AS Care Limited

At our last inspection in May 2016 we rated the service good. At this inspection on 15 and 16 January 2019 we found the evidence continued to support the rating of good and 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 service had a registered manager in place. 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.

There were sufficient staff to meet people’s needs. We received mixed views from people and relatives about visit times. The registered manager told us there was a system in place to monitor, respond and reduce the risk of late calls. They said, in future, they would ensure clearer understanding and expectations of call times would be discussed at the person’s assessment stage. Recruitment processes and procedures were robust. Staff received appropriate induction, training and supervision to provide safe and effective care.

Medicines were managed safely. People’s nutritional and healthcare needs were met. People told us staff were caring and kind. Staff respected people’s privacy, dignity and encouraged them to remain independent. Staff had a good understanding of what care and support people might need as they were approaching the end of their life.

Staff understood how to keep people safe from harm. Processes were in place to keep people safe and risks associated with people’s care and support needs had been assessed. Staff had access to a plentiful supply of gloves and aprons to support good infection control management.

Choices were respected and staff encouraged people to retain their independence. 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.

It was evident from our discussions with staff they had a good knowledge of people’s care and support needs. The new support plans were detailed and person centred.

Staff said they felt supported by the office based staff and the registered manager. There were effective quality assurance systems in place to monitor the quality of the service provided, understand the experiences of people who used the service and identify any concerns. The registered manager worked in partnership with other organisations to support people’s needs. People and relatives knew how to make a complaint and these were managed appropriately and outcomes actioned.

Further information is in the detailed findings below.

At our last inspection we identified three breaches of legal requirements and asked the provider to take action. At this inspection we found the provider had made improvements and was now meeting all legal requirements.

Kestrel House provides domiciliary care services to people in their homes in Leeds and Wakefield, and is known to people who use the service as ‘Carewatch’. At the time of our inspection there were 246 people using the service.

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.

People told us they felt safe and had confidence in the care provided and that improvements had been made in the reliability of the calls. Staff confirmed they had been given more time to get from call to call and said the provider was now better at planning rotas to enable them to meet people’s needs.

Staff we spoke with had a good understanding of safeguarding and how to report any concerns. They were confident the registered manager would act on what they were told, and said they had seen and understood the provider’s whistleblowing policy.

The provider ensured recruitment practices were safe. References were taken up and checks were made with the Disclosure and Barring Service before new staff commenced work.

Care plans contained assessments of risk associated both with people’s care and support. These assessments included guidance for staff to help them minimise any risks.

Medicines were managed safely, although we found medicines administration records (MAR) were not always completed correctly. The registered manager showed us they had identified this issue and had discussed it in recent staff meetings. Their checks showed no medicines had been missed.

We saw evidence which showed staff received an effective induction and probationary period which included a range of training and shadowing which helped prepare them for their roles. During their employment staff received regular training to keep their skills up to date.

The provider held regular supervision meetings with staff to discuss performance and training needs, and we saw evidence which showed this programme was supported with annual appraisals.

There were robust arrangements in place to assess the decision making capacity of people who used the service, and appropriate arrangements in place to ensure decisions made on people’s behalf were in their best interests.

People gave us positive feedback about their relationships with staff and told us they were caring. Staff we spoke with talked with fondness for the people they supported and knew their needs and preferences well. We found there were good practices in place for protecting people’s privacy and dignity when receiving personal care.

We saw evidence that care plans were written in consultation with people who used the service, and the provider had systems in place to ensure care plans were kept up to date and reflected people’s current needs. This was achieved by regularly consulting people about their needs.

People we spoke with told us the provider had made improvements which meant staff were better able to arrive on time at their calls. There were systems in place to monitor calls and alert supervisory staff to any instances of calls which may be missed. Supervisory staff who received these alerts contacted people by phone so that alternative arrangements could be made.

The provider had systems in place to respond to complaints appropriately, and people told us they had been made aware how to complain and were given phone numbers to enable them to contact the office whenever they needed to. Records of complaints showed the provider followed their policy and investigated concerns brought to their attention.

Staff told us they liked working for the provider and felt the registered manager and senior team were approachable and listened when staff made suggestions. The registered manager held regular meetings with staff and we saw minutes which showed a range of operational issues were discussed. People told us they were satisfied with the service they received.

There was a programme of audit and action plans in place to ensure that quality was monitored and improvements were made when necessary. Surveys were used to monitor satisfaction, and people told us they were sent information about the results of surveys.

We carried out this inspection in response to anonymous concerns, raised with us in July 2014, regarding care delivery and practice.

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they were treated well and their privacy and dignity were respected. One person said, 'Very happy with the care, they are all lovely and kind.' People also told us they felt safe. One said, 'I feel very safe they give 100%.' One person's relative had concerns that staff changes were quite frequent and this meant their relative became unsettled and had to get to know new staff regularly.

People who used the service said they were pleased with the punctuality and consistency of their care workers. They said they were usually on time and they received a call if the care worker was running late. One of the eight people we spoke with said they had recently had a 'missed call'. The Provider had systems in place to monitor if any calls were missed. We saw a small number had recently been recorded and actions put in place to reduce the risk of their re-occurrence.

There were a number of different measures in place to check that systems were safe and working effectively. This included audits on daily notes, care plans, risk assessments and medication administration. There was also a risk assessment carried out in the home of each person who used the service to make sure the environment and equipment used was safe. However, care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. Gaps and omissions in care plan and risk management plans could lead to people's needs being missed or overlooked.

Safeguarding procedures were in place and staff understood how to safeguard the people they supported. Procedures were linked to the local authority safeguarding policy to ensure investigations took place. However, we reminded the Provider they needed to make sure CQC were also informed of all allegations and investigations in case we needed to take any action to protect people.

Systems were in place to make sure learning from events such as complaints, accidents, incidents and safeguarding investigations took place. This reduced the risks to people and made sure the service continually improved.

Is the service effective?

People's health and care needs were assessed with them and they were involved in writing and reviewing their plans of care. One person told us, 'It's all written down in the file and we go through it now and then.' Another said, 'We discuss what I need to see that I get proper care.'

Most staff spoke highly of the training and support they received to enable them to carry out their job effectively.

People who used the service said they thought staff were well trained. Comments included:

'They seem very well trained and very thoughtful, especially where privacy and respect is concerned.'

'I have peace of mind as they are so good.'

Is the service responsive?

People who used the service told us they knew how to complain or raise concerns if they had any. One person told us they had had some 'Minor grumbles' and these had been sorted out to their satisfaction.

We looked at complaints records and saw these were investigated in line with the Provider's policy. It was clear that action was taken in response to complaints of concerns raised. For example, changes to care workers or care delivery times.

Is the service well led?

The Provider had systems in place to regularly assess and monitor the quality of service that people received. The Provider sent out annual questionnaires for people who used the service and also conducted regular telephone surveys to ask people about their satisfaction with the service. We saw these were reviewed and analysed to see where any improvements could be made.

All the feedback records we looked at showed a high degree of satisfaction with the service and any suggestions for change had been acted upon.

Most staff said they felt the service was well managed and the management team were approachable. The majority of staff we spoke with said they had confidence in them and that any issues brought to their attention were always dealt with properly and thoroughly.

'Staff show respect for mum and the whole household. They help her transfer and respect her dignity and privacy without fuss.'

'Staff are always polite and respectful, for example they always ask me first how I would like to be called.'

'They dry me properly and if they spot any problems they will get the doctor'.for example when I had some swelling of my feet.'

'Hygiene is very good.'

'They are lovely. They are very thoughtful and considerate. They don't rush and they let me take my time.'

Some people said there was occasional lateness but said they had raised it with the Provider and the situation had improved.

We spoke with nine members of staff; this included the Manager and the Training Manager. Staff said the service was well managed and gave examples of how they met people's needs well and with dignity.

People who used the service spoke highly of the staff and said they were treated well. Their comments included:

'Mum is very at ease and relaxed with all the staff.'

'I have a regular girl now. She is right good.'

'Staff seem to be trained to help with my specific needs but I also tell them.'

Overall, the provider had an effective system to regularly assess and monitor the quality of service that people receive.

'They treat me well, they are very nice.'

'They do all they can for my husband.'

'(name of person) is very comfortable with the carers.'

We saw records that showed people who used the service and their representatives were involved in developing their own plans of care. People we spoke with said they understood their care and support plans and that staff had explained things well to them.

People who used the service said they got the help they needed with their medication. We found some inconsistencies in the way that staff documented medication prompting for people who used the service.

People said staff were knowledgeable regarding their support needs. They spoke highly of the staff and said they were treated well. Their comments included:

'I know them and they know me, we all get along great.'

'All the staff are caring and polite.'

People we spoke with said they could talk to care staff or the manager at the office if they had any concerns and were confident that they would listen and deal with their concern appropriately.