Archived: Care Avenues Limited

Care Avenues provides personal care to people in their own homes. At the time of our inspection the service was supporting 103 people.

There was a registered manager in place who was present during our inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had taken effective action to address the concerns form our last inspection. This included improving recruitment processes, risk assessments, mental capacity assessments and quality monitoring.

People told us that they felt safe. Staff knew how to report allegations or suspicions of poor practice and recognise when people were becoming unwell.

People who needed prompting with their medicines were supported appropriately. Staff knew how to dispense medicines safely and there was regular training to make sure this was done properly.

People were supported by staff who had the appropriate skills and knowledge they needed to meet their care needs. Staff knew and respected people’s cultural needs and heritage.

People received care in line with their care plans. People were supported to eat and drink enough to stay well and staff assisted people to eat meals safely. The registered manager sought and took advice from relevant health professionals when necessary.

People were supported by regular staff with whom they had developed meaningful relationships. Staff knew how to treat people with dignity and respect.

Staff were knowledgeable about people’s preferences and provided care in line with their wishes. People were involved in deciding how they wanted their care to be delivered in line with the Mental Capacity Act 2005.

The registered manger took effective action when people’s conditions changed to ensure they continued to receive the appropriate support. People had access to a complaints system and the registered manager responded appropriately to concerns.

People who used the service and staff expressed confidence in the leadership of the senior team. The registered manager had a clear vision of the service which they shared with staff and they understood their responsibilities to the Commission.

The registered manager assessed and monitored the quality of care and operated a robust system to ensure people received their calls on time.

At our latest inspection we found the registered manager had taken action to address our concerns however further improvement was still required.

Care Avenues Ltd provides domiciliary care to 110 people in their own homes. At the time of our visit the nominated individual was also a registered manager for the service. A care coordinator had also recently become a registered manager for the service and shared the responsibilities of this role jointly with the nominated individual. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt the service kept them safe. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice. Care records however did not always contained detailed information for staff about how to protect people from the risks presented by their specific conditions.

Those people who required assistance to take their medications told us they were happy with how they were supported. Staff knew how to help people take their medications however it was not possible from people’s records to identify if people had received their medication as prescribed.

People told us that they were very happy with the support they received. People gave us examples of how the service had improved the quality of their lives and specific acts of kindness from the staff who supported them.

People and, where appropriate, their relatives, were consulted about their preferences and people were treated with dignity and respect. It was not always clear from records however if people had been supported in line with the Mental Capacity Act 2005.

Staff could explain the specific needs of the people they supported and how they met them. Staff were appropriately trained, skilled and supervised and they received opportunities to further develop their skills. New members of the senior management team had the skills, knowledge and experience they required to lead the service.

Although people told us there were enough staff and they were happy with the times they received support, we noted that calls were not always on time. Additional senior staff had been recruited to help deliver the service’s improvement programme.

People who required assistance to eat and drink told us that they were supported by staff who understood and met their nutritional needs and preferences. The manager sought and took advice from relevant health professionals when needed.

There was effective leadership from the nominated individual. Senior staff had a clear understanding of their roles and those areas of the service which they were responsible for managing and improving. Although senior staff were committed to improving the service there was no clear plan in place which could be used to reviewed and evaluate the provider’s improvement programme. Senior staff monitored the quality of care through observation and regular audits of events and practice although some of the systems to monitor and improve the service were still to be implemented. Some people told us that their complaints had not been handled promptly.

The nominated individual had taken action to ensure the service complied with the requirements of its registration. The nominated individual was in the process of applying to register another office in a different region so that people could be supported by a care team closer to their homes.

People in their homes and their relatives were consulted to find out their views on the care provided. This information was used this information to make improvements, where possible.

We gave short notice of our inspection so that we were able to make a judgement about the service provided. At the time of our inspection the service provided personal care and support to 70 people. To determine the standard of care provided and the satisfaction of people using the service we spoke with three people who used the service, four relatives of people who used the service, six care workers, the manager and three staff that were working in the office. We also spoke with the contracts monitoring officer.

We considered all of the evidence we had gathered under the outcomes that we inspected. Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that staff had received further training in safeguarding vulnerable adults. The staff we spoke with demonstrated a good understanding of what safeguarding vulnerable adults meant to them in their roles as care workers.

We found that the systems in place to monitor the quality of care provided by new care staff during their shadowing and probationary period had improved and were more robust. Staff were regularly reviewed during this period to ensure they could deliver care safely.

The provider had a call monitoring system in place that alerted staff if there were any late or missed calls. There had not been any missed calls since the monitoring system had been put in place. Records showed that any late calls were addressed immediately.

We saw that several new staff had been appointed. This ensured there were enough staff available for calls that required two staff and to cover staff absences. We looked at the provider's rotas and saw that staff were being allocated time to travel between calls. This meant people generally received care which kept them safe from the risk of harm.

Is the service effective?

Staff training was sufficient to meet all the needs of people using the service.

Is the service caring?

We spoke with three people being supported by the service and four relatives. We asked them for their opinions about the staff that supported them. Feedback from people was positive. One of the people who used the service said, 'They (the staff) do anything I ask them. They are very good.' One relative said, 'The standard of care is very good.' Another relative told us, 'They (staff) go out of their way to help. I'm perfectly satisfied.'

Is the service responsive?

People knew how to make a complaint if they were unhappy. All the people and relatives we spoke with told us if they had any complaints they would ring the office and were confident any concerns would be addressed. One relative told us, 'I've never had to complain but I have a number if I want to.' One person who used the service said, 'I've never had cause to complain, I do have a number to ring.'

We saw that the systems in place to respond to complaints had improved. Records showed that the provider responded to complaints in a consistent manner and in line with the complaints policy. Therefore people could be assured that their concerns would be dealt with appropriately.

We looked at the provider's process for recording, monitoring and reviewing complaints. The provider had reorganised the log of complaints to ensure it was accurate. We were told a system was in place to review complaints to identify any common themes with a view to reducing any complaints.

Is the service well-led?

After our last inspection, the provider had sent us a plan identifying what actions they intended to take in order to ensure the service was compliant with current health and social care legislation. At this inspection we saw that the provider had responded to our last report, improvements had been made and all our concerns had been addressed.

We found the systems in place to assess and monitor the quality of service that people received had improved. Systems had been put in place to check if people were receiving support at the agreed times. The provider had improved the system in place to capture the views of staff in order to identify how to improve the service. We found that the provider had improved the system to monitor the quality of care provided by new care staff during their shadowing and probationary period. The quality of staff training had been reviewed.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Safeguarding issues were identified by the provider as such and reported. However staff had not been well trained in safeguarding and their knowledge about safeguarding the people they supported was limited.

We looked at the recruitment of new staff. The records showed that the required recruitment checks into qualifications and experience were being followed. This meant people were supported by staff suitable to work with older, vulnerable people.

We looked at how staff cared for people. The provider did not have suitable systems to monitor if new members of staff were providing care in accordance with people's care plans or if they had any concerns about how to deliver care safely during their probationary period. The provider did not have a robust system to monitor if missed or late calls were becoming more frequent. We looked at the provider's rotas and saw that staff were not always given enough time to travel between calls. Therefore people were at risk of not receiving care which kept them safe from the risk of harm.

There was no consistent system in place to make sure that the provider learnt from events such as incidents and investigations. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people's safety.

Is the service effective?

People's health and care needs were assessed. Care plans were updated as people's needs changed and we saw that the provider supported people to access other health professionals when necessary. All the staff we spoke to could explain how to meet the individual needs of the people who used the service. This meant that the provider knew people's care needs and how they should be met.

Is the service caring?

We spoke with five people who used the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive. One person told us, 'They have made a big difference to my life'. When speaking with staff it was clear that they genuinely cared for the people they supported.

People using the service and their representatives completed an annual satisfaction survey. We saw that the provider actively sought people's views about specific aspects of their service.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. However we saw that the provider did not always respond to complaints in a consistent manner. Therefore people could not be assured that their concerns would be dealt with in line with the provider's complaints policy.

We looked at the provider's process for recording, monitoring and reviewing complaints. The provider did not keep an accurate log of complaints received or review complaints to identify common themes. In one instance the provider could not show us evidence that a person had received a response to their complaint. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that people are supported by a robust complaints system.

Is the service well-led?

The provider regularly sought the views of the people who used the service. We saw evidence that although the provider held meetings to seek the views of staff, these were not always well attended or documented. The system does not make sure that staff are able to provide feedback to the provider, so their knowledge and experience is not being properly taken into account.

The service had a selection of audits and checks but no formal quality assurance system. There was no evidence of the regular checking of the quality of care provided by staff. The provider did not monitor calls that were either too late, too early or missed to see if they were meeting people's care needs or if there were regularly occurring concerns. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing a service that effectively assesses and monitors the quality of service provision.