s mental capacity and mental health were consistently completed in all people’s care records we looked at.

During our previous inspection, we noted that the majority of care workers we spoke with had limited knowledge of what mental capacity was. During this inspection, we found that the service had taken steps to address this since the last inspection. We saw documented evidence that care workers had received refresher Mental Capacity Act (MCA) training and staff we spoke with had knowledge of the MCA.

Care workers were aware of the importance of respecting people’s privacy and maintaining their dignity. They told us they gave people privacy whilst they undertook aspects of personal care. People who used the service told us that they felt the service was caring and relatives were satisfied with the care provided by the service.

Our previous inspection of the service in October 2016 found there was limited information in care support plans about the support that people required from care workers. The information was task-focused and there was a lack of instructions about what tasks needed to be carried out and we found a breach of regulations in respect of this. During our inspection in October 2017, we found that the service had taken appropriate action in respect of this and had updated all care support plans to include necessary information. These were person centred and included information about people’s preferences.

Our previous inspection in October 2016 found that the service did not have an effective system in place to monitor the quality of the service. The service had failed to effectively check essential aspects of the care provided in respect of late visit monitoring and MARs and we found a breach of regulation in respect of this. During our inspection in October 2017, we found that the service had taken action to address this and had made improvements. We found that the service had implemented an electronic system for monitoring staff punctuality and attendance and it was fully operational. We also found that the service had implemented a comprehensive MARs audit.

Inspection carried out on 24 October 2016

During a routine inspection

We undertook an announced inspection of Aquaflo Care Barnet on 24 and 25 October 2016.

Aquaflo Care Barnet is a domiciliary care agency registered to provide personal care to people in their own homes in Barnet and Brent. At the time of our inspection, the service told us that they were providing care to 63 people.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Aquaflo Care Barnet was previously registered with the CQC under a different name and at a different address. Aquaflo Care Barnet re-registered with the CQC at the new location on 26 September 2016. This was the first inspection of the service.

People who used the service told us that they felt safe around care workers. They said they were treated with respect and dignity when being cared for by care workers. Relatives told us they were confident that people were safe when being cared for by care workers.

Individual risk assessments were completed for people. However, a significant proportion of assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments. This could result in people receiving unsafe care and we found a breach of regulations in respect of this.

There were processes in place to help ensure people were protected from the risk of abuse. Despite receiving safeguarding training as part of their induction, some care workers we spoke with were unable to describe the process for identifying and reporting concerns and were unable able to give example of types of abuse that may occur.

There were arrangements to manage medicines safely and appropriately. Records showed care workers had received medicines training as part of their induction. Medicines policies and procedures were in place. However, we found unexplained gaps in five out of the 10 people’s Medication Administration Records (MAR). Further, we found that MARs were not completed fully. People were therefore at risk of not receiving their medicines safely and we found a breach of regulation in respect of this.

The service used an electronic system for monitoring care worker's timekeeping and whether they turned up on time or were late. We looked at a sample of people’s timekeeping records and found that there were numerous instances of calls being made to people which were in excess of 30 minutes of the agreed time. The registered manager confirmed that in these cases, the issues with the current electronic system was the reason why the records indicated that there were late visits.

As a result of the above we spoke with some of the people whose call logs indicated that there were a number of late visits as well as other people and relatives about the punctuality of care workers. All people we spoke with told us that generally care workers were on time and they raised no concerns regarding this. We also asked people and relatives if there were any instances where care workers had failed to arrive for a scheduled visit. All people and relatives told us that care workers always arrived for their contracted visits and stayed for the duration of the time required. Where people required two care workers for a visit, we asked them whether two care workers attended their visits and they told us that they did.

We looked at the recruitment process to see if the required checks had been carried out before staff started working with people who used the service. We looked at the recruitment records for twenty members of staff and found background checks for safer recruitment including, enhanced criminal record checks had been undertaken and proof of their identity and right to work in the United Kingdom had also been obtained. Two written references had been obtained for staff.

Care workers we spoke with told us that they felt supported by the registered manager. They told us that management were approachable and they raised no concerns in respect of this. Records showed that care workers had undertaken an internal induction which included training in areas that helped them to provide the support people needed.

There was evidence that care workers had received regular supervision sessions and this was confirmed by care workers we spoke with. We also saw evidence that staff had received an annual appraisal about their individual performance and had an opportunity to review their personal development and progress.

Care plans lacked information about people’s mental health and their levels of mental capacity to make decisions and provide consent to their care. Care workers we spoke with had a limited knowledge of the Mental Capacity Act.

Care workers were aware of the importance of respecting people’s privacy and maintaining their dignity. They told us they gave people privacy whilst they undertook aspects of personal care. People who used the service told us that they felt the service was caring and relatives were confident in care provided by the service.

There was limited information in care support plans about the support that people required from care workers. The information included in people’s care plans was task-focused. We found that there was a lack of clear instructions for care workers about what tasks needed to be carried out. We spoke with the registered manager about this and she explained that they were currently updating all care plans and ensuring that they were in the new format. The new format of care plans were person centred and would include information about people’s preferences. We noted that the service had made progress in respect of updating care plans but had a considerable number to complete. We found a breach of regulations in respect of this.

We found that the service did not have an effective system in place to monitor the quality of the service being provided to people using the service and to manage risk effectively. The service had failed to effectively check essential aspects of the care provided in respect of late visit monitoring and MARs. We found a breach of regulations in respect of this.

We found three breaches 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 the report.