We carried out a review of the data available to us about Almost Family Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Almost Family Limited, you can give feedback on this service.
At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.
About the service
Almost Family Limited is a domiciliary care agency providing personal care to 6 people at the time of the inspection. The service provides support to older people. The service supported 10 people in total.
People’s experience of using this service and what we found
Right Support: People were involved in their care planning and were provided with a draft of their care plan to modify and finalise. Care plans were regularly reviewed, and support was adapted to peoples changing needs. People told us they were encouraged to be as independent as possible. 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.
Right Care: People’s diversity was not being captured as accurately as it could be and the registered manager changed their system as a result of our feedback on the day of inspection. The registered manager explained it was important that they respected people’s privacy and dignity by being subtle in their provision of care. They told us, “There is nothing worse than having a branded car on your drive which says ‘care’. We could be a relative. It takes the stigma away.” People told us they felt an effort was made for care to be provided in the way they chose.
Right Culture: The ethos of Almost Family Limited was to promote a bespoke care service which was tailored to the persons needs rather than service led. There was a focus on providing care calls at the time people specifically requested rather than directed by staff availability and service needs. Staff were conscientious in their work and wore additional personal protective equipment if they had a cold and felt it would make people feel more comfortable. People and their relatives told us the management and team were approachable and open with their communication.
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 22 August 2019). The service had been inspected since, where we found breaches of regulation had been met, but the rating of the service was not updated (published 15 October 2020).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Almost Family is a domiciliary care agency. It provides a service to older adults, some of whom are living with dementia. At the time of our inspection, it was providing personal care to four people living in their own houses and flats. 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.
People’s experience of using this service and what we found
We found improvements were made since our last inspection. This meant people received safe care as risks to people had been reviewed and medicines management systems had been updated.
People told us they felt safe and well treated by staff. They told us staff knew their care and support needs, and they trusted staff to provide the best support possible to them.
The registered manager had made improvements around risk management. People had detailed risk assessments in place within their care plans which included guidance for staff about how to reduce that risk.
The management of the agency had improved and there was a robustness about the management oversight. This was facilitated by the introduction of an auditing programme and spot checks and supervisions carried out with staff. Staff told us they felt valued by the provider and felt proud to be a part of the organisation.
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.
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 21 August 2019) and there were multiple breaches of regulations associated with person-centred care, consent, safe care and treatment, good governance and staffing. 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 sufficient improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
Breaches of legal requirements were found when we carried out an unannounced comprehensive inspection of this service on 11 August 2019. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
We undertook this targeted inspection to check the provider had followed their action plan and to confirm they now met legal requirements in relation to safe care and treatment, staffing, and management of the service. This report covers our findings in relation to the key questions of safe and well-led which contain those requirements.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We undertook this targeted inspection to follow up on breaches and one recommendation identified at the previous inspection. The overall rating for the service has not changed following this targeted inspection and therefore remains requires improvement.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Almost Family LTD on our website at www.cqc.org.uk.
Almost Family is a domiciliary care agency. At the time of our inspection, it was providing personal care to eight people living in their own houses and flats. It provides a service to older adults, some of whom are living with dementia. Not everyone using Almost Family receives a 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.
People’s experience of using this service and what we found
The lack of good governance over the service has resulted in multiple breaches in the regulations and putting people at risk of not receiving safe, effective or responsive care. Risks to people, medicines and accidents and incidents were not appropriately recorded, which left people at risk of avoidable harm. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The provider did not have a clear set of mandatory training modules that staff were required to complete, meaning that their induction process was therefore not thorough. Staff did not receive regular supervision or spot checks to ensure they were effective and competent at their roles.
Care plans were not personalised to reflect the individualised care that people received, or their medical conditions and the care people required due to these. Complaints were dealt with in a timely manner but were not formally recorded or responded to. The service was not delivering end of life care to anyone at the time of the inspection, but this topic had not been approached with people and their relatives in preparation. The service worked alongside other agencies but did not fully utilise other connections to local organisations. Quality assurance audits were not thorough which meant that the shortfalls we found had not been identified by the registered manager or provider.
However, people and relatives felt the management team were approachable and staff felt valued. People and their relatives were approached on a regular basis for feedback, which had been positive. There were plans in place to improve the service by introducing an electronic care planning system.
People and their relatives told us they felt safe, and staff were aware of their role in safeguarding people from abuse. There was a sufficient number of safely recruited staff to meet people’s needs. Staff felt there was an effective communication system in place to provide consistent care, and referrals to healthcare professionals were made where required.
People and relatives told us staff were kind and caring and treated them with dignity and their belongings with respect. People were encouraged to be independent where safe and involved in decisions around their care where possible. Where people were unable to be involved in these decisions, their next of kin had been approached.
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)
At the last inspection the service was rated Good (3 December 2016).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to safe care and treatment, people’s rights being protected, staff training, personalised care being delivered and good governance. Please see the action we have told the provider to take at the end of this report.
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 we receive any concerning information we may inspect sooner.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
This inspection took place on 8 November 2016. The provider was given short notice of the inspection date as the service provides care to a small number of people and we needed to ensure that people would be available for us to speak to at the service office.
There was a registered manager in post. 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. On the inspection we met with the nominated individual from the registered company which operates the service. They told us the registered manager would be making application to remove themselves from the registration of Almost Family. The service had already appointed a new manager who we met on this inspection. They told us they would be making an application to register, but as they were not yet registered are referred to throughout this report as the manager.
As part of this inspection we received positive feedback from people receiving a service and staff working for the agency. All of the people we spoke with told us that they had a regular small team of carers that knew them well, staff arrived on time, and they never had any missed visits.
People were supported by sufficient staff who had the skills and knowledge to meet their needs. There were clear training programmes for both individual staff and the service as a whole. Although these were not yet completed for all staff, staff were working to complete these in a short time framework. Staff were supported through regular supervision, spot checks and appraisals of their work, and told us they felt the management were approachable and they had the skills they needed.
People were protected from the risks associated with poor staff recruitment. A full recruitment procedure was followed for new staff. This included disclosure and barring (police) checks, references and checks on people’s identity.
People were protected from risks associated with their care because the service carried out regular assessments of the risks and mitigated these where possible. People’s care plans included assessments of people’s skin, falls risks, nutrition, mobility, moving and positioning. They also covered any concerns about their home such as access issues.
People received their medicines safely where this was a part of their care plan. One person told us about how staff were very careful when dealing with their medicines which gave them confidence. Other people were able to maintain their independence with medicines as staff would guide and prompt them to take them when needed.
People’s healthcare was supported because the agency liaised with community healthcare professionals where there were concerns over people’s wellbeing. We heard of how staff had for example contacted community nursing teams in response to concerns over a person’s well being, and in another recent incident had contacted the paramedic service as a person had ben found on the floor. They waited with the person until the person was taken to hospital.
People were supported to eat regular healthy meals where this was a part of their care plan. This included being supported and encouraged to eat a healthy diet where this was possible. Records helped ensure that people received a varied diet where staff provided this.
People were protected from the risk of abuse through the provision of policies, procedures and staff training. Staff understood how to raise concerns about people’s well-being and how to ‘whistle blow’ about the organisation if they suspected people were being abused. Policies were in place to ensure staff were clear about areas such as supporting people with their finances or receiving gifts.
People’s needs were met by staff who related to them in a friendly and positive manner. Staff expressed positive feelings towards the people they were supporting and this was also evidenced in the way records were written, reflecting people’s positive qualities in respectful language. People receiving a service told us how they enjoyed the relationships they had built up with staff and how important they were to them. People’s privacy and dignity were respected and supported, and their confidentiality was respected. Records were maintained securely and computer passwords protected information from people who did not need access to this, for example financial transactions.
People benefitted because staff ensured they understood and respected their wishes and choices about their care. People receiving a service from Almost Family had the capacity to make decisions for themselves and staff supported them with this, by encouraging them to express their wishes. These were then reflected in their assessments and care plans, which people signed to confirm their agreement.
People were protected from the risks of cross infection as staff understood how to reduce these risks. Staff told us they had a plentiful supply of gloves, aprons and hand cleansers to help support good infection control practices in people’s homes.
People benefitted from safer care because the new manager had begun a programme of auditing of the service to identify what was working well and what could be improved. This already had covered areas such as medicines, supervision and recruitment files. The manager and nominated individual took advantage of learning resources to improve the service, including use of the intranet, CQC reports and membership of the United Home Care Association.
People and relatives were able to make changes at the service as they were consulted about their views on how the service could be improved through annual questionnaires. Quality assurance systems were independently operated and audited by an external consultant to help ensure people could feel they could be as honest and open as they wanted to be about the services they received.
People could be confident concerns and complaints would be investigated and responded to. Systems, policies and procedures ensured that complaints would be listened to and actions taken to address any concerns identified.
Good record keeping helped ensure people’s needs were understood and met. Records seen were up to date and well maintained. There were safe facilities for disposal of records no longer needed, and the provider had clear information available about notifications that needed to be sent to the CQC.
We looked at a sample of care plans which showed people were involved in the decisions about their care, how they wanted their care provided and their preferences regarding times of care visits and care workers.
We found that people were provided with appropriate information about their care plans and given support in relation to these. We found evidence the provider, with agreement of people liaised with other professionals involved in their care including Local Authority social care staff and healthcare professionals.
We found evidence the provider worked with people to enable people, where able, to retain their own self care skills and management of their own care, and that the provider promoted people's autonomy, independence and community involvement.
People told us they received care in a way which met their needs. One person commented, 'I have regular staff. They have been flexible to my needs and have accommodated extra shifts. I don't have to struggle to be in charge of the household anymore. If I am ill I know I can stay in bed.'
We found people felt the service was delivered safely and people felt protected from harm. A relative commented to us, 'I feel perfectly confident (my relative) is safe.' A person using the service said, 'I feel safe with the carers; if there is a hold up they will call me, I have never been left without a service, they even got to me in the snow. I have been very impressed.'
People were recruited safely and checks were undertaken to make sure they were suitable to work with vulnerable people.
None of the people we spoke with said they had needed to raise any formal complaints. They said whenever they had made comments about the service they had been responded to and issues had been resolved to their satisfaction. One person commented, 'I feel I can speak to the office staff at any time. The staff are all lovely people. They listen to us, respond to concerns and try and resolve them.'