AA-I-Care - 35 Southwell

AA-I-Care - 35 Southwell is a domiciliary care agency service providing personal care to people in their own homes. At the time of our inspection, they were providing a live-in care service with personal care to 9 people who lived in Dorset.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene. Where they do, we also consider any wider social care provided.

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

People were at reduced risk of harm due to substantial improvements made in relation to risk management and the oversight of medicines administration. However, further work was needed to ensure the system of assessing staff competency to administer medicines and help people to move safely was embedded effectively.

People were supported by staff who had been recruited safely.

The owner/provider was responsive to all issues raised during our inspection. They were committed to the service.

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 (supplementary report published 13 July 2023).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

The provider told us the requirements of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had also been met. We checked this during this inspection.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Enforcement

We have identified a continued breach in relation to safe care and treatment.

Please see the action we have told the provider to take at the end of this report.

Follow up

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

AA-I-Care - 35 Southwell is a domiciliary care agency service providing personal care to people in their own homes. At the time of our inspection, they were providing a live-in care service to 10 people who lived in Dorset.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene. Where they do, we also consider any wider social care provided.

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

The service had changed the focus of its provision since our last inspection. This change had coincided in changes in the structure of the senior team. Whilst people, and their relatives were mostly positive about the service, these changes had led to oversight systems becoming ineffective and risks to people had not been identified.

People were at risk of receiving unsafe care. The administration of medicines was not robust and the competence of staff administering medicines and supporting people to move safely had not been sufficiently assessed. Risks were not always adequately documented.

Recruitment processes did not always ensure every measure had been carried out to ensure people were supported by staff of good character and with the necessary qualifications, competence, skills, and experience required of the role. Staff told us they were provided with the training and support they needed to carry out their jobs effectively. The induction and competence checking processes were not clearly aligned with the Care Certificate. We have made a recommendation about this.

People’s rights were not always respected as the provider was not compliant with the Mental Capacity Act 2005 [MCA]. MCA assessments had not always been completed when required to determine if a person could give informed consent themselves and best interests decisions had not been completed when appropriate. Staff had provided consent on behalf of people.

Whilst the systems did not reflect the legal framework of the MCA, staff had a good understanding of people’s needs and supported and encouraged them to make choices about their day to day lives. Staff made detailed records about the care and support they provided.

People’s needs were assessed and they had personalised care plans in place. Oral care needs were not reflected in people’s care plans. There were aspects of these plans that lacked the detail to ensure people received support in their preferred way. We have made a recommendation about this.

People were supported by staff who were trained to recognise signs of abuse and knew who to report if they had concerns. People told us, or showed us, they felt safe. Relatives were confident in the kindness and compassion of the staff.

There was a supportive culture at the service. Staff felt looked after and supported and the owner/provider spoke very highly of the whole staff team.

The owner/provider was responsive to all issues raised during our inspection. They were committed to the service.

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 good (published November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about medicines management and staff understanding of consent. A decision was made for us to inspect and examine those risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for AA-I-Care - 35 Southwell on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to consent and mental capacity, safe care and treatment, governance and fit and proper persons employed.

We have made recommendations about the personalisation of assessments and care records and the alignment of the induction with the Care Certificate.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

AA-I-Care – 35 Southwell is a domiciliary care agency. It provides personal care to people living in their own homes in the community. Not everyone using the service receives a regulated activity; the 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 the inspection the service was providing personal care to 23 people living in their own homes.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and who to report this to if abuse was suspected.

Staffing levels were sufficient to provide safe care, and recruitment checks had ensured they were suitable to work with vulnerable adults.

When people were at risk staff had access to risk assessments and understood the actions needed to minimise avoidable harm.

The service was responsive when things went wrong, they were open and reviewed practices and had a robust system in place to manage incidents.

Medicines were administered and managed safely by trained and competent staff. The quality assurance and management lead carried out monthly audits of Medicine Administration Records (MAR).

People and their relatives had been involved in assessments of care needs and had their choices and wishes respected including access to healthcare when required. The service worked well with professionals such as nurses, occupational therapists and social workers.

People were supported to have maximum choice and control of their lives and the policies and systems in the service together with staff understanding supported this practice.

The registered person and the quality assurance and management lead, actively sought to work in partnership with other organisations to improve and nurture positive outcomes for people using the service.

Care and support was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. Staff felt supported by the registered person and quality assurance and management lead.

People, their relatives and professionals described the staff as caring and caring. People could express their views about their care and felt in control of their day to day lives.

People had their dignity, privacy and independence respected and staff understood their responsibilities in relation to this.

People had their care needs met by staff who were knowledgeable about how their individual preferences.

The service had an effective complaints process and people were aware of it and knew how to make a complaint. People and their relatives told us they felt confident their concerns would be addressed. The service actively encouraged feedback from people.

Relatives and professionals had confidence in the service. The service had an open and positive culture.

Leadership was visible in the service and promoted inclusion. Staff spoke positively about the management team and felt supported by them.

There were quality assurance and auditing processes in place and they contributed to service improvements. Action plans were carried out and those responsible kept things up to date.

The service understood their legal responsibilities for reporting and sharing information with other services.

The owner of the service was the registered provider and the manager and this meant there was no registration requirement for a registered manager to be in post. As registered provider, they were a ‘registered person’. 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.

At our last inspection in October 2014 we had concerns about how feedback from staff and people was used to improve quality. There was a breach of regulation. At this inspection we found improvements had been made. Feedback from people and staff was now captured formally and informally and used to improve the service people received.

Staff understood how people consented to the care they provided and encouraged people to make decisions about their care. Care plans did not reflect that care was being delivered within the framework of the Mental Capacity Act 2005 when people did not have capacity to make decisions for themselves. However, staff showed they understood the importance of enabling people to make their own decisions wherever possible and providing care that was in a person’s best interests.

Staff were consistent in their knowledge of people’s care needs and spoke with confidence about the care they provided to meet these needs. They told us they felt supported in their roles and had received training that provided them with the necessary knowledge and skills to do their job effectively.

People felt safe and well cared for. They were protected from harm because staff understood the risks they faced and how to reduce these risks. They also knew how to identify and respond to abuse. They knew how to access the contact details of agencies they should report concerns about people’s care to. Care and treatment was delivered in a way that met people’s individual needs and promoted their independence and dignity. Staff kept accurate records about the care they provided.

People had access to health care professionals and were supported to maintain their health by staff. Staff understood changes in people’s health and shared the information necessary for people to receive safe care. Where people had their food and drink prepared by AA-I-Care staff they told us this was prepared well. People were left with access to drinks and food appropriately. People received their medicines as prescribed.

People were positive about the care they received and told us the staff were friendly and compassionate. Staff treated people and each other with respect and kindness throughout our inspection.

We spoke with seven people who used the service and two relatives. Everyone we spoke with was happy with the care that they, or their relative, received. Comments made included: "I'm perfectly happy with it.', 'They are efficient, caring and they look after (name removed) well', and, 'They go beyond the call of duty'. People told us that the service was reliable and responsive and care was planned and delivered appropriately.

The provider worked with other professionals and agencies to ensure care was planned to meet the needs of the people who used the service.

People were protected from abuse and staff knew how to respond appropriately to allegations of abuse.

Staff felt supported to carry out their roles, however some mandatory training was not current.

The agency did not have a system of quality assurance in place that monitored the quality of the service provided.

We found that the provider worked well with other agencies, especially with healthcare colleagues to meet the needs of the service users.

Respect and dignity for people was reflected in the training, induction and supervision of staff and this was strongly promoted by the management of the service.

One service user told us 'I've found the staff pretty good to get on with' and another person told us that the staff 'were fantastic in the recent bad weather as they still got to me'. Some service users told us that their carers could appear rushed on occasions however people were very positive about the service they received overall.

The care records were detailed, included information about preferences and risk assessments were completed and linked to the care plan. This helped to ensure that the needs of people were met appropriately and safely.

We inspected the practice for safeguarding adults and found that staff understood their role in providing safe care. We found that procedures had been implemented for dealing with safeguarding issues. People were aware of who to contact if they had concerns.

We found that there were systems in place to regularly monitor, observe and improve the quality of service delivery.