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Archived: Advance Home Help and Support Services Also known as Lesley Lewington

Overall: Requires improvement read more about inspection ratings

349 Ordnance Road, Enfield, Middlesex, EN3 6HF 07950 648301

Provided and run by:
Mrs Lesley Diane McDaid

All Inspections

13 February 2020

During a routine inspection

About the service

Advance Home Help and Support Services is a domiciliary care agency providing personal care to people living in their own houses and flats in the community.

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. At the time of the inspection the service was providing care and support to 17 people.

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

People were not always supported by staff who had consistently received the necessary training and support to fulfil the role they were employed to do. We have made a recommendation about this.

Quality assurance system and processes were not sufficiently robust and were not effective in addressing the concerns we found.

Recruitment at the service was safe and sufficient checks took place before people were employed to work with vulnerable adults.

Assessments of people's care and support needs were carried out before they started using the service.

People told us they were treated with respect, kindness and compassion. People were supported by a small but consistent staff team who knew them well.

Risks to people were assessed, monitored and reviewed regularly or when people's needs changed.

People were supported with their medicines safely; they received these on time and as prescribed. However, competency assessments to assess staff understanding and knowledge in medicines administration had not been recorded. We have made a recommendation about this.

People were supported with their nutritional and hydration needs where this had been identified as part of their care.

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.

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 (report published 14 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

9 February 2017

During a routine inspection

This inspection took place on 9 February 2017 and was announced. The service was given 48 hours' notice. This was to ensure that someone would be available at the office to provide us with the necessary information.

At our last inspection on 2 March 2016 we found that the provider was not meeting all the standards that we inspected. We identified breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not have effective systems in place to record and monitor the quality and safety of service provision in order to improve, learn and develop. Staff did not receive regular supervision to support them in their role. Staff appraisals were not taking place which meant that staff performance was not being effectively monitored and reviewed. At this inspection we found that the provider had addressed these concerns.

Advance Home Help and Support Services is a domiciliary care agency based in North London which provides care in the community within people’s own homes, predominately in Enfield. At the time of this inspection there were 14 people using the service. The service provides personal care, to older people some of whom are living with dementia and or have physical disabilities.

The service had a registered manager. 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.

People using the service and a relative told us that they were happy with the care and support that they received from Advance Home Help and Support Services. People told us that they received care and support from care staff that respected their privacy and dignity and supported them according to their needs and wishes.

Systems and processes were in place in order to protect people from harm. Care staff demonstrated a clear understanding of safeguarding adults and were able to describe the steps they would take in order to protect people from abuse or significant harm. Other procedures that the service followed in order to keep people safe included personalised risk assessments which assessed people’s individual identified risks and robust recruitment processes.

The registered manager told us that at present they felt that they had sufficient numbers of staff to meet the needs of the people they supported. In addition the registered manager and deputy manager were always available to deliver care where required. Rotas seen allowed for travel time between each call.

There were suitable and safe arrangements in place in relation to the administration and recording of medicines. The registered manager carried out weekly and monthly audits to ensure that where a person required support with medicines that this was monitored regularly.

The provider ensured that all staff recruited had received the necessary training to deliver good care. Most care staff had been through the mandatory social care training through previous employments and were able to provide evidence of this. Where gaps in knowledge were identified by the registered manager, appropriate training was organised and delivered. Opportunities were also provided to all staff to develop their knowledge and skills.

Care staff told us and records confirmed that regular supervisions were taking place and that these were an opportunity to discuss any concerns or issues that staff may have and the areas where further support maybe required. Annual appraisals were also taking place which addressed future development and training.

The registered manager and all care staff were able to demonstrate a good understanding of the key principles of the Mental Capacity Act 2005 (MCA) and how these were to be applied when supporting people. People told us that they were supported to make their own choices and decisions where possible. Care staff were able describe ways in which they encouraged and supported people to make their own choices and decisions.

Each person receiving care and support had a care plan in place which was individualised and provided detailed information about the care and support that they required. Each care plan clearly set out the person’s needs and the support they required taking into account their wishes, likes and dislikes. Care plans were regularly reviewed and updated as and when required.

The registered manager ensured that details of all communication that took place between people, relatives and the service were clearly documented and held as part of the person’s care plan. This also included details of all actions taken by the service in response to the communication which included follow up to medical appointments, financial clarifications and any other issues or concerns related to the care and support that the service provided.

People told us and rotas confirmed that they received care from a regular team of care staff with whom they had developed good working relationships. People and relatives told us that they were treated with respect and dignity. We were told that although staff were present to support people they also encouraged and promoted people to build their independent living skills.

The registered manager confirmed that had not held any team meetings as most staff worked part time for the service and also were in employment elsewhere which made organising staff meetings difficult. However, the registered manager told us that they were always in regular contact with all care staff and were always available to care staff when required. In addition the registered manager planned to develop and produce monthly newsletter as a method of information exchange.

People and relatives knew who the registered manager was and felt able to raise concerns or issues relating to the care and support that they received. They also felt assured that any concerns or issues raised would be appropriately addressed by the registered manager.

A number of quality assurance systems were in place to monitor the quality of the service being provided and to identify any issues or concerns. These included medicine audits, spot checks, regular telephone monitoring, quality surveys and staff questionnaires. This allowed the provider to learn and improve the quality of service provision.

2 March 2016

During a routine inspection

Advance Home Help and Support Services is a domiciliary care agency based in North London which provides care in the community, predominately in Enfield. This was an announced inspection and the service was given 48 hours’ notice. This was to ensure that someone would be available at the office to provide us with the necessary information.

This inspection was the first inspection of the service since it was registered with the CQC in December 2013.

At the time of the inspection there were ten people using the service. The service provides personal care, escort and cleaning services to older people some of whom are living with dementia or have physical disabilities.

The service had a registered manager. 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.

People using the service and their relatives told us that they were very happy with the care and support that they received. Care staff knew the people they were supporting very well and carried out their duties with dignity and respect at all times.

Each person using the service had a care plan and a detailed overview of the care and support they required which was held at the persons own home. Care plans were reviewed regularly and updated where required. Care plans also included risk assessments with information on what the risk was and how these were to be managed to ensure people were kept safe from harm. However, the service had failed to complete a risk assessment for a person who had been prescribed a blood thinning medicine and was at risk of bleeding if they sustained a cut or injury. The registered manager was made aware of this and a risk assessment was compiled and was sent to the CQC the next day.

There was no available quality assurance audit system to ensure that internal systems and processes were checked in order to highlight issues and concerns so that the service could learn and improve. The main issue identified as part of this inspection was the lack of completed paperwork especially around the areas of supervisions, appraisals, maintaining detailed care planning records and staff meetings.

The service had a supervision and appraisal policy. The supervision policy stated that staff were to receive supervision once a month. During the inspection, records that we looked at did not evidence that supervisions were taking place as per the policy. The service had also not completed any appraisals for its staff members.

Staff recruitment processes were robust. We looked at four staff files which showed that prior to employment of care staff all appropriate checks had been completed. Staff files showed two written references, identity and visa checks and criminal record checks.

People received care and support from staff who had the knowledge and skills needed to carry out their roles and responsibilities effectively. Most of the staff employed by the service were professionals within the adult social care sector. The registered manager explained to us that most staff employed by the service had received in-depth training through their own respective professions and brought this experience and knowledge with them to their role.

The provider had a complaints procedure which gave people direction on who to contact if they had an issue or concern to raise. We also saw a copy of this procedure within the care file held at people’s own home.

At this inspection we identified two breaches of Regulation 17 and Regulation 18. These breaches were in relation to lack of supervision and appraisals for staff and lack of records.