Archived: Assist Home Care

The inspection took place on 13 November 2017 and was announced.

There was a registered manager in place at the time of our inspection. Like registered providers, registered managers are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our last inspection on 16 October 2015 we found the agency did not always have sufficient staff to provide the services required. People told us this meant that sometimes care staff were late arriving with them or they received different care staff from those they had been allocated. Care staff reported that their calls were usually scheduled back to back which meant they had no time to travel between calls. This is the first time the service has been rated Requires Improvement overall, however, Safe was rated Requires Improvement at the last inspection.

At this inspection we found this issue had not been satisfactorily addressed. Whilst some people told us they could rely on their care workers to arrive at the scheduled time, others reported that their care workers often arrived late. Many care workers reported that their visits were still scheduled back to back, which meant they had no time to travel between calls. This meant staff were under pressure to complete their scheduled calls and that people’s calls were often delayed. For some people, this problem was compounded by the fact that they had not been contacted to inform them staff were running late.

Some people regularly had their calls cancelled by the agency, sometimes at short notice, which meant they had to manage some aspects of their care themselves or ask their relatives to provide the support they needed. Many people had raised concerns about late and cancelled calls and poor communication in satisfaction surveys but these problems continued to occur regularly.

Information supplied by the provider showed that three care calls had been missed and that 170 calls had been cancelled by the agency between 1 September 2017 and 13 November 2017.

The agency did not have an effective system of monitoring the timings of calls made by staff. Staff signed in and out in a book at people’s homes but the provider did not have access to real time information about call completion. There was also a risk that the provider would be unaware that a care worker had not attended a visit unless the person receiving care, or someone acting on their behalf, contacted the agency to let them know. Although missed calls were infrequent, the potential consequences of missed calls for some people were serious.

People felt safe when staff provided their care because their care workers understood their needs and any risks involved in their care. Risk assessments had been carried out to ensure that people receiving care and the staff supporting them were kept safe.

People told us staff maintained the security of their homes and said staff helped them keep their homes clean and hygienic. Care staff received training in the prevention and control of infection and people said staff wore appropriate personal protective equipment when providing personal care. Where people’s care involved support with medicines, this was managed safely.

There was a contingency plan in place to ensure people would continue to receive their care in the event of an emergency. Accidents and incidents were recorded and reviewed to identify any actions that could be implemented to prevent a recurrence.

People were protected by the provider’s recruitment procedures. The provider carried out checks to ensure they employed only suitable staff. Staff attended safeguarding training and understood their responsibilities in terms of recognising and reporting abuse

People’s needs had been assessed when they began to use the service to ensure the agency could provide the care they needed. Staff had access to the induction and training they needed to carry out their roles. All staff had an induction when they started work, which included shadowing other care workers to observe how people preferred their care to be provided. Staff attended regular supervision with their managers which gave them an opportunity to discuss their training and development needs.

People’s care was provided in accordance with the Mental Capacity Act 2005. People had recorded their consent to their care and told us staff asked for consent before providing their care on a day-to-day basis. Staff understood the importance of enabling people to make choices about their care.

People told us staff prepared meals they enjoyed and knew their likes and dislikes. People’s dietary needs were discussed during their initial assessment and any needs related to nutrition and hydration were recorded in their care plans. Staff attended training in nutrition and hydration in their induction and had regular refresher training in this area.

Staff supported people to maintain good health and liaised with healthcare professionals on their behalf if they wished. People told us staff had responded appropriately if they became unwell, including calling emergency medical services if necessary.

People were supported by kind and caring staff. People had developed positive relationships with their regular care workers and enjoyed their company. They said staff treated them with respect and maintained their privacy and dignity when providing their care. Staff supported people to maintain their independence and people were encouraged to be involved in planning their care.

Each person had an individual care plan drawn up from their initial assessment which provided guidance for staff about the care they needed. People said they had been encouraged to participate in the development of their care plans and were confident that if they requested changes to their care plans their wishes would be respected. People were happy with their regular care workers and said they were well matched to their needs. Some people said contact with their regular care workers helped protect them from social isolation.

The provider had a complaints procedure which was provided to people when they began to use the service. Most of the people we spoke with told us they had not needed to complain, although all said they knew how to do so. People who had complained said they were satisfied with how the agency dealt with their complaints.

The care people received was monitored by the agency’s field care supervisors during regular spot checks. Field care supervisors also checked important aspects of people’s care, such as medicines management and the written notes of the care provided. The provider had notified CQC and other relevant agencies of significant events when required.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found that people's individual needs were assessed and that care was planned and delivered to meet their needs and promote their welfare. A person said "I am highly appreciative of the little things that I can't manage or that don't occur to me that staff help me with". A person's relative said "they are respectful and my relative is very happy with them". Some people told us they had been frustrated and/or inconvenienced by occasional cancelled or changed calls.

We found that staff understood their responsibilities to safeguard people at risk of abuse and who to report their concerns to. The provider took steps to prevent abuse and acted to protect people's safety and welfare.

People told us that they were satisfied with the standard of care they received from the provider's staff. We found that the provider carried out the relevant checks to ensure people were supported by staff that were trained and/or experienced and of good character.

We found that people were asked about the quality of service they received and that the provider had suitable arrangements in in place to identify and manage risks to people who used and worked in the service.

As part of our inspection we spoke with five people who used the service and three people's relatives.

We spoke with the agency's operational manager and four members of staff.

People told us that were happy with the care and support provided although two people said that there had been some staff changes which meant that sometimes people did not always experience consistency of care from staff who knew their needs well.

People told us that the staff were caring and respectful. Comments included, "Excellent care", "the staff are very caring and I am very pleased with them', "he staff are friendly and personable" and "they are lovely people that make my relative feel important and valued as a person".

We looked at the agency's medication administration systems. People told us that they received their medication.

People or their representatives said that they were consulted about their care plan and that regular care reviews took place

People who used the service were asked for their views about the quality of the care and support.

We gathered evidence of people's experiences of the service by reviewing the results of client satisfaction surveys which was undertaken in October 2012.