AQS Hampshire East

At our last inspection we rated the service good overall, but requires improvement in safe. At this inspection we found the evidence continued to support the rating of good and the services had made improvements in the area of safe, which is now rated good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Risks to individuals were assessed and monitored. There were plans to minimise the risks to people associated with their health, wellbeing or care arrangements in the event of an emergency. Incidents were used as a way to promote staff learning and reduce the risk of incidents reoccurring.

There were systems to identify and protect people from abuse. Staff understood their responsibilities to safeguard people and there were systems in place to investigate concerns and complaints.

There were enough staff in place with the right skills mix to meet people’s needs. The provider had carefully considered how to grow the business sustainably by not taking on more care packages than it could cover. The provider made pre-employment recruitment checks, which helped them make informed recruitment decisions about the suitability of new staff.

Where people required support with their medicines, the appropriate level of staff input was clearly identified. Staff had received training and understood the steps needed to prevent the spread of infections.

The registered manager understood the key challenges to the service and consistently drove improvement to meet them. Where deficiencies were identified, action plans had been implemented which monitored how the required improvements were embedded. These plans were regularly monitored by senior management, which helped to ensure there was oversight from the provider.

People, social workers and health professionals helped to develop care plans. People were consulted about how they would like to receive their care. Staff understood how to put this guidance into practice to promote people’s choice and independence. People were asked for feedback and the service made changes in response to these suggestions.

Staff received training which was relevant to their role and ongoing support through supervision, which reviewed their working practices and behaviours. Staff were asked for their input in team meetings to discuss issues and agree ways to improve working practices.

People told us that staff were caring and compassionate. Staff respected people’s dignity and privacy.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The support that people required around their nutrition and healthcare was identified in their care plans.

The registered manager had made links with other stakeholders to help ensure that people were supported appropriately when transferring between different environments such as hospital to home.

The registered manager understood the importance of working in partnership with other agencies when providing care at the end of people’s life.

Staff had received training and understood the steps needed to prevent the spread of infections.

Further information is in the detailed findings below

The last inspection of the service took place on 12 and 14 May 2015, where we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We set a requirement notice relation to the deployment of sufficient numbers of suitably qualified staff. The provider sent us an action plan stating they would be meeting the requirements of the regulations by 30 June 2015.

This was an unannounced inspection, which was carried out between 13 and 22 April 2016. At the time of our visit the service was providing personal care to 53 people. During the inspection we found the provider had completed all the actions they told us they would take.

There was a registered manager in place at the service. 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. The registered manager was also the registered manager for two other services owned by the provider. The service also had a ‘Homecare Manager’ who was responsible to the registered manager for the day to day running of the service.

People and their families told us they felt the service was safe. Staff and the registered manager had received safeguarding training and were able to explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who had received an induction into the service and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

There were suitable systems in place to ensure the safe management of medicines, were administered by staff who had received appropriate training and assessments. Healthcare professionals such as, GPs and district nurses were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People were supported to have enough to eat and drink.

There was an opportunity for people and their families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through spot checks and a questionnaire.

People and their families told us they felt the service was well-led and were positive about the registered manager who understood the responsibilities of their role. The provider had established a safe and effective recruitment process and had arrangements in place to deal with any concerns or complaints.

Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the service. There were systems in place to monitor the quality and safety of the service provided.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

People we spoke with told us they were happy with their care plan and said staff did what they asked them to do. We asked two people and two relatives whether they were supported by regular care staff. One said, 'I do now but it was a problem four or five weeks ago with new people. But I spoke to the office and they let me pick my own carers. I now have two ladies who are regular'. The two relatives we spoke with said their relative did have the same staff visit them. This meant the manager was aware of the importance of people having regular staff which ensured staff were familiar with their individual needs.

We were told everyone had a care plan in place. We looked at three and found they did not include completed or robust risk assessments or moving and handling assessments where they were needed.

Two of the five personnel records we looked at did not contain all the necessary information. This meant the provider could not demonstrate that the staff employed to work at the agency were suitable and had the skills and experience needed to support the people it supported. We have asked the provider what they are going to do to meet the requirements of the law in relation to ensuring recruitment procedures are robust.

Some records we looked at were not completed accurately, for example, one person had been supported to take their medication but the medication record did not show this. We saw three files regarding people who used the service had been left on the top of a filing cabinet overnight and were therefore not secure. We have asked the provider what they are going to do to meet the requirements of the law in relation to ensuring records are completed accurately.

Is the service effective?

Where people needed the support of two staff at the same time, staff worked together as a team for the whole shift. This meant they could meet at the beginning of the shift and drove around together so they arrived at the same time. People we spoke to confirmed this was usually the case. People also said they received care and support from regular care staff.

People's needs were met by staff who were trained to do the job they were doing. The provider employed a training manager and there was a training programme in place. Training covered subjects such as moving and handling, medication, safeguarding and infection control.

Staff were not receiving regular appraisal or professional development. The provider told us staff should receive two supervision sessions, two 'spot checks' and one appraisal a year. However, this policy had not been followed. We have asked the provider what they are going to do to meet the requirements of the law in relation to ensuring staff are supported.

Is the service caring?

One person told us the agency always sent 'lovely girls' and said they were 'good timekeepers'. Another person told us the staff, 'aren't rushed and they have time to have a chat after they have done what they need to do'. A relative told us the person was really happy when the staff were there.

Is the service responsive?

One relative was, 'Really pleased' and said the agency was pro-active, suggesting ideas as to what would work best for the care plan. People told us, and we saw from records, staff arrived more or less at the time they were expected. One person told us staff always apologised if they were early but they did not mind this. We also saw from records staff allocation was consistent which meant people usually had the same staff support them.

Is the service well-led?

The provider had recruited a new manager as well as two new staff who were based in the office. However, the team had only been there since the beginning of February and the provider told us they had received five to six weeks training and had been 'getting to grips' with company systems for two to three weeks. We spoke with three staff who all spoke highly of the new manager, saying the company was 'on the up', 'picking up' and, 'going in the right direction'. One staff member also said they were now 'proud to work' for the company.

We spoke with people who used the service and their relatives about whether the agency had contacted them. One said the manager telephoned them often to discuss their care needs. A relative of a person who used the service told us they had met the manager twice and the manager phoned them weekly to discuss the care package. However, a relative of another person who used the service said after the initial assessment, no-one had visited or contacted the person to see if everything was alright with the care package.

People told us they felt they could contact the office to discuss any issues they were not happy about and the manager would listen and deal with the situation. One person said they had not felt able to do that before the new manager arrived.

The provider and manager were aware of the need to inform us regarding any events that could affect the people who use the service. They had sent us a notification of an incident which had occurred before our last inspection.

We found improvements had been made but more time was needed to develop robust systems and for them to be embedded in practice. We have asked the provider what they are going to do to meet the requirements of the law in relation to ensuring the quality of the service is monitored appropriately.

We found the service did not maintain accurate or appropriate records with respect to people's care. Records were not available when required. The provider did not have effective systems to assess and monitor the quality of service. People were not asked for their views on their care and support. People did not always receive care and support at the correct time, and their care plans were not reviewed and kept up to date. However, systems were in place to enable medicines to be administered safely.

At the time of our inspection the provider did not have a registered manager in post.

We found that staff sought consent from people and met their assessed needs in ways which suited them. Staff supported people with their medication when needed and as part of their care plan. The agency recruited staff appropriately after ensuring the necessary checks were completed. The agency had a complaints procedure in place and gave people information about how to complain.