Advanced Care Yorkshire Limited

Advanced Care Yorkshire is a domiciliary care service providing personal care and support to people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection the service was providing personal care to 48 people.

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

People and relatives were happy with the support they received and spoke positively about staff. Some people told us calls were sometimes late. We raised this with the provider who acknowledged this feedback and told us they were working towards recruiting more staff to alleviate shortages.

Risks to people’s health, safety and well-being were effectively managed. Medicines were administered safely. The provider had effective infection prevention and control systems in place.

Effective recruitment procedures were in place. Staff received training and support to provide care in a person-centred way.

Support was personalised and based on people's assessed needs and preferences. Staff worked effectively with external professionals to ensure people received the support they wanted and needed. 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 and their relatives were involved in making decisions about their care. Staff respected people’s privacy and dignity and promoted their independence. People and relatives were aware of the provider’s complaints procedure and knew how to raise concerns.

Systems were in place to monitor and develop standards at the service. The provider promoted continuous learning and improvement and listened to staff, people and partners, taking on board their views.

This was an 'inspection using remote technology'. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 5 March 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 7 January 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to Regulations 17 and 18 (Good Governance and Staffing).

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements. 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 requires improvement to good. This is based on the findings at this inspection.

Follow up

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

Advanced Care Yorkshire is a domiciliary care service providing personal care to people in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. The service was supporting 54 people with personal care at the time of inspection.

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

The provider had failed to address the areas identified as requiring improvement at the last inspection. Checks in place to monitor the quality of care provided were not always effective. Records were not always in place or fully completed.

Staffing levels did not meet people’s needs. Staff were not always supported and/or confident to carry out their role.

Protocols were not in place to guide staff on when to administer ‘as and when required’ medication. Medication records for these medicines were not always accurately completed. We have made a recommendation in the report about this.

Accidents and incidents records were not always fully completed. There was no analysis to identify trends and ensure appropriate actions had been taken. Complaints were responded to but not always effectively monitored by the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, records in relation to consent were not always in place.

People told us staff were kind and caring. Staff had developed positive relationships with people and encouraged their independence. People’s nutritional needs were met. Staff supported people with their health care needs.

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 (published 17 January 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of regulations. This is the second consecutive inspection the service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staffing and governance of the service at this inspection.

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

At this inspection we recognised that the provider had failed to display their rating. This was a further breach of regulation. We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will hold the provider to account if it is necessary for us to do so’.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Advanced Care Yorkshire Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults with a variety of needs.

Not everyone using Advanced Care Yorkshire receives regulated activity; 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 inspection 78 people were receiving a regulated activity.

There was a registered manager in post at the time of inspection. The registered manager was also the provider. 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 and the training manager were present during the office visits to support the inspection. The training manager took on a variety of roles within the organisation including supporting the registered manager with the running of the service.

We found there was no robust governance and monitoring of the service. There was no formal system to audit parts of the service to ensure compliance and continuous improvement. Spot checks were carried out by the service. However, these were not consistently completed so did not always identify areas found at the inspection. There was no monitoring of accidents and incidents to monitor for trends. When incidents occurred, we found there was no records available.

Person centred detail was not always included in people's care records and some people did not have care plans in place. People's care records did not reflect their needs or detail how people like to receive their support. Staff told us they did not always read peoples care plans. This meant staff did not always have information to provide people with person centred care.

We found not all risks relating to the health and safety of people who used the service were assessed and managed. Risk assessments were not always completed when a risk had been identified and control measures were not always in place to try to reduce the risk to people.

There was no call monitoring system in place to monitor late or missed calls. This meant the service relied on people or their families to inform them if staff did not attend the call. We received mixed views regarding staff attending calls on time. During the inspection we attended a call where a staff member was 20 minutes late.

We reviewed people’s medication administration records and found gaps in recording. There was no evidence people did not receive their medication as prescribed.

Staff were not receiving regular supervisions or appraisals as in line with the company’s policy.

People told us they felt safe. Staff had knowledge of safeguarding procedures. People and relatives told us staff were caring and their privacy and dignity was respected.

Staff attended an induction programme which included training and shadowing, and received ongoing training the provider classed as mandatory.

Staff told us they felt supported by the management team. The manager told us they communicated with people through newsletters.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Advanced Care Yorkshire Limited provides care and support to adults and children in their own homes in Hull and the East Riding of Yorkshire area. People that use the service may be elderly, disabled or have a medical condition, which means they require support with their daily living, personal care or health care. The service is a medium sized service, providing support to approximately 80 people who are supported by 45 support workers.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for four and a half years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Support workers were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual and environmental basis so that people avoided injury of harm wherever possible.

Staffing numbers were sufficient to meet people’s needs and people we spoke with were satisfied with the calls they received, the punctuality of workers and the length of time workers stayed to assist them. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support vulnerable people. We found that the management of medication was safely carried out, in cases where people required this.

People were cared for and supported by qualified and competent staff that had excellent opportunities for training and updating this. Support workers were regularly supervised and their personal performance was assessed using an appraisal system. Communication within the organisation was effective.

People’s mental capacity was appropriately assessed and their rights were protected. Support workers had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act 2005 (MCA) and they understood the importance of people being supported to make decisions for themselves. Where a person lacked capacity to make their own decisions the registered manager was able to explain how the service worked with other health and social care professionals and family members to ensure a decision was made in the person’s best interests.

Where people required support with their meals this was provided to ensure they received adequate nutrition and hydration for their health and wellbeing. Support workers had completed a food hygiene training course.

People received care and support from workers that were caring and helpful and knew about people’s needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before support workers undertook care and support tasks.

People’s wellbeing, privacy, dignity and independence were monitored and respected and support workers helped them to maintain these wherever possible. This ensured people were respected, that they felt satisfied and were encouraged to maintain control of their lives.

We saw that people were supported according to their person-centred care plans, which reflected their needs well and which were regularly reviewed. People were also encouraged to maintain good family connections and support networks.

There was an open and positive culture within the service and support workers felt they were valued. There was a system in place to monitor and assess the quality of the service, which included seeking the views of people that used the service and their relatives and auditing the systems and practices in relation to service delivery. However, there was inadequate analysis of the information gathered and action planning had not been evidenced. We have made a recommendation about this.