Axe Valley Home Care Limited

Axe Valley Home Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone using Axe Valley Home Care Limited 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.

At the time of our inspection 127 people were being supported with personal care by this service.

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

We received mixed responses from people about their experiences of using the service. Everyone praised the care staff and the care they received. However, some people were not happy about changes the provider had recently made. People were not happy that they were not always having their regular carers and did not know who would be undertaking their visits.

The provider had been making changes to the staff routes by putting in place clusters to minimise the distance staff travelled between visits. They had developed small teams of staff in each cluster, so there would be continuity. This had been successfully rolled out in Seaton but was causing anxiety for people in Exmouth where it was being rolled out.

The provider told us at the beginning of the pandemic they had considered the best use of the office team. They had decided not to send out weekly care rota’s in order to prepare staffing time and resilience for managing the service in the pandemic. They had written to everyone using the service setting out the time of their visits as commissioned and naming the locality supervisor and key worker.

The provider recognised that they could have improved their communication with people about the changes. They had restarted sending out their monthly newsletter in October 2020 which advised people, they had taken onboard the need to improve communication, particularly in terms of visit times.

Staff did not always speak positively about staffing, the way visits were scheduled, and the changes communicated about their rotas. The provider said they were in regular communication with the staff through newsletters and staff supervisions. However, they had recognised staff were under additional pressure during the pandemic and the changes being made and had increased their visibility in the community to support staff.

Improvements had been made to ensure that systems and processes were operated effectively to ensure people were protected from abuse and improper treatment. They were ensuring the providers policy to safeguard vulnerable adults was being followed.

The provider had a business continuity plan which set out how they would operate in extreme conditions. They had risk assessed each visit people received to prioritise visits in case they needed to implement their business continuity plan. They also employed rapid response staff to cover staff absences to help ensure people received their visit.

Medicines continued to be safely managed and people told us staff wore the correct PPE during their visits. The service had implemented a number of additional infection control measures in response to the coronavirus pandemic.

People were given the opportunity to provide feedback to the service about their experience of the care received. Quality monitoring calls were completed on a quarterly basis to speak with people to ask about the service they receive and if they had any concerns.

We have made a recommendation that the provider continues to look at their communication methods and ensure the new systems they have put in place are fully embedded so improvements continue and are sustained.

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 Requires improvement (published 18 March 2020).

Why we inspected

The inspection was prompted in part due to concerns about missed and shortened visits to people and a negative culture between office and management staff and care staff. A decision was made for us to inspect and examine those risks. We also looked at a breach of legal requirements which had been found at the unannounced comprehensive inspection in January 2020. The provider had completed an action plan after the inspection to show what they would do and by when to ensure systems and processes were operated effectively to ensure people were protected from abuse and improper treatment. This focused inspection checked they had followed their action plan and to confirm they now met legal requirements.

We undertook an announced focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Axe Valley Home Care Limited on our website at www.cqc.org.uk.

Axe Valley Home Care Limited (“Axe Valley”) was providing personal care to 110 people in their own homes aged 65 and over at the time of the inspection.

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 had not always been protected when raising concerns about poor practice. The provider/registered manager had not then ensured national and local policy and procedures were followed. The local authority and CQC had not been informed of allegations that had been made which meant external scrutiny and support had not been possible.

Other than the issue above, people and relatives were largely happy and satisfied with the service provided by Axe Valley. There were some comments about improved communication with the office being desirable, but systems were already being reviewed and new efforts planned to improve this.

People told us the staff who came to their home were respectful, considerate and compassionate. Staff acted to support people to be in control of their care and stay in their homes if that was their desired goal. In life and at end of life people were enabled to live their life within their community. Extra effort was made to ensure people were safe and protected from risks as much as possible. Needs in respect of people’s medicines, food and fluid were all safely and effectively met.

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.

The service was active in supporting people to be less isolated in their community and to enable people living with dementia to live as full a life as possible.

Staff listened to people’s concerns and fed their views to the office staff to ensure these could be addressed. There was regular contact with staff, people and relatives to encourage open and honest communication.

Rating at last inspection

The last rating for this service was Good (published 24 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Axe Valley Home Care Limited on our website at www.cqc.org.uk.

We have identified a breach in relation to how the service safeguarded people at this inspection. This means the rating for this service has changed to Requires improvement.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

At the last inspection in June 2015, the service was rated Good overall, although the Responsive domain was rated as requires improvement as we found a breach of regulations. We asked the provider to submit an action plan of how they would address the breach.

This inspection took place on 22 and 25 May 2017 and was announced. The provider was given short notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. At this inspection we found the service remained good in the Safe, Caring and Well-led domains and had addressed the breach of regulation in the Responsive domain.

The inspection team consisted of two adult social care inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses domiciliary care services. The expert by experience and one inspector spoke by telephone with people and their relatives following the second day of inspection.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers and nominated individuals, 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 registered manager understood their responsibilities and worked with other senior managers and staff to maintain and improve the quality of the service. This included undertaking quality assurance checks and audits to monitor the service.

At this inspection the service remained Good overall. However, the service was not fully effective as most staff had not completed regular training updates. However the registered manager had recognised that this was an area where improvement was required. Staff received some supervision, although not all staff had had the supervisions described in the organisation’s supervision policy. Where staff were not performing to the standards required, there was evidence that this was addressed with them and support was given for them to improve.

Staff were recruited safely and were provided an induction when they joined the service. This included undertaking training as well as work shadowing colleagues.

The service had recognised they needed to improve their responsiveness to changes in people’s care needs. A new electronic care record system had been introduced which allowed care records to be revised and updated during a visit by staff. This meant that people received care which met their needs more fully. The service was able to respond more quickly where a visit did not occur at the right time.

People were supported to have choice and control of their lives by staff who were kind and caring. Feedback from people was mainly very positive and included comments such as “They’re always chatty, cheerful, happy”, “They make you feel they would do anything you ask them” and “Very kind, very very very kind.”

Staff supported people to take their medicines safely and also ensured that where required, people were supported to access health and social care professionals as well as have sufficient to eat and drink.

Staff understood their responsibilities in terms of safeguarding vulnerable people. Staff also understood and worked within the requirements of the Mental Capacity Act (2005).

We spoke with 26 people and relatives about the care received and we looked at 14 people's care records. We spoke with 14 staff and looked at six staff files. This included office based staff, care workers and the registered manager.

People and relatives we spoke with were happy with the care provided by the agency. One person said, 'I am very happy with the carers, they are my friends'. A second person said, 'They are very good, I am happy with the care'. A third person said, 'They do what I can't do'. Most people reported that the care workers who visited them were caring and compassionate and that staff treated them with dignity and respect.

We found people's care needs were assessed and there were care plans in place about how to meet each person's needs. These included information about individual risk factors and how to reduce those risks for people. People said they thought the agency was reliable and confirmed they received weekly rota information about the names of care workers and the times of planned visits. They said staff mostly arrived on time, and stayed for the agreed time. Where there were any delays, most people said the agency let them know.

People were protected from risk of infection because they confirmed that staff washed their hands before and after providing personal care and wore gloves and aprons. People were protected from abuse because staff had received suitable training to recognise signs of abuse and knew how to report concerns appropriately. Where concerns about abuse were raised, they were reported to the local authority and were followed up appropriately. We found the agency had enough staff to meet people's needs. We also looked at record keeping and found accurate records were maintained. The provider told us about further improvements being introduced to make records of daily visits more person-centred.

People and relatives we spoke with confirmed staff arrived on time and stayed for period agreed. One person said 'the carers always chat, they have a friendly approach, I don't know what I should do without them', another person said care workers 'have a cheerful presence and do the job willingly and well'. One relative we spoke with said the care workers visits were a positive experience for the person, they said 'he is always delighted to see them', another relative said, 'If it wasn't for them, I wouldn't see anyone at all, they are all so cheerful'.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We found people experienced care, treatment and support that met their needs and protected their rights. We found safe and appropriate arrangements in place to manage people's medicines. Appropriate checks were undertaken before staff began working at the agency. Comments and complaints people made were responded to appropriately.

We found the service was meeting the five standards we inspected.