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Inspection carried out on 25 June 2018

During a routine inspection

The inspection took place on 25 June 2018 and was announced to ensure staff we needed to speak with were available. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older people, who may be living with a diagnosis of dementia, people with a physical disability, people with a sensory impairment and younger adults. At the time of the inspection 40 people received the regulated activity of personal care.

At our last inspection we rated the service good overall, but requires improvement in the key area of safe, where we found one breach of the regulations. At this inspection we found the evidence continued to support the overall rating of good, the breach had been met and now the key area of safe is also judged to be good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The provider operated safe recruitment processes. People received continuity of care from regular staff. Systems were in place to monitor the capacity of the service to provide people’s care and relevant actions had been taken to ensure people received their care safely, when there was pressure on staffing capacity.

Staff had undertaken relevant training and processes were in place to safeguard people from the risk of abuse. Risks to people had been assessed and managed to ensure their safety. Processes were in place to ensure people received their medicines safely from trained staff. People and staff were protected from the risk of acquiring an infection. Staff understood the requirement to report any concerns to the provider. Where required, investigations were completed and improvements to the service made for people.

People’s needs had been assessed and their care was delivered in accordance with current legislation and guidelines. People were supported by staff to eat and drink sufficient for their needs and to ensure their health needs were met. Staff could provide end of life care to people as required. Staff were supported to provide effective care to people through the provider’s induction, training and supervision processes.

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. People received responsive and adaptable care that was tailored around them and their interests.

People were treated by staff in a caring manner and provided with the emotional support they required. People were encouraged to express their views and to be actively involved in decisions about how they wanted their care provided. People’s privacy, dignity and independence were respected and promoted by staff.

There was an open culture and clear values which underpinned the delivery of peoples’ care. There was a registered manager to run the service who understood their legal responsibilities. Processes were in place to seek and act upon people’s and staff’s feedback and to monitor the quality of the service provided. Processes were in place to enable people to make a complaint and any issues raised were investigated and addressed for people. The service worked in partnership with other organisations to ensure people received high quality care.

Further information is in the detailed findings below.

Inspection carried out on 12 September 2016

During a routine inspection

This comprehensive inspection took place on 12 and 13 September 2016 and was announced to ensure staff we needed to speak with were available. Altonian Care Ltd is registered to provide personal care to older people and those living with dementia. They also provide a service to people with a physical disability, sensory impairment and younger adults. At the time of the inspection there were 60 people using the service.

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.

We previously carried out an announced comprehensive inspection of this service on 29 February and 1 March 2016. Breaches of legal requirements were found in relation to safe care and treatment and clinical governance. The provider was served with two warning notices that they were required to meet by 30 June 2016. Following the inspection the provider sent us an action plan detailing how they would meet the regulatory requirements by the required date. At this inspection we found the requirements of these regulations had been met.

At this inspection we found action had been taken to ensure people received their medicines safely. Staff were required to undertake medicines training, followed by an assessment of their competency to administer people’s medicines. Improvements had been made in relation to the processes for recording people’s medicines. The registered manager planned to introduce topical cream charts to provide staff with visual guidance for their administration, in addition to the written guidance available.

Staff received an induction to their role based on industry requirements. The registered manager had determined the staff mandatory training requirements and staff were required to keep their knowledge up to date. Staff were supported in their professional development and received regular supervision of their work which included observations of their practice to check their competence to deliver people’s care.

Since the last inspection the registered manager had reviewed the robustness of the systems they had to enable them to deliver people’s care and to monitor the quality of the service provided. Processes were now in place to enable them to audit people’s medicine records effectively. There were also systems to enable the registered manager to identify and address staff training and supervision requirements. People’s views on the service had been sought and action had been taken where required in response to the feedback received, to improve the service for people.

The registered manager had completed recruitment checks in relation to staff. However, they had not always ensured that applicants had provided the date when they completed their full-time education to enable them to establish if they had a full employment history, nor had they always sought an explanation for any gaps in the applicant’s employment history. There was the potential that people might have been placed at risk from the recruitment of staff as the provider had not always fully assured themselves of their suitability for their role.

People and their relatives told us they received consistency in their care staff. People received their care on the days they needed it and at the times they required. Staff were now expected to use the electronic system to ‘log-in’ and out of people’s calls to ensure a record of the call time and duration was maintained.

Staff had undertaken safeguarding training and understood their role in relation to safeguarding people from the risk of abuse. Safeguarding alerts had been made to the local authority by the registered manager as required to safeguard people from the risk of abuse.

People had risk assessments in

Inspection carried out on 29 February 2016

During a routine inspection

The inspection took place on 29 February and 1 March 2016 and was announced to ensure staff we needed to speak with were available. Altonian Care Ltd is registered to provide personal care to older people and those living with dementia. They also provide a service to people with a physical disability, sensory Impairment and younger adults. At the time of the inspection there were 60 people using the service.

The service has a registered manager who is also the provider; they work within the service managing it on a daily basis. 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.

Medicine audits were not effective and MARs had either not been audited or contained gaps that had not been identified or addressed, this had placed people at risk of unsafe medicines administration.

There was a lack of robust systems to assess the quality of the service people received and to identify any potential risks to people. Information generated from incidents, care calls and staff training and staff supervisions for example, had not been used to monitor the quality of the service people received or to identify any trends in relation to people’s care to ensure their safety.

Accurate and complete records were not always maintained. People’s views on the service had been sought however there was a lack of evidence to demonstrate feedback had been used to drive service improvement.

The provider had not ensured that when staff joined the service from other providers that they had obtained written evidence of their medicines training prior to them being rostered to administer people’s medicines. There was a lack of evidence to demonstrate staff’s competency had been assessed following medicines training. People’s MARs were hand written and not checked for errors. Although there was no evidence that people had come to harm, people had been placed at potential risk of harm from unsafe medicines administration.

Records showed not all staff had completed training in areas such as safeguarding, Mental Capacity Act (MCA), and moving and handling. Staff had been rostered to support people with moving and handling without written evidence of their qualifications and competence to do so. Although there was no evidence that people had come to harm, people had been placed at potential risk of harm from unsafe or ineffective care.

People provided positive feedback about staffing. They told us they received consistency in their care and that staff stayed the required length of time. The provider did not have a formalised system to plan for their staffing needs, but they understood staffs availability and the capacity of the service to take on new packages of care. The provider had not ensured they had monitored the duration of people’s calls, to ensure they received calls of the required length. The provider had completed relevant pre-employment checks upon staff to ensure their suitability to work with people.

Staff told us they felt supported by the provider in their role. Staff records demonstrated staff had received some one to one supervisions and spot checks of their work. However, as the provider did not keep a central record of these, there was a lack of written evidence to demonstrate that staff were sufficiently supported, to ensure they could support people effectively.

People told us that they felt safe from abuse or harm. Staff told us that they knew what to do if they suspected that someone was being abused or was at risk of harm. The provider did not have a robust system in place for recording their management of safeguarding concerns, to demonstrate the actions they took and to be able to demonstrate people were adequately safeguarded.

People had ris